Vision Learning Center Navigation... Refractive Surgery Options   -iLASIK® (CustomVue™ blade-free LASIK with Intralase)   -RL-Refractive Lensectomy/PRELEX℠   -CK-Conductive Keratoplasty   -ICL-Verisyse™ and Staar™ Implantable Contact Lenses   -PRK-Photorefractive Keratectomy   -INTACS®-Corneal Segments   -AK-Astigmatic Keratotomy Valley Eye Report Card Financing Options Testimonials Cataracts Frequently Asked Questions Prevention Guide Insurance Information Valuable Vision Links   Photorefractive Keratectomy What is Excimer Laser Photorefractive Keratectomy? Excimer Laser Photorefractive Keratectomy (PRK) is a vision correction procedure designed to reduce or eliminate nearsightedness or farsightedness, with or without astigmatism. Nearsightedness, also called myopia, occurs when the shape of the eye is elongated so that light is focused in front of the retina (the "seeing" part of the back of the eye). Farsightedness, also called hyperopia, occurs when the shape of the eye is shortened so that light is focused behind the retina. PRK corrects nearsightedness by flattening the cornea (the clear window in the front of the eye). The laser beam gently reshapes the center of the cornea. This reshaping of tissue moves the focus point of the eye onto the retina. PRK corrects hyperopia by steepening the cornea. In this case, the reshaping occurs in the outer regions of the cornea. PRK, developed over 20 years ago in America, has been carefully studied and performed for over 15 years in the United States, Canada, and Europe. The laser treatment can also be programmed to reduce or eliminate astigmatism. Astigmatism occurs when the cornea has the shape of a football, resulting in multiple blurred focus points. The Excimer laser has applications in other fields of medicine. Who is a candidate for Excimer Laser PRK? Candidates for PRK may experience difficulty wearing glasses and contact lenses. Generally, the best candidates have low to moderate amounts of myopia or hyperopia. The excimer is currently approved for -1.00 to -7.00 diopters and +1.00 to +2.00 diopters. Astigmatism of -.25 to -4.00 diopters may also be treated with the laser. In addition, candidate's lifestyle or career may require good vision without the use of glasses or contact lenses. Individuals are encouraged to attend a free educational seminar given on a regular basis at Valley Eye Associates or visit the office for a Free Complementary Consultation. A thorough eye examination is required prior to having PRK. If there are no contraindications for laser treatment, the next step is a "PRK Evaluation". This includes computer mapping (computed topography) of the cornea, thickness measurements of the cornea (pachymetry) and a counseling session. Computed topography provides a detailed surface map of the cornea to guide your surgeon in formulating a specific treatment plan. The counseling session (including meeting your surgeon face-to-face) allows you the opportunity to have your questions answered. How is the Procedure Performed? PRK is performed in the professional atmosphere of the outpatient laser center at the Theda Clark Laser Center. The staff provides your care in a relaxed and comfortable atmosphere. No two individuals are alike and your doctor will take the time to discover your unique lifestyle, career goals, and physical needs. No single formula can provide the perfect correction for everyone. This is why the individual consultation is so important in planning for PRK. For example, if you spend 8 hours a day working at a computer screen, you visual needs will differ form someone who spends much of the day driving. If you are over 40, you may experience problems with your near vision focusing up close. By leaving one eye slightly undercorrected, the need for reading glasses can be reduced. This technique, called monovision, has proven successful in helping individuals adjust to the natural aging process. If both eyes are corrected for good distance vision, reading glasses will probably be necessary as patients enter their 40's and 50's, unless additional treatment is performed. Your specific needs are taken into consideration when a treatment plan is developed. With PRK, your surgeon attempts to reduce the amount of myopia in one treatment session. If more correction is needed to safely obtain the desired result, additional PRK, or iLASIK, (see our handout, iLASIK - Answering Your Questions) may be performed. Additional treatments are known as enhancements. This conservative approach gives you and the doctor more control over the results of the laser treatment, and also reduces the risk of overcorrecting the eye. What if I Have Astigmatism? Excimer lasers can be programmed to correct astigmatism at the same time as the myopia or hyperopia is being treated. Another technique, called Astigmatic Keratotomy (or AK for short), has been performed over the last 20 years to reduce or eliminate astigmatism. In this procedure, arc shaped incisions are made in the cornea. These incisions are in the periphery of the cornea and relax areas where the cornea is too steep. What Happens Before the Day of PRK? Prior to your treatment date, you will receive a list of pre-operative instructions. No history or physical examination is required by your family doctor. You will be asked to wear comfortable clothing and you do not need to change your clothes for PRK. You are required to make arrangements for a relative or friend to drive you home afterwards. You will be instructed to stop wearing your contact lenses 3 days prior to PRK if they are soft lenses and 2-4 weeks prior to PRK if they are hard or gas-permeable contact lenses. This is to ensure that your cornea resumes its natural shape prior to treatment. What Happens on the Day of PRK? Excimer PRK is performed on an outpatient basis in the laser suite. In this relaxed atmosphere, you will receive professional experienced care. The staff is there to answer you questions and assist you in understanding the procedure. Preoperative sedatives (usually a Valium pill) may be required. A topical anesthetic (numbing drops) is all that is needed so that you will not feel discomfort during laser treatment. During the procedure you will be positioned in a reclining chair under a microscope which is connected to the laser. The light may be somewhat bright initially but will do no harm to your eye. You may feel slight pressure from the instrument that keeps your eyelids open. You will be asked to focus on a colored fixation light during the laser procedure. You will hear a rapid tapping sound as the laser is applied, which is normal. The total procedure will take about 5 to 10 minutes. When the laser treatment is complete, a bandage contact lens will be placed on your eye. This will be removed several days later in the office. Post-operative medications will be given to you and the staff will go over your post-operative written instructions with you. How Do I Care for my Eye After PRK? You should avoid rubbing or bumping the eye after PRK. You may experience discomfort such as scratchiness, tearing, or a foreign body sensation in the eye. This is normal and may last for a few days. Pain relievers are occasionally needed and are prescribed if necessary. Women should refrain from wearing eye make-up for a few days. The limitations on activities may vary from person to person. However, generally speaking, you may immediately resume normal activities like bending, watching TV, taking a shower, or reading. Contact and racquet sports should be avoided for one week after PRK until the top skin layer of the cornea heals (epithelium). People involved in boxing or karate should wait a month following PRK before resuming these activities. We recommend that you wear protective eye wear anytime you participate in racquet sports, regardless of whether you have had PRK. What Follow-up Care is Necessary? Patients are generally seen 1 day, 1 week, 1 month, and 6 months after the procedure. More frequent visits may be necessary. Visits during the first six months after PRK are included in the fee. Of course, regular eye examinations by your eye care provider are essential to maintain healthy eyes. It may take more than one procedure over this time to safely reduce or eliminate your nearsightedness, farsightedness, and/or astigmatism in each of your eyes. Patients referred by their optometrist may receive a portion of their post-operative care from this doctor. There is no additional fee for this service. We recommend waiting 2-4 weeks between treating the first and second eye. Under special circumstances, the wait between treating both eyes may be shortened, but both eyes are usually not treated the same day. What are the Risks of Excimer Laser PRK? As with any surgery, there is always a slight risk of post-operative infection, although this is minimized by the use of pre-operative and post-operative antibiotics. With PRK there is a chance that the eye will be overcorrected or undercorrected which would mean that glasses, contact lenses, or additional surgery would be needed to obtain your best possible vision. In the first weeks after PRK, you may be sensitive to bright lights or see starbursts around lights at night (glare). This usually decreases several weeks after surgery. You may notice that your vision may be temporarily affected by fatigue. This should improve in time as healing progresses. Recovery of vision is usually longer for patients who have PRK when compared to those who have had iLASIK. Other complications that have been described with PRK (but are rare) include continued problems with glare, vision fluctuation, scarring of the treated cornea (usually in patients who have a tendency to form scars on other parts of their body), development of irregular astigmatism with distortion of vision even with glasses, monocular diplopia, glaucoma, and loss of vision. These complications are less common with a conservative approach to PRK which includes lower laser energy settings and larger treatment (optical) zones. This list is not a complete list of all potential complications of PRK, and it is impossible to list all potential problems with this procedure, either immediately, months or years following the surgery. No guarantee or warranty can be made as to the results or safety of PRK. Will I Have "Perfect Vision"? The goal of PRK is to reduce your dependence on glasses or other optical aids. A small amount of correction may be needed for near vision or far vision. Contact lenses may be used after PRK. The results of PRK will depend on your cornea's response to the laser and the healing process. While the procedure can be done more than once, it cannot be performed an infinite number of times. How Much Will PRK Cost? You will be charged a surgeon's fee, a facility fee, and if applicable, a co-management fee paid directly to your optometrist or ophthalmologist, for each eye. The surgeon's fee is reduced by the co-management fee when your optometrist provides part of the post-operative care. Your payment covers follow-up visits for the next six months. Prior to surgery, you can meet with a financial counselor who will answer your questions about the fees. For our patients' convenience, we accept cashier checks, cash, MasterCard, VISA, and Discover. A discount for cash payment is available, as well as a 0% down, 0% interest financing plan. Payment in full is required 5 business days before the procedure, unless a financing arrangement has been made. If payment is not received 5 business days before the procedure, the procedure will be postponed. Very few insurance companies cover refractive surgery. However, we do encourage you to check with your insurance provider before the surgery.