PCVI News Room

LASIK or PRK: Which is better?

June 25, 2008
LASIK is the most popular type of vision correction surgery. But some experts say PRK (or photorefractive keratectomy) is safer and may produce better visual outcomes.

At the recent annual meeting of the American Academy of Ophthalmology, surgeons Vincent P. de Luise, MD and Minas T. Coroneo debated which procedure is better.

Dr. de Luise is assistant clinical professor at the Yale University School of Medicine (New Haven, CT). Dr. Coroneo is professor and chairman of the ophthalmology department at the University of New South Wales (Sydney, Australia).

The case for PRK

Dr. de Luise took the position that PRK is superior to LASIK because it is a surface ablation procedure with no corneal flap. Because the first step of LASIK is the creation of a corneal flap, this increases the risk of complications and potential vision problems, according to Dr. de Louise.

Some experts, including Dr. de Luise, also consider LASEK and epi-LASIK to be surface ablation procedures. Though an ultra-thin flap of epithelium is created in these procedures, the flap can be discarded and new epithelial cells will grow over the laser treatment.

Dr. de Luise admits that surface ablation procedures like PRK, LASEK and epi-LASIK still have risks, such as corneal haze, scarring and post-operative discomfort and pain. But he feels that new medications and techniques used during and after these procedures have now minimized these problems.

He points out that since there is no need to create a flap during PRK and other surface ablation procedures, potential complications associated with LASIK flaps are eliminated. Potential flap complications that can occur with LASIK include: Dr. de Luise also notes that because no flap is created, PRK is easier for surgeons to perform than LASIK, and that some studies have shown surface ablation procedures may provide better contrast sensitivity than LASIK.

And while infections can occur after PRK as well as after LASIK, infections after surface ablations are generally easier to treat than infections taking place under a LASIK flap.

Dr. de Louise concedes that vision recovery takes longer after PRK, LASEK and epi-LASIK compared to LASIK, but he says that new advanced surface ablation techniques are closing the gap.

The case for LASIK

Dr. Coronea, however, contends that LASIK safer and more effective than PRK and other surface ablation procedures.

He cites a study of military helicopter pilots who underwent laser vision correction surgery. The study shows that pilots who had LASIK experienced much faster vision recovery than pilots who had PRK, and that the pilots who had LASIK experienced better night vision after surgery.

Dr. Coroneo also notes that excessive exposure to the sun's UV rays appears to put PRK patients at greater risk for haze after surgery, and that there is less risk of vision disturbances caused by haze after LASIK.

Episodes of recurrent cornea#l erosion are also more common and more severe after PRK compared to LASIK surgery in some individuals.

According to Dr. Coroneo, more patients choose LASIK over surface ablation procedures because it provides nearly instant results, it is essentially pain-free and LASIK is preferred by eye surgeons whose opinion they respect.

The debate as to which procedure – LASIK or PRK – is better will no doubt continue for some time. Most studies show that visual outcomes for the procedures is essentially equal at 6 months after surgery. If you are considering laser vision correction, ask your eyecare professional their opinion about which procedure is best for you and why.