When it comes to refractive surgery, the two best options are LASIK (laser-assisted in situ keratomileusis) or PRK (photorefractive keratectomy). LASIK will result in a faster healing time, but may present more secondary complications. In addition, not all individuals are good candidates and may even suffer from serious issues post surgically if LASIK is performed. PRK is an alternative that has a longer healing period, but does not pose the same risks as LASIK. It requires more patience and therapy post surgically, but is a better procedure for individuals with thinner corneas, dryer eyes and other important factors.
PRK is performed by initially placing a ring on the surgical corneal area and filling it with alcohol to weaken the bonds of the corneal epithelium. Next, this outer corneal layer is moved aside using a surgical brush exposing the inner layers of the tissue. At this point an excimer laser is employed to ablate and reshape the inner layers of the cornea. This is the same laser used in LASIK. Upon completion of this step, a bandage contact lens is placed over the surgical area. This lens permits the re-epithelialization of the cornea. In addition, it protects the cornea and improves patient comfort. The patient should be seen frequently as long as the contact lens is on the eye to monitor healing of the abrasion, and possible infection of the wound.
The contact lens will be removed between 4-7 days once the epithelium is fully healed. In an effort to prevent infection, the individual must use a topical antibiotic such as Zymar for at least a week, and a topical steroid like FML for at least 6 weeks post operatively. The steroid will reduce the swelling, improve patient comfort and prevent scarring during this healing period. Depending on several factors, these drops may be modified if any corneal haze is present, there is over/under correction, an increase in intraocular pressure or an allergy to the drops. Further, immediately following the surgery there may be substantial discomfort; a pain reducing drop is used for 1-2 days like Xibrom is employed. It must be discontinued shortly following the procedure since it does retard the healing process.
Since the healing is slower and will be less comfortable initially, some patients may be reluctant to have this procedure. In addition, sunglasses must be worn for a full year following the surgery since UV light often will make the cornea hazy even after the healing appears to be complete. This is another distinction between PRK and LASIK.
The bottom line is that before one decides to have refractive surgery, they must be properly advised as to the benefits of all the options. Then, and only then can a truly informed decision be made. The choice should really be made by the surgeon as to which procedure would be safest and best for any patient. It should not be up to the individual based on what they would prefer. The final result is what is most important not simply how one gets there.
This article is written by Dr. Jay Stockman, contributing consultant to
CLE Contact Lenses. Dr. Jay Stockman has co-managed a significant number of refractive surgery patients. Advise, and medical questions can be directed to
New York Vision Associates
