PRK Eye Surgery: Who It's For, What Recovery Is Like, Results and Cost

PRK (photorefractive keratectomy) reshapes the cornea with the same kind of laser as LASIK, but on the surface, after the thin outer layer of cells is removed. There’s no flap. The trade-off is a slower, more uncomfortable first week; a Cochrane review found that results a year after surgery are similar to LASIK. PRK is often the better choice for thin corneas and for people whose work or sport puts their eyes at risk of a blow.

How PRK works

PRK was the first laser vision correction procedure. The FDA approved the first excimer lasers for PRK in 1995, before LASIK became common. It treats nearsightedness, farsightedness and astigmatism.

The procedure has two steps:

1. The surface layer comes off. The surgeon removes the epithelium, the thin layer of cells covering the cornea, using a special brush, a blade, a laser or an alcohol solution.
2. The laser reshapes the cornea. You look at a target light while an excimer laser, programmed with your eye’s measurements, removes a precise amount of tissue from the exposed surface. You’ll hear a clicking sound while it works.

A bandage contact lens then goes on to protect the eye while the surface layer grows back over the next few days.

You may also see these names, which are variations on the same idea:

• LASEK loosens the surface cells with a dilute alcohol solution, moves them aside as a sheet, and lays them back after the laser treatment.
• Epi-LASIK separates the surface layer with a special instrument instead of alcohol.
• TransPRK removes the surface layer with the laser itself instead of a brush, blade or alcohol.

All of them treat the surface of the cornea, so their recovery is closer to PRK’s than to LASIK’s.

Who PRK suits

The American Academy of Ophthalmology (AAO) points to three groups for whom PRK can be the better choice:

• People with thin corneas. LASIK’s flap uses up some of the cornea’s depth. PRK leaves more of the cornea untouched, which matters when there isn’t much thickness to spare.
• People with very active lifestyles or jobs. With no flap, there’s nothing to dislodge if the eye takes a blow. After PRK, an injury to the eye causes a surface scrape, as it would in an eye that never had surgery.
• People fine-tuning vision after cataract surgery with certain lens implants.

EyeWiki adds that surface treatment can give an extra margin of safety in corneas with an unusual shape, and that corneal nerves seem to recover faster than after LASIK, which can mean less dryness.

To be a candidate, the AAO says you should be at least 18 (ideally over 21, when vision is more likely to have stopped changing), have a prescription that hasn’t changed in the past year, have healthy corneas and good general eye health, and have realistic expectations. People who usually aren’t candidates include those with:

• a prescription that is still changing;
• skin or other diseases that affect healing, or a history of heavy scarring;
• corneal scars or disease;
• advanced glaucoma, or a cataract that affects vision;
• uncontrolled diabetes;
• a history of certain eye infections; or
• pregnancy or nursing.

Your surgeon’s measurements decide the rest. See the LASIK candidacy checklist for how corneal thickness and shape are assessed.

PRK vs LASIK

A Cochrane review of 13 randomized trials (1,923 eyes) compared the two for nearsightedness. LASIK gave faster visual recovery and was less painful, and results one year after surgery were comparable. The reviewers rated the evidence as low quality for most outcomes and called for trials using current techniques, so treat that as the best available summary rather than the final word.

For SMILE and the lens-based alternatives in the same comparison, see LASIK vs. PRK vs. SMILE.

The procedure

The AAO says PRK usually takes about 15 minutes. Before the day, your surgeon measures your cornea and you discuss what vision you want from surgery; if you play sports, for example, clear distance vision may matter most.

On the day, your eye is numbed with drops and an eyelid holder keeps you from blinking. The surface layer is removed, you focus on the target light while the laser works, and the bandage contact lens goes in. Someone else needs to drive you home, and the plan for the rest of the day is to rest.

Recovery

PRK’s first week is the hardest part. The surface layer grows back from the edges toward the center over about 3 to 4 days, and discomfort is usually worst on the second and third days.

A few things matter more after PRK than after LASIK:

• Drops for longer. Steroid drops are often continued for up to about four months to reduce the risk of haze. Use them exactly as prescribed.
• Sun protection. The AAO advises wearing sunglasses outdoors for as long as your doctor tells you, because sun exposure after surgery can lead to corneal scarring.
• Call if the pain isn’t controlled. If over-the-counter medicine doesn’t help, contact your ophthalmologist.

Plan time off work accordingly. If your job involves driving or detailed screen work, a full week is a sensible starting assumption to discuss with your surgeon. LASIK eye drops guide covers lubricating drops, which help with PRK too.

Results

The AAO says about 9 out of 10 people who have PRK end up with 20/40 vision or better without glasses or contacts, and, as the Cochrane review found, results at one year are similar to LASIK’s.

PRK can’t fix presbyopia, the age-related loss of close-up focus. Almost everyone with excellent distance vision needs reading glasses from around their 40s. Some people choose PRK for monovision, with one eye set for distance and the other slightly nearsighted for reading; try it with contact lenses first. LASIK after 40 explains how monovision works.

Risks

The AAO lists these risks of PRK:

• glare and halos around lights, particularly at night;
• corneal scarring;
• corneal haze (cloudiness of the cornea);
• corneal infection;
• under- or overcorrection, which glasses, contacts or a further laser treatment can often improve; and
• very rarely, worse vision than before even with glasses or contacts, or blindness.

Haze is the risk that sets PRK apart. As the surface heals, the cornea can become slightly cloudy. Mild haze is common and usually too faint to notice; the goal of the steroid drops is to keep it that way. Surgeons can also apply a medication called mitomycin C to the cornea during surgery. A 2021 meta-analysis of 17 studies (3,536 eyes) found that it reduced both early and late-onset haze, with no significant effect on the cornea’s inner cell layer. Ask your surgeon whether they plan to use it for your prescription.

For a fuller picture of night-vision effects, see LASIK night vision: halos, glare and starbursts, which applies to PRK too.

If you need an enhancement

If the result falls short, PRK can be repeated in essentially the same way as the original treatment after your eye has healed. Ask how your surgeon decides when an enhancement is needed and whether the price includes it. LASIK warranties and enhancement packages explains what to look for in the terms.

What to check in a PRK quote

There’s no reliable national average for PRK, and prices vary by practice and city. Because PRK’s recovery takes more care than LASIK’s, check what the quote covers:

• Follow-up visits in the first week, while the bandage lens is in and the surface is healing, and over the following months.
• Prescription drops, including the steroid drops that may continue for months.
• Mitomycin C, if your surgeon plans to use it.
• Enhancements, including how long they are covered.
• Per eye or both eyes, and whether the consultation is included.

LASIK prices are a reasonable benchmark when you compare quotes, since most practices that offer one offer the other; most centers in LASIK Score’s directory list both. LASIK cost by state and city shows LASIK prices near you, and the LASIK cost guide explains how to read a quote.

PRK is elective, so insurance rarely pays for it. IRS Publication 502 counts eye surgery to correct defective vision, such as laser eye surgery, as a medical expense, which is why HSA and FSA funds can generally be used; confirm with your plan. See does insurance cover LASIK? and LASIK financing and payment plans.

Finding a PRK surgeon

PRK is widely offered. Use the LASIK center directory to see the practices near you; each center’s page shows the procedures in its listing. Choose a surgeon as you would for LASIK, by training, experience and how they handle complications and enhancements. How to choose a LASIK surgeon has a checklist, and if you’re comparing PRK with a flap-free alternative, see SMILE eye surgery.

Questions to ask your surgeon

• Why do you recommend PRK over LASIK or SMILE for my eyes?
• How will you remove the surface layer, and will you use mitomycin C?
• How much pain should I expect, and what will you give me to manage it?
• When can I expect to drive and return to work?
• How long will I use steroid drops, and how often will you see me in the first week?
• What does your quote include, and how are enhancements handled?

Bottom line

PRK gets to much the same result as LASIK by a slower road. You trade a few uncomfortable days and a longer wait for your sharpest vision for a cornea with no flap and more untouched tissue. That trade is often worth it if your corneas are thin, your work or sport puts your eyes at risk, or your surgeon has other reasons to avoid a flap. If none of those apply and fast recovery matters most, LASIK is usually the easier path.