The choice between PRK and LASIK depends on several factors, including your eye health, your lifestyle, and your personal preferences.
For himself, Dr Bidgoli chose PRK. Would you like to know more about how his procedure went? Click here.
Here is a comparison of the two techniques to help you make an informed decision:
PRK (Photorefractive Keratectomy)
Indications
Myopic or astigmatic patients
Specific and mandatory indications:
- Patients with thin or irregular corneas.
- Those who practice sports or activities with a high risk of eye trauma.
Advantages of PRK
- No cutting. This avoids complications related to cutting, such as dryness and weakening of corneal resistance.
- No creation of a corneal flap. This avoids complications related to flap creation, such as an incomplete or decentered flap. No interface is created within the cornea (which can be a potential source of complications such as inflammation or epithelial cell ingrowth). In case of infection, it would be located on the surface (just beneath the epithelium) rather than within the stromal interface, as with intrastromal techniques (LASIK and SMILE).
- Ablation in the anterior stroma with preservation of the deeper corneal layers, which appear to play an important role in corneal strength, resulting in less weakening of corneal biomechanics.
- A safe and effective method with stable long-term results.
- Lower risk of complications in the event of post-operative eye trauma.
Disadvantage
- Longer recovery time (a few days), resulting in greater discomfort during the first 2–3 post-operative days and blurred vision during the initial healing phase (4–5 days).
LASIK (Laser-Assisted in Situ Keratomileusis)
Indications
- Myopic or astigmatic patients with a sufficiently thick cornea.
- Hyperopic patients.
Advantages of LASIK
- Rapid recovery with clear vision as early as the next day or a few days after surgery.
- Less post-operative discomfort compared with PRK.
- More predictable visual outcomes and less dependence on healing.
- Treatment of choice for hyperopia, as regression of the correction is often observed over time after PRK. In addition, in hyperopic patients, ablation has less impact on corneal biomechanics (photoablation is performed in the peripheral cornea rather than centrally as in myopia), and therefore does not weaken corneal strength.
Disadvantages
- Corneal cutting using a femtosecond laser, with related complications such as dryness and weakening of corneal resistance.
- Creation of a corneal flap and complications related to its formation, such as an incomplete or decentered flap. The presence of an interface between the two layers is also a potential source of complications such as inflammation or epithelial cell ingrowth. In addition, in the event of infection, it would be located deeper within the stroma rather than on the surface as in PRK.
- Not recommended for those practicing contact sports or activities with a risk of eye trauma.
- Higher risk of dry eye compared with SMILE or PRK.
Conclusion
- Choose PRK if you have thin or irregular corneas, dry eyes (contact lens wearers), or if you practice contact sports, and above all if you prefer to minimize all risks.
- Choose LASIK if you are hyperopic, if you have sufficiently thick corneas, if you want a very fast recovery with minimal post-operative discomfort, and if you do not practice activities with a high risk of eye trauma.
And what about SMILE?
The true indications for SMILE still appear to be limited. It is a good alternative to LASIK for myopic or astigmatic patients who want faster recovery and greater comfort compared with PRK. The technique has its own surgical risks, and post-operative side effects and complications are similar to those of LASIK, except for a lower incidence of dry eye. Hyperopia is difficult to correct with SMILE, and LASIK therefore remains the technique of choice.