Photorefractive keratectomy, or PRK, is a laser eye surgery that reshapes the cornea to correct nearsightedness, farsightedness, and astigmatism. Unlike LASIK (laser-guided in situ keratomileusis), which lifts a thin flap of corneal tissue before reshaping the eye underneath, PRK works directly on the corneal surface and never creates a flap. The Food and Drug Administration approved PRK in 1995, making it the first laser vision correction procedure available in the United States. At Lake Nona Ophthalmology in Orlando, PRK is often discussed with patients who have thin corneas, active or contact-sport lifestyles, or a history of dry eye, since it eliminates the risk of flap complications. Recovery takes longer than LASIK, generally three to five days before the surface heals, but long-term visual results between the two procedures are generally comparable.

What’s Ahead

What Is PRK?

PRK, or photorefractive keratectomy, is a laser eye surgery that remodels the cornea, the clear dome at the front of the eye, to correct how it focuses light. When the cornea is curved unevenly, light does not land precisely on the retina at the back of the eye, causing nearsightedness (myopia), farsightedness (hyperopia), or astigmatism, an uneven curve that blurs vision at every distance.

The cornea has several layers. The outermost is the epithelium, a thin layer of cells that protects the eye and regrows on its own, much like skin. Below it lies the stroma, the thicker tissue layer that gives the cornea its structure. During PRK, the surgeon removes the epithelium, uses an excimer laser (a device that delivers precise pulses of ultraviolet light) to correct the prescription in the stroma, then places a clear bandage contact lens over the eye. At the same time, a new epithelial layer grows back.

PRK was developed in the 1980s. PRK was the first laser refractive procedure the FDA approved in 1995. LASIK followed several years later.

How Is PRK Different From LASIK?

Both procedures use the same Wavelight Plus excimer laser to reshape the cornea. The difference is how the surgeon reaches the stroma.

LASIK entails creating a thin, hinged flap in the cornea’s outer layers, usually with a specialized laser. The surgeon folds the flap back, reshapes the exposed stroma, then lays the flap back into place, where it seals on its own without stitches.

PRK skips the flap entirely. The surgeon removes the surface epithelium, reshapes the stroma underneath, and lets the body regenerate a new epithelial layer over the following several days. Because there is no flap, nothing can shift, wrinkle, or dislodge later.

Why Do Some Patients Choose PRK Over LASIK?

A LASIK flap becomes a permanent part of the cornea’s structure. Complications are uncommon, but they are not impossible, and some patients and providers prefer to avoid the risk entirely. A few reasons PRK comes up as an option:

  • No flap to dislodge. Because PRK does not create a flap, nothing can shift or tear after a facial impact. 
  • More corneal tissue is preserved. Every cornea has a limited thickness. Creating a LASIK flap uses some of that tissue before any correction begins, leaving less depth to work with. PRK does not require a flap, so it can be an option for patients with thinner corneas who are not candidates for LASIK.
  • Less disruption to surface nerves. Cutting a corneal flap temporarily affects the nerve endings that help regulate tear production. Because PRK does not disturb those nerves as deeply, it is sometimes considered for patients with a history of dry eye, though individual results vary.

Who Is a Good Candidate for PRK?

PRK tends to come up for patients who fall into a few categories:

  • Corneas that are thinner than average
  • A prior evaluation that ruled out LASIK
  • Corneal surface irregularities that make a flap less predictable
  • A history of mild to moderate dry eye
  • At least 18 years old with a stable prescription for a full year

A comprehensive eye exam and corneal mapping are the only way to know which procedure fits a particular set of eyes. 

What Happens During the PRK Procedure?

PRK is an outpatient procedure performed while the patient is awake but comfortable with a sedative.

  1. Numbing drops. The doctor places anesthetic eye drops in both eyes, and a gentle lid speculum keeps the eye open so the patient doesn’t have to worry about blinking.
  2. Removing the surface layer. The surgeon clears the epithelium using an alcohol solution, a soft brush, or a surface laser. This step takes only a few seconds.
  3. Laser reshaping. The patient looks at a fixed light while a computer-guided excimer laser reshapes the cornea. Treatment typically takes less than a minute per eye.
  4. Bandage lens placement. A clear, non-prescription contact lens is placed over the eye to protect the healing surface, along with anti-inflammatory drops.

Patients go home the same day.

What Should You Expect During PRK Recovery?

Recovery is the main trade-off between PRK and LASIK. LASIK sight often improves within a day, while PRK depends on the epithelium regrowing, which takes longer.

Days 1 to 3: This is the main healing window. Watery eyes, light sensitivity, and blurred vision are common while the surface regrows. The team typically prescribes protective drops and comfort medication for this period.

Days 4 to 5: The epithelium finishes closing. At a follow-up visit, the care team at Lake Nona Ophthalmology checks the surface and removes the bandage contact lens.

Weeks 2 to 4: Vision continues to sharpen as the corneal surface smooths out completely.

How Do PRK and LASIK Compare Long Term?

In the months right after surgery, LASIK patients generally see clearly sooner than PRK patients. But once the eye has healed, the two procedures tend to land in a similar place. A randomized study published on PubMed comparing PRK and LASIK for moderate to high myopia found that longer-term visual outcomes were generally similar between the two procedures, even though LASIK improved faster in the short term.

No single laser procedure is right for everyone. What matters most is working with a board-certified ophthalmologist who maps the cornea and pairs the procedure to a patient’s eyes, occupation, and lifestyle. Chirag J. Patel, MD, FACS, and the team at Lake Nona Ophthalmology in Orlando offer detailed diagnostic evaluations to help determine whether PRK, LASIK, or another option such as the EVO ICL fits a patient’s needs. 

Frequently Asked Questions

Does PRK hurt?

Patients do not feel pain during the procedure itself, since numbing drops are used throughout. In the first two to three days of healing, a mild scratchy or watery feeling is common while the surface regrows, and this is generally managed via prescribed drops.

Both procedures have strong safety records. PRK is often considered for patients with thin corneas or jobs that carry a higher risk of eye trauma, since it removes the possibility of a late flap complication.

Most patients plan for several days of rest, often scheduling the procedure for a Thursday or Friday. Individual healing time varies, and the care team will outline a specific timeline at the consultation.

Yes, PRK is typically performed on both eyes during the same visit, though a surgeon may recommend a different approach based on an individual exam.

Key Takeaways

  • PRK reshapes the cornea with an excimer laser but does not create a corneal flap, unlike LASIK.
  • The FDA approved PRK in 1995, making it the first laser vision correction procedure in the United States.
  • PRK is often considered for patients with thin corneas, active or contact-sport lifestyles, or a history of dry eye.
  • Recovery takes about three to five days for the surface to heal, longer than LASIK’s typical one-day recovery.
  • Long-term visual outcomes between PRK and LASIK are generally comparable once the eye has fully healed.

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At Lake Nona Ophthalmology, Dr. Patel and his team provide compassionate and cutting-edge care for patients throughout Orlando and greater Central Florida.

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