PRK Pain

PRK, or photorefractive keratectomy, was the original laser-based vision correction surgery. While PRK represented a great advancement in eye care technology, it had its drawbacks. During the PRK procedure, the eye surgeon removes the outer layer of the cornea and then uses the laser to reshape the cornea. Because that outer layer was removed, recovery from PRK takes several days while the cornea heals. In addition, that process makes PRK painful.

How PRK Works

• The PRK procedure uses an excimer laser. The excimer laser produces a cool ultraviolet beam. The surgeon uses this beam to remove small pieces of the cornea to reshape it. By reshaping the cornea, you improve the way it focuses light into the eye. This, in turn, makes vision clearer. PRK is appropriate for both nearsighted and farsighted patients. For nearsighted patients, the cornea is flattened, while the cornea is steepened for farsighted patients.

Where PRK Pain Comes From

• During the PRK procedure, the surgeon uses a topical anesthetic, and PRK pain doesn't appear until well after the procedure, once the anesthetic has worn off. Some patients report pain for several days after the PRK procedure, and vision tends to remain blurry for that time, as well. Many patients don't experience PRK pain at all, and instead suffer from minor itching and irritation.

LASIK as the Answer to PRK Pain

• PRK pain is one of the reasons this procedure dropped off in popularity once the LASIK procedure was introduced. During the LASIK procedure, the outer layer of the cornea isn't removed. Instead, the surgeon creates a corneal flap. This flap is lifted before using the laser. After the surgeon reshapes the cornea using the laser, the flap is replaced. This flap then serves as a bandage of sorts that helps to reduce pain and discomfort. In addition, the patient's vision usually clears a few hours after the procedure.

PRK Pain and Pain Management

• Advances in pain management, however, have eye care specialists looking more closely at a return to PRK. For example, Ista Pharmaceuticals' product, Xibrom, is an anti-inflammatory eye drop that shows promise for helping to control pain after the PRK procedure. Some surgeons are using Xibrom to saturate the bandage contact lens after PRK surgery. This procedure has been so effective that some patients don't need any oral pain medication to treat their PRK pain.

A Return to PRK

• Many eye surgeons are now considering offering PRK for certain patients. PRK has some specific advantages over LASIK. The corneal flap that the LASIK procedure creates can cause damage to the corneal nerve endings, which can contribute to dry eye. It can also damage the corneal fibers that help the eye to maintain its shape. PRK doesn't create these risks. PRK is considered safer than LASIK, and if surgeons can manage to address the issue of PRK pain, PRK becomes a more viable alternative to LASIK for many patients.