PRK

Your eye works like a camera. Light enters through the clear front of the eye (cornea), passes through the lens, and lands on the retina at the back. If the cornea is too curved, too flat, or shaped unevenly, light does not focus sharply on the retina and you see blurry. Glasses and contacts bend light to make up for the difference. PRK reshapes the cornea itself so the eye focuses on its own ¹.

The PRK procedure has three main steps:

• 1. Numbing. Eye drops numb the eye. A small speculum holds the eyelids open. Some surgeons offer a mild oral sedative.
• 2. Removing the epithelium. The surgeon gently removes the surface skin of the cornea (the epithelium). Different techniques are used — alcohol-loosened ("standard PRK"), a brush ("epi-PRK"), or the laser itself ("transepithelial PRK / TransPRK"). The chosen technique does not change the final vision much; it changes the first-day experience and chair time.
• 3. Reshaping with the excimer laser. The same excimer laser used in LASIK reshapes the cornea by removing a tiny amount of tissue. The laser is guided by your prescription and corneal map and takes 15-60 seconds per eye.

A bandage contact lens goes on to protect the eye while the epithelium grows back. The surface skin closes over the laser-treated zone within about 4-7 days. Unlike LASIK, there is no flap — so there is nothing that can be displaced years later by a blow to the eye.

Many surgeons use mitomycin C (a brief topical application) at the end of PRK to lower the risk of corneal haze, especially for moderate or high prescriptions ⁵.

Good signs you may be a candidate for PRK:

• You are 18 or older (most surgeons prefer 21+).
• Your glasses prescription has not changed much in 12 months.
• Your prescription is within the range your surgeon's laser is designed to correct (often roughly -8.00 to +5.00 with up to about 6 diopters of astigmatism; ranges vary by device).
• Your eyes are healthy — no significant dry eye, keratoconus, advanced glaucoma, or cataracts.
• You are in good general health.
• You have thin corneas, prominent corneal maps, a high-risk job for flap injury, or you simply want to avoid a corneal flap.
• You can take 4-7 days mostly off work and follow a strict eye drop schedule.

Signs PRK may not be right for you:

• You are under 18, or your prescription is still changing.
• You are pregnant or breastfeeding (hormone changes can shift the prescription).
• You have keratoconus or active corneal disease.
• You have very severe dry eye that is not controlled.
• You have uncontrolled diabetes, an autoimmune disease that affects healing, or you take systemic steroids or immunosuppressants long-term.
• You cannot reliably use the eye drops on schedule for several weeks.
• You need sharp vision in days, not weeks (LASIK or SMILE may be better in that case).

PRK is the preferred laser refractive surgery for many military, law enforcement, and first-responder programs because there is no corneal flap to worry about during physical training or combat ⁶.

PRK has been done for more than 30 years and is one of the most studied refractive surgery procedures. Most people are happy with the result, but no surgery is risk-free ⁷:

• Pain and discomfort in the first 3-5 days. Much more than LASIK while the epithelium grows back. Numbing drops, oral pain medicine, cold packs, dark sunglasses, and the bandage contact lens all help.
• Slow vision recovery. Vision is blurry for days to weeks. Many people are not driving comfortably for 1-3 weeks.
• Corneal haze. A slight cloudiness in the cornea, more common with higher prescriptions. Mitomycin C use during surgery has made significant haze uncommon ⁵.
• Dry eye. Common in the first months, usually back to baseline by 6-12 months. Often less severe than after LASIK because no corneal nerves are cut by a flap.
• Halos, glare, or starbursts at night. Common at first, usually fade over weeks to months.
• Under- or over-correction. Some people still need glasses for some tasks, or need a touch-up procedure.
• Infection. Very rare with proper drop use, but possible.
• Ectasia. A rare condition where the cornea bulges over time. Even rarer with PRK than with LASIK because no flap is made.
• Loss of best-corrected vision. Very rare — about 1 in 1,000 — losing the ability to see 20/20 even with glasses after surgery.

What PRK costs in the U.S.:

• Standard PRK: $1,800-$2,800 per eye.
• Wavefront-guided or topography-guided PRK: $2,200-$3,200 per eye.
• LASIK (for comparison): $2,000-$3,000 per eye.
• SMILE (for comparison): $2,500-$3,500 per eye.

The price almost always includes the pre-op exam, the surgery, follow-up visits for the first year, and any touch-up needed in that window. Confirm exactly what is included before you sign.

What insurance usually covers:

• PRK is considered elective in almost every plan. Most U.S. health insurance and Medicare do not cover it.
• Some employer vision plans offer a discount (often 10-20%) at certain refractive surgery centers.
• Most refractive surgery practices offer financing — interest-free 12-24 month plans are common.
• You can pay with HSA or FSA pre-tax dollars.
• Active-duty service members may qualify for PRK through their branch's vision readiness program at no out-of-pocket cost.