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Laser Eye Surgery Primer: Lasik vs PRK

July 17, 2011 |  by  |  Science

I’m going in for PRK Laser Eye Surgery in a few days, and true to character I’ve done more than my share of research. I’ve learned quite a bit, and I’d like to share some of it with you. [Edit: Be sure to check out my follow-up account of the surgery: My Laser Eye Surgery, Part I: PRK Pre-Op Preparation and the forthcoming Part II] Unfortunately I don’t have the time to give this topic the full attention it deserves, so this post will be a primer on Laser Eye Surgery and especially why I think Lasik and other corneal flap-based methods are ill-advised compared to PRK and other surface ablation methods. See this as an advisement to seek further information.

Please don’t take my word for this. Please use this as a jumping-off point for your own research.

I don’t want this to be a ‘scare’ post, but I’ve spoken with many people recently who really didn’t know much about the laser eye surgery they had done, especially the complications specific to Lasik. I spoke with one man who had Lasik done, but he didn’t know that he had a flap cut in his cornea! Indeed he insisted that there was no flap. We did establish that he had Lasik, he had no pain and good vision the next day (definitely Lasik), but he was adamant that there was no flap to worry about. That was scary to me, because it means that, whether or not he was actually told about the procedure or about the flap risks, he certainly never understood the procedure, the risks, or the care you have to take with the flap.

In my experience with my own research of the available information on Lasik and PRK over the past 10+ years, and especially in the past several weeks, the practitioners of both procedures largely (or completely) gloss over the risks, and most patients make uninformed decisions. If people go in with eyes-open (ahem), then it’s their choice, but I hate to see people getting the wool pulled over their eyes (apologies again for the punnery).

If you’ve informed yourself and want Lasik, I’d suggest stopping here. However, if you’re unsure of the differences between the procedures, or if you are unsure of the risks of the procedures, you may want to continue reading. Please don’t take my word for this. Please use this as a jumping-off point for your own research.

On Irony and Selection Bias

First, an aside on irony. I’ve done my research, I understand the risks of PRK and Lasik. I have my PRK scheduled for a few days from now (July 20, 2011) and I understand and accept that I could be one of the edge cases that have serious or merely undesirable side effects (*knock wood*). I understand that I could know 1,000 people that are perfectly happy with Lasik, but I also know that anecdotal evidence is relatively worthless.

Whatever my outcome, whatever the outcome of your cousin, your co-worker, or everybody you know, the dice are being rolled with each procedure, and each procedure has its different risks. These risks exist and must be looked at on aggregate for each procedure, hopefully before you go under the laser.

Lasik vs PRK

Both PRK and Lasik have somewhat similar risks of undesirable side effects to your vision (stars, halos, dryness, etc), some suggest PRK has somewhat less of them (especially chronic dryness), but it seems to be debatable, and often it comes down to individual reaction to the procedures. You can make choices about your individual procedure (either Lasik or PRK) that will mitigate those risks, such as getting the better lasers, the latest techniques, etc (please inform yourself), but the risks will always remain.

I’m willing to take those risks (with either surgery), but I’d not take on the flap risks that are specific to Lasik (even the all-laser Lasik).

While PRK and other ‘surface ablation’ methods, make the correction on the surface of the cornea, Lasik methods cut a flap part-way through the cornea itself (about 15-20% of the way through). This creation of the flap introduces a host of side-effects and complications that just don’t apply to the surface ablation treatments such as PRK.

Note that same lasers can be used to make the correction in either procedure, though there are some important differences between lasers, eye tracking, algorithms, etc, which play a somewhat important role in mitigating those ‘minor’ quality of vision side-effects.

From all I’ve seen, Lasik is the very definition of a ‘quick fix’.

For me PRK is the better choice, actually the only choice I’d consider. You can find a good overview of the differences between PRK and Lasik here.

With Lasik, the flap never really heals, and most Lasik providers will feed you the oft-quoted maxim that “after 2 years when it heals to its maximum, any trauma strong enough to dislodge the flap would be strong enough to injure the eye”. The problem is that this doesn’t seem to be true.

You can find many Ophthalmologist accounts of flaps that have been dislodged through fairly incidental contact (your own finger, tennis ball, tree branch, etc). Sure the risks are low that this happens, but the flap never actually heals. Pretty much only the skin layer overtop actually heals; many ophthalmologists report that the lasik flap can be very easily lifted open many years after the procedure. Those considering Lasik would be well served by reading more about flap complications (be mindful that while they are rare, they are very real).

The Lasik method of cutting a corneal flap not only seems dodgy from the outset, but is starting to show some long-term side-effects. While laser eye surgery has been around for several decades, Lasik and it’s flap-method was FDA approved in 1998. Somewhat rare, but not all that uncommon, issues have been found with ectasia (corneal bulging, due to comprised cornea integrity), epithelial in-growth under the flap, striations (wrinkles) in the flap with or without trauma, and partial flap dislocation, all many years down the road.

Lasik also has a higher need for re-treatment, but ironically the risks of Lasik compound on multiple procedures. This makes re-treatment much more difficult and much more risky with Lasik than the no-flap methods of surface ablation, like PRK. With PRK the need for re-treatment has been reported to be considerably lower, but in the cases where it is necessary (or where the vision needs a touch-up years down the road), that re-treatment is no riskier than the original treatment.

Conclusions

Laser eye surgery isn’t without its risks. I’ve weighed those risks, and am going to do PRK. The only real benefit of Lasik is the fast recovery. From all I’ve seen, Lasik is the very definition of a ‘quick fix’. If Lasik was the only method available, I would stick with glasses and contacts.

I truly hope this helps those who may otherwise go uninformed, encouraging them to take pause and research for themselves the reality of the various laser eye procedures.

Continued Reading

Here are my posts on PRK and laser eye surgery, continue reading or, feel free to join the discussion in the comments below!

Laser Eye Surgery Primer: Lasik vs PRK (You are Here)
Lasik vs PRK: What the Lasik Doctor Doesn’t Tell You
My Laser Eye Surgery, Part I: PRK Pre-Op Preparation
My Laser Eye Surgery, Part II: The PRK Operation
My Laser Eye Surgery, Part III: PRK Post-Op Recovery
Halos: A Likely Complication of PRK or Lasik
    

More Information


45 Comments


  1. Thanks for the article. I’ve been standing on the fence in regards to which procedure I’m going to do next week and this article is basically what my brain has been telling me all along.

    Did your doctor charge you MORE or LESS for PRK compared to LASIK? I’ve read that PRK is cheaper but I wasn’t as familiar with the procedures that my doctor is offering as well as I am now that I’ve done some research.

    • Hi Phil,

      I’ve been writing a follow-up post with a lot more detail, but it’s challenging to cover all the bases that one should look at before going under the laser. As a result it’s been sitting half-done for far too long.

      One of the things I wanted to talk about was the fact that the Lasik/PRK decision is really only one of the variables in the procedure (granted the most important one, in my opinion). That decision is basically about “where” the correction is made (PRK is corneal surface, while Lasik is mid-cornea) and “how” the correction site is accessed (PRK removes the skin layer, whereas Lasik cuts a flap into the cornea).

      Now, there are a great many other important differences between Lasik/PRK and even between two places both offering Lasik or both offering PRK. Here’s a short list of variables that are really independent of the Lasik/PRK decision:

      - What sub-type of Lasik/PRK is being used to access the correction site? There are several different options that are sold under the simple banner of “Lasik” or “PRK”, but each of these can be different in important ways.

      - How the correction ‘map’ is built and whether you get a fully custom map applied or not (some Wavefront procedures aren’t actually customized to your eye, they’re just used to find the closest ‘preset’!)

      - How the correction map is applied, which laser system is used and which version of that laser system (is it older, or the latest). This area alone has many considerations, such as:

      – How the laser actually sculpts the cornea (different pass/timing techniques have different pros/cons)

      – How big is the actual correction area (not including the ‘blend’ area)? Is that bigger than your pupil at night?

      – How is the eye tracked? The best correction map in the world is useless if they eye moves and part or parts of the correction are applied slightly off centered.

      Some systems require *you* to do all the work in the eye tracking by staring at a dot of light (while laser light is flashing on and off in that eye).

      Most new systems have eye tracking in addition to the light you have to stare at, but how often does it update? Will it stop the laser quickly enough?

      Also, what does the eye-tracking key on? Some key on the inside of the pupil, but have trouble tracking as the pupil goes through its natural dilations/contractions during the surgery, others track on the outside and are more stable.

      Finally, does the eye-tracker work in 3 dimensions? Most only track your eye in 2D, and ignore the third, which obviously only paints half the picture.

      - And don’t forget about after-care. Some places offload all after-care to your own ophthalmologist, while others take care of it all, including that (and all the medications and drops in the price). I much prefer the idea of the latter, as a large part of the recovery is dictated by how much and how long the various anti-bacterial, pain, and steroid drops are used post-opp. I much preferred going to an expert for that, and I don’t think an ophthalmologist who’s only had a few dozen (or even a few hundred) post-opp laser patients would be nearly as qualified as the people who have done thousands of surgeries and followed up directly with their own patients.

      Anyway I (not so) briefly mention all this, because I want to impress upon you that costs really can’t be compared between Lasik and PRK. There’s simply too many variables under each.

      If a doctor keeps the latest laser systems in-house, working closely with the company that provides them, then he’s going to incur a lot more costs. On the other hand, you’ll see laser shops around town that are offering much, much cheaper prices. These guys are either just starting out, trying to build a client-base, or are using yesteryear’s technology.

      Unfortunately, the only way to really know what you’re getting is to start researching into each of those questions above, so that you know what to look for. Once you have a good understanding of that, you’ll be able to assess the local doctors by asking them related questions. You’ll quickly find that there will likely only be a couple places in town that you would even consider going to (they’ll probably offer both Lasik and PRK as well), and their price will probably be quite close to each other.

      I’m incredibly pleased with my results, but I understand that I am on the far end of the bell-curve for ease of recovery and quality of results. Part of that is my natural healing ability, part of that is luck I suppose, but a whole lot of that is due to the fact that I *agonized* over the decision, fully educating myself about the above, and found the best place in town (London Eye Centre in greater Vancouver, BC).

      Good luck!

      • Hi,

        I have also researched fairly deeply and came to the conclusion London Eye Centre in Vancouver was the best place to get PRK done. Can you tell me more about your experience there?

  2. Adding my experiences:

    The most respected doctor in my area insisted that I went with all laser lasik rather than PRK. I was informed that he only recommends professional athletes (with high post-op eye trauma risks), or those with too thin of a cornea to go forward with PRK.

    The all laser lasik (with custom maps) was about five times the cost of PRK.

    I know several people who have had the same lasik surgery and are very happy/side effect free, as am I. At the same time, I know several people who have had PRK, and have suffered debilitating eye dryness issues. Sometimes not cropping up until years after the surgery. My optometrist has confirmed that PRK has a much higher incident rate of post op non-trauma side effects.

    While the author states that Lasik is the very definition of a “quick fix”, I say PRK is an example of trying to save a few bucks on a dangerous optional surgery.

    “Please don’t take my word for this. Please use this as a jumping-off point for your own research.” <- Respect this statement.

    • “The all laser lasik (with custom maps) was about five times the cost of PRK.”

      This is simply not true. I suspect that your doctor was spinning a tale for you, perhaps because he didn’t offer PRK procedures, or just didn’t want to do the extra work he would have had to in order to do PRK.

      Lasik and PRK operations using the latest of each laser systems, custom WaveFront mappings, etc will be very similarly priced. Often, PRK will be slightly higher priced as it usually incurs greater cost for the doctor.

      In my case, of the two places in Vancouver, BC I was considering due to their strong reputations and their use of latest version of the laser systems (most recent excimer lasers, fully custom WaveFront, latest eye tracking, etc), both offering and performing both Lasik and PRK, both charged slightly more for PRK.

      Also of note, most professional athletes get Lasik done, not PRK. The rub with PRK is that you will not have your optimal post-op eyesight until 3 weeks to 3 months, even 1 year (over a month or so is rare, but happens) after the surgery. This is something a professional athlete cannot afford to have happen. These people have very different risk-vs-reward equations than we mere mortals, and often make rather poor health decisions (steroids, etc) for the sake of extra millions.

      One of the reasons doctors prefer Lasik is that there is little or no after-care. The patient is satisfied almost immediately, and does not require the 1-day, 3-day, 5-day, 5-week, 6-month, and 1-year follow-up visits. Overall, Lasik patients require significantly less hand-holding and post-op follow-up expertise. Patients are also instantly wowed, go to work the following day or so, and rave about the procedure to all their friends. That factor alone, the quick-fix factor, especially compared to the longer, more painful, and gradual process of PRK, is excellent advertising, and makes up part of the reason that Lasik is such an easier sell, and a bigger money-maker for eye surgeons.

      I suspect strongly that had you talked to more than just one doctor, who performs only Lasik, you would have heard a wildly different report. Remember, no matter how respected he was in your community, that doctor was trying to close the sale with you. He lied to you in order to do that, and was successful.

  3. Hello, and thank you a great deal for taking the time and effort to document your findings! I have debated doing this for over a decade and decided to finally get this done. I located a reputable local corneal sugeon who does both lasik and PRK, keeps current with tech and methods, and has done literally 10′s of 1,000′s of procedures over many years. After a Very non-rushed, 3 hour, consultaion visit where a great many scans were taken of my eyes and cornea shape and all of my questions were answered, the surgery place called me today to let me know that after reviewing all of my scans, the surgeon said he thought I was a better candidate for PRK rather than lasik. I was a bit disappointed until I ran across your article. I spoke with the surgery center and they told me that PRK was far and away, the more “mature” procedure, had less risks overall than lasik, and that after the longer healing time, my results should be comparable to lasik. They also said that PRK was the more conservative procedure and while there is more short term discomfort, the end result was the same as lasik. They could have easily told me lasik with it’s “instant” results and fewer followups, etc. was the way to go, but they had no problem coming out and saying that for my particular situation, PRK was the best choice. I felt the surgeon made his decision based on all of his previous experience with a great many different eyes. This place charges the same for PRK and lasik. I am scheduled for Auguest 30, 2012. I will post again after the procedure.

    Thank you again for your informative aritcle, it was greatly appreciated!

    Mike Oncale

    • Hello Mike,

      Do let us know your experience post procedure.

      Thanks
      Jay

      • Hello again! Just to follow up my PRK procedure that I mentioned in my Aug. 10 post above. After much research into both the procedure and doctors who did this, I had my PRK procedure done on August 30, four weeks ago tomorrow. No pain to speak of and as expected, within a day or two, I was seeing very well. But, the second week after PRK, as the layer of cells grew back over the center of my eye, my vision got worse (tho not near as bad as it was prior to PRK), and that second week was a Very frustrating and depressing time. I felt I was not seeing well enough to drive a car safely so I just sat around the house and “waited to heal”. I had a number of follow up visits with the surgeon and my local eye doctor and they both said that I was alittle behind the healing curve but still well within expectations. By day 15-16 tho, I noticed very dramatic improvements in my vision over the next week on an almost daily basis. Now, just about 4 weeks after, I am seeing about 20/25 and am told to expect more, gradual improvements over the next 1-2 months until I reach optimal vision. I use 2.0 “off the shelf” reading glasses for very close reading, but other than that, the difference is just this side of amazing. I am not experiencing any dry eye symptoms or any other of the possible, more common, side effects of the procedure. What I did come to realize after the fact, is that my expectations for how _soon_ I would be seeing consistantly better, was Very over optimistic. That combined with the fact that I did heal abit slower than average, and it was a major downer for me. The surgeon did tell me that PRK is a “Slow procedure!”. I should have managed my expectations a bit better! That being said, I am past the initial healing curve and am seeing great. Still reach up to take my glasses off when I sit on the edge of the bed, 40+ years of habit is hard to break! Also, being 4 weeks past the procedure, I am very glad that the surgeon recommended PRK over Lasik for my particular case. As I mentioned in my first post, he said PRK is far and away the more mature and “conservative” eye surgery with substantially lower risks for a number of complications involving that “flap” they do with Lasik.

        Thank you again for your site and for sharing your experiences and what you have learned. It helped me to make an informed personal choice. I just wanted to follow up well after my procedure, after I got a good feel of how well I was doing and how well it went for me and improved my vision. Bottom line for me personally, I am Very happy I had it done! The first couple of weeks, while not at all “painfull”, was Not fun, but, being past that point, it’s Great now!
        Thanks again,
        Mike O.

        • Hi, i came across that PRK is to correct the most common vision defects of slight to moderate severity whereas lasik is to correct defects of medium or severe myopia. However i have myopia of -8.50.Wonder if I suitable to go under PRK. Do you mind to share your vision condition before the PRK? Many thanks.

  4. Hello Mr Temple,

    Thanks a ton for bringing all the necessary info required to make a decision.I had been thinking to go for LASIK for quite sometime until one of my friend went ahead with the LASIK procedure.He started boasting about how easy it was for him and how he was able to have a wonderful vision the next day.

    This lead me to take an appointment with one of the famous LASIK and PRK surgeon in the area (Official Lasik surgeon for SF 49ERS).After completing all the tests,the doctor showed me the shape of my cornea and said it was mild and hence suggested me to go for PRK.

    At this time,I was disappointed as PRK was a gradual and painful healing process coupled with the conversation I had with the counselor on the medications I need to take post procedure.

    I started researching more on LASIK Vs PRK leading me to your blog,after reading all the info you have provided,I feel,I am in a good position to understand the difference.

    Please do let me know your suggestions,the do’s and dont’s before and after the procedure.And also are you able to see 20/20 or better ?

    Thanks
    Jay

  5. Your story and Mike Oncale’s story are helping me make the decision if I want to proceeded with PRK. I just had by consultation and was told b/c my cornea’s were too thin, I had no choice but to go with PRK. They’re requirements are at a minimum 500 and my cornea thickness is 470 and 460. I’d really be interested in anyone who has had PRK, how long ago and what the outcome was. I understand that everyone is different and that we probably will have different surgeon but I would still be interested in the outcomes. My only hesitation and slight disappointment is because I was so set on LASIK and it’s quick recovery time. When told that told I’d have a down time of at least 4 days and that b/c my corneas were so thin, I wouldn’t be able to redo the procedure or have corrections done if needed, I feel hesitant.

  6. Hey,
    I am looking into having lasik as well but I am not too fond of the idea of a flap. Having it cut and having it permanently. Kind of turns me off.
    I heard about PRK and like that method better. My vision is not super bad, – 3.25 and – 3.75, but still enough to wear glasses all day long. I have my first appointment for a check up in less than two weeks, just to see if I would qualify at all.
    I am a little bit creeped out about the days after the surgery though. I have read many blogs and not too many sound as good and cheerful as yours. So I keep my fingers crossed.

  7. Hi all, I’ve added a new account of my PRK surgery, have a look:

    My Laser Eye Surgery, Part I: PRK Pre-Op Preparation

  8. Great Article.

    I have already had ilasic. 2 years later I am back to wearing my old glasses. Now the Eye doctor says I need PRK at a “special price”.

  9. I was thinking about these options too PRK and LASIK. thanks for the lengthy post! very good info…my main concern is getting dry eyes from these procedures? http://www.yourvisionoptions.com says that theres a good chance of getting dry eyes. i’m thiking implantable collamer lens which doesn’t cut the cornea might be the way to go?

    • From what I’ve read, there’s a lot more risks and complications involved with ICL and it’s a much more invasive surgery. I prefer the least invasive PRK.

  10. Hi there! I have recently had PRK surgery, on the 16th of January to be exact, and it’s now just over a week since surgery and I must say that my vision has improved drastically from yesterday to today!

    Yes there was pain after the surgery for a good 3 days and I even had to keep the bandage contacts in for an extra day as I was healing slower. But I think now that choosing PRK was the best choice for me. I suffer with terrible dry eye syndrome and my surgeon advised that because the cutting of the cornea in LASIK compromises the surface area of the eye, it can cause dry eye. Now already having dry eye syndrome and struggling with it everyday, I did not want to make it any worse! My surgeon also told me that the eye is more stable after PRK as there is not flap cut into the eye. And the chances of having any touch ups is less likely with PRK.

    And with regards to the price, I paid more for PRK surgery than LASIK. And the post op care has been phenomenal, my surgeon met me over the weekend just to check that I was healing well. And scheduled another check up for today when I only need to see him in 4 weeks time.

    I can totally relate to how you felt after surgery Mike, I felt particularly depressed once my vision got worse and I was frustrated as I couldn’t do everything I was used to doing, reading was a mission! But I am optimistic that my healing will improve everyday and I’ll be seeing all sorts of things soon!

    Good luck to all of you with your healing!

  11. I have thinner than average corneas (just above 500 microns), large pupils and around -3.00 in each eye. I was told that I could have either LASIK or PRK. I never liked the idea of a flap being cut and have been intensely researching the subject for over a month now. I agree with what’s written on this blog post. I planning on having PRK on Tuesday 28th January. I expect and hope that my recovery will be in line with what others have commented above.

  12. I got PRK before my first deployment in 2004. My results were relatively instant. Probably only two weeks of discomfort. PRK was recommended for the possiblility of eye trauma. Nine years later, my eyes are regressing noticeably. I’m making an eye doctor appointment in the next two weeks. I’m assuming I’ll have to get another procedure. Which sucks, but I guess we’ll have to see. Not sure if anyone has had the procedure done twice, but hopefully I’m a candidate again! Or they have some magic eyedrops.

    • Brian,
      I am so indecisive as to which surgery I should have done even after reading these articles as well as numerous articles. I am a good candidate for both and my eye site is not that terrible. -1.75 in each eye if that helps. I am getting my surgery done next Thursday 2/6/14. I know this response is a year since your last response and if you get this I was wondering how your second procedure went? Also, if given the choice of lasik vs. PRK, now that you have had it done, would you still choose PRK?

      • Emily,
        I too am indecisive about which to go with. The whole flap thing is kind of a turn off for me and would much rather go with a longer recovery rate if that means avoiding it. My vision is about the same as yours and I’m thinking I want to go with PRK. If you did decide to go with PRK can you share your experience? I’m still not even 100% sure I even want any of the surgeries. If PRK wasn’t too unpleasant ill probably take the leap and go for that one.

  13. Hey,
    I have thinner corneas (just around 476 and 477 microns). One doctor suggested PRK and one doctor suggested to go for ICL as he dont prefer borderline surjery on PRK. Can any please suggest is it really safe to go for PRK with my thinner corneas (just around 476 and 477 microns).

    Thanks in advance.

  14. I had PRK done in both eyes in late 1996, just before turning age 40. This was just before LASIK was being commonly done. I was -7.5 in both eyes, near the outer edge of PRK at the time. I had researched the procedure for some time, understood the risks and was comforted by the large amount of time my doctor spent with me prior to the procedure. At the time, the preferred procedure was to do one eye at a time and wait for the first to heal before doing the second, which considerably extended the healing process. Healing went smoothly in both eyes, a little faster in the right eye than in the left and vision improved to 20/10 in the right eye and 20/15 in the left eye. I noted night starbursts at first, but these decreased almost completely as the eyes healed. There has been a bit more bright light sensitivity. Overall, I have been thrilled with the results.

    I am now age 57 and vision has regressed to 20/30, still quite satisfactory. I did not start using reading glasses until after age 50 (although I did notice that I needed better light to read shortly after the procedure) and now use +1.5 off the shelf reading glasses, although I can still get by without them when necessary. I experience occasional dry eyes, but find I only rarely need ordinary eye drops.

    I had a friend who had PRK done at the same time and achieved similar results. Most of the LASIK patients I have come across since have had to go back for “touchup” work.

  15. Thank you all heaps for sharing your experiences here. I am currently in colombia and have found a doctor I feel comfortable with, and he seems to be slightly suggesting customized (wavefront) LASIK, but I ‘think’ I’m leaning towards PRK. I am about -6.0 in both eyes and this doctor says that since I have relatively bad case of myopia – that the PRK procedure is more likely to produce blurring effects down the line. I’m 28 and do many extreme sports like skateboarding, surfing, snowboarding, cliff-jumping… and this is the only real ‘pro’ the doctor gives for PRK over LASIK, that I am much more active and more likely to suffer eye trauma which could displace the flap created with LASIK. Flap complications terrify me not-with-standing my ‘extreme’ lifestyle

    I’m still lost on femtosegundo/laser created flap over normal manual microkeratome flap. Femto here costs $500 more but it seems as though if all of the technology is up to date – flap complications are much less common. Pricing (both eyes) if anyone is interested is ~$850 for standard (PRK or lasik) and ~$1400 for wavefront technology using either method. I’ve been to 3 of the best clinics in town and pricing seems very similar. Once you mention it – a TON of colombians have had this procedure done and I haven’t heard a single horror story yet, although some people’s vision regressed years later.

    knowledge is power, and this site has a ton of it. Thank you to all who have contributed. I clicked ‘notify me of new posts’ if anyone has questions/comments.

    • “I am about -6.0 in both eyes and this doctor says that since I have relatively bad case of myopia – that the PRK procedure is more likely to produce blurring effects down the line.”

      I’ve never heard of this. And from what I know of the surgeries, I can see no way this would be the case (more cornea is preserved, less is cut, with PRK).

      I would highly recommend you get a second opinion who is both medically qualified and who ideally isn’t necessarily trying to sell you a service.

      “I’m still lost on femtosegundo/laser created flap over normal manual microkeratome flap.”

      My advice is to run away from the cornea flap. It’s true that the laser has less chance of cutting the cornea flap too deep (it’s more precise than the microkeratome blade), but you’re still cutting into the cornea unnecessarily.

      Cornea flap = bad idea, regardless of how it’s cut.

    • Hey Bryan,

      I’m also from Colombia (Medellín) and seriously considering Trans PRK for my myopia of -6.75. What decision did you finally take? Regards.

      • Best to use is the Amaris Laser 1500, I believe, they use in London and Copenhagen, as it can do NO TOUCH PRK. I’m told the quicker the laser, nothing touching your eye, the better the outcome. That’s what I would do if I wasn’t too old. I’m 63.5 and they say my next step is to watch out for cataracts. However, if I were younger, definitely PRK, No Touch, Amaris lasers… not yet approved in USA but in Europe and elsewhere, they are more advanced, I’m told.

        • Thanks for your reply, I’m also tempted to go with no touch PRK, Amaris 1500 is not available in my city, just 500e, and 750s in other cities. I hope they’re enough for a very good outcome.

          • You know, for No Touch, my eyes, sight is too valuable. It’s unfortunate this country is controlled by some that pay the FDA to stall new improvements because these lasers cost millions. This country uses cheap lasers, some better and faster than others. In New England, I cannot find one that uses this modern technology. They try to trick you but NO TOUCH is the key. No TransPrk with No Touch, but still chemicals they want to use. Your eyes are too valuable. Take a trip to London. It’s what I would do. Don’t do FLAP with laser that never heals. What a crock!

          • How did you make out with the Amaris 750s? This one pass short surgery means your eyes get less trauma and heal faster. I still have to travel out of this country to get my one eye done, The USA has inferior machines and technology, 10 years behind the rest of the world due to FDA infighting and bought off officials and corruption. I hope you came out OK!

  16. Hi, Could you please email me back and let me know which eye centre and location you went to and who your surgeon was that worked on your eyes, and if you are having any problems – dry eyes, blurred vision, halos, trouble seeing at night etc. And what your vision is right now – 20/20 etc. I really want to do it and am scared. It sounds like you had a good experience though :-) I look forward to hearing back from you. Thanks for your time and help :-)

  17. If I get mine done, it’s in London or Copenhagen where I want it done with the most advanced lasers, the Schwind Amaris 1050 RS that does 1 diopter a sec at 1.3 secs with cold laser not huting the eye with 7D tracking if the eyeball moves, a 1 minute procedure and a 100% success rate called “no touch prk.”

    The software is the most advanced in the world and do to politics, the usa FDA will not allow it in US, except at experimental colleges. I did my homework, you see.

    Talk about my cost to fly over there and I’m 62 and only getting my left eye done for what I like, monovision. I only use one contact in the left eye and sometimes wear glasses. I wish the USA wasn’t behind 10 years. Also, they have one on Ontario… so I’m considering that one too or worse case, wait until they have that machine in the US.

    It’s the laser that maps to your eye and does the procedure quickly that matters and heals it faster when done fast (less time under the laser) and correctly. Hope this helps. Your eyes are too important to risk. Note this machine is over 1 million dolllars. Don’t let them use an old machine with PRK… they will tell you theirs are just as advanced…. NOT!

  18. Hi,
    Thanks for such a detailed explanation.I am someone who is up for vision correction.I have Myopia -8.25 D.Other then this everwhere I read that for high vision corrections like mine Lasik(or femto-lasik as per my doctor) is more advisable then PRK.Could you please shed lught on this.I am myself want to go for PRK but considering my high correction I cannot conclude if it’l be better choice than PRK.Thanks

    • I think you will find literally no doctors who would say Lasik preserves more cornea than PRK.

      It’s just not how it works. Lasik cuts deeper into the cornea than PRK or Lasek. Just physics.

      Most surgeons will not do Lasik (but would do PRK/Lasek) if your cornea is too thin or your needed correction is too high.

      There were some studies a number of years ago, which showed for very high corrections (such as yours), the Best Corrected Visual Acuity was actually better with Lasik than with PRK, but I would strongly suggest you look more closely into those results (how long after surgery they were measured, etc). More importantly, how those patients fared long-term between the two (the Lasik group having a much higher risk of ectasia).

      There’s a reason eye surgeons are now much more hesitant to perform Lasik on high-correction or low-corneal-thickness patients (lots of serious complications and ensuing lawsuits).

      If I were you, I’d be wary of choosing the surgery with the best ‘peak’ vision if it meant you might have much more severe vision issues a few years down the line. It may be that if you look carefully at both options, you’ll decide both have unacceptable risks, and neither is right for you.

      That said, it’s my strong opinion that Lasik (especially for very high corrections like yours) would introduce way to much risk to your eye, which would definitely trump any potential vision acuity benefits.

      If I had to chose between Lasik and eyeglasses/contacts, I’d choose the no-surgery route 10 times out of 10.

      • Hi,
        Thanks for the reply.You are right I did some reasearch and got to under stand both procedures PRK and femto-lasik.However everywhere I read is femto-lasik has good results in long run then PRK.The retreatment rates and regression rates are low compared to PRK.I am very much confused.My doctor says I am eligible for both and there is nothing for me to worry about if I undergo any of the procedures.But he says femto is more good for my profile.as I have high myopia and PRK is advised to be used for max -6 D for best results.PRK takes longer to heal and it could go 3 months or a year before I can get full vision recovery.Also my job is in IT that requires.9 hrs in front of screen and I can offord 4 to 5 week days off from my job for the healing process

        • Sorry I mean to say I CANT afford.4 to 5 weeks off from work

          • The best anywhere is Amaris Laser PRK, less time, half minute, no touch or transprk, but can’t get in this country. Even emerging countries have it, the latest, but FDA won’t approve in USA. I’ll get mine in Denmark or London… almost everywhere in Europe. Expensive machines but I want the best!

            • By the way, I found a place in Sao Paulo, Brazil which has the Amaris 750 laser and they do TransPRK.

              Since the dollar is strong it will cost me around $1,800 max for both eyes.

              I have family there so I can hang around for a month for the follow ups.

      • Hey Mr.Temple

        I have severe starbursts at night with mild glare and haze. my eyesight also diminishes in clarity during the night.

        whats my best course of action? PRK enhancement? would that clear up the starbursts, glare and haze? Would there still be a flap from the original Lasik after PRK enhancement?

        Ive also heard of wave front surgery, what is your take on that. Any information would be helpful. I don’t 100% trust my optometrist and eye surgeon anymore after recommending I get only the basic Lasik while not making me fully aware of the risks.

        Thank you.

        • hmm if you already had LASIK then your flap is there. They can just reopen it. I honestly don’t think I would go back for a enhancement if I had done PRK because I would be afraid to remove the epithelial again and create scarring.

          I know lots of people who came back for an LASIK enhancement.

          If you had PRK and have all these side effects have a look a TransPRK method. It’s said to be less invasive but will still remove your epithelial. — Cheers

  19. Nancy L Burleson MD

    My son, Max Cronin, age 27 years old, committed suicide 1-14-16, as a direct result of complications he experienced from Lasik. He left suicide letters stating this and kept details of his complications. He experienced vision loss, constant eye pain, dry eyes, haze, and loss of quality of life resulting in depression and his suicide. He was unable to work or continue his life goals due to his eye complications.

    As a medical physician, I can definitely state that Lasik complications can lead to suicide. I can also say that no one should have elective Lasik on their eyes.

    For an elecive procedure, the risks and long term complications are understated.
    The resultant complications and negative quality of life issues increase the risks of depression, attempted suicide, and suicide.

    Nancy L. Burleson MD FACOG
    Gonzales, Texas

    • Hi Nancy,

      I think I’ve come across your website. Would you mind me asking if your son had the PRK surgery or lasik ie. Flap surgery?

      Thanks

    • It’s a shame. Worst, the USA is not using advanced “No Touch” Amaris 1050rs lasers, which are so fast that it can do an eye in seconds.

      Brazil has the newest Amaris equipment that takes off just a tiny bit in a matter of seconds using the newest technology. This means your eyes exposure to the laser rays is minimized so that there are no cases of dry eyes, haze, or long periods of healing.

      Why the USA doesn’t use the most modern equipment has to do with the corrupt FDA- it caters to whom pays them the most and that is the vendors and Doctors that don’t want to lose their investment in their current technology.

      It’s not about the successes, “it’s about the money!”

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