If we were to consider good vision as a destination, and laser eye surgery as our mode of transportation to get there, LASIK would be a commercial flight and photorefractive keratectomy (PRK) would be traveling by railway. A flight can create the illusion of a far-off destination feeling easier to get to than it should. I’m reminded of this when I talk to LASIK patients several times a day.
Not uncommonly, I’ll see someone who was near blind without glasses before their LASIK procedure. Now, less than 24 hours later, that patient's vision is better than 20/20 and the only comment on their post-op day one chart says “eyelashes feel annoying from eyedrops.” On a few occasions, I’ve talked with a 20/20 patient—six hours after LASIK—discussing what they don’t like about the post-op sunglasses required for the first six hours. It is (and there’s no sarcasm here) genuinely delightful. The recovery was so quick and painless, the flight from here to there so fast, that it’s possible to focus on something relatively trivial compared to the miracle of modern technology. Discussions at LASIK post ops are often the refractive surgery equivalent of having an uneven tray table on a flight across the country.
You can’t tell these stories to the folks on the railroad. The destination is the same, (vision after LASIK or PRK is identical) but having PRK gives the distance travelled much more of a sense of accomplishment. The procedure itself has come a long way with vast improvements in the last 20 years. It’s changed enough that it technically has a new name at this point: advanced surface ablation (ASA). It earned the new name because the recovery is so much quicker and more painless, and because the final visual result is so much better. Now it’s a very speedy, very finely appointed train. Even the best train, however, will still have passengers who aren’t going to want to hear about how your plane had to sit on the runway for 20 minutes. There are times, heaven help us, where spouses will have LASIK for one and ASA/PRK for the other. No marriage retreat obstacle course will ever compare to the intensity of patience and understanding required of those couples.
Here’s the interesting thing about all this: modern PRK really isn’t a big deal. Everything I just wrote is true, but it’s true because LASIK is so ridiculously quick and easy, not because PRK is that hard. It just seemed appropriate to pay homage to the difference from the beginning because chances are, if you’re a candidate for PRK and reading this, most of the people you’ve known who’ve had laser eye surgery had the LASIK version of it. Don’t compare your journey to theirs. It’s a plane vs. a train. If you want to compare it to anything, choose radial keratotomy (RK) from the 80s. Those guys rode horseback.
The PRK procedure takes 10 minutes to complete for both eyes and is completely painless. Because it skips the first laser required in LASIK—the one that feels like pressure—PRK is a slightly more comfortable procedure than LASIK. At the end of the procedure, an Acuvue Oasys contact lens with no prescription is placed in the eye. It stays there for four days and during that time your vision will transition from decent, to blurry, and back to almost decent. When the contact comes out, the vision starts to rapidly recover and most people are 20/20 within a day or two of the contact lens removal. As for discomfort, there’s almost never a level that people describe as pain. It’s mostly light sensitivity and so sunglasses are helpful even indoors. The feeling of a piece of sand or eyelash in your eye varies from person to person. The light sensitivity and foreign body sensation are almost always just about 48 hours in duration.
The nice thing about PRK is that even though the vision gets to 20/20 pretty quickly after the contact comes out, it keeps getting better from there. It doesn’t take three months to get good vision, but the vision keeps improving for three months.
The only special rule during that extended period of time is the need for sunglasses during the first six weeks. It’s important to wear them anytime you’re outdoors during that period. If anyone asks why you’re wearing sunglasses when it’s cloudy, you can tell them you had PRK—or you could say that you’re a spy.
Once you’ve gained the super vision achievable with modern PRK, the journey there feels easily worth it according to everyone I talk to who’s had it done. Plus, if you meet someone who has had LASIK, you can feel a sense of superiority because of the journey you took that they skipped. That alone is probably worth the ride.