LASIK or PRK to correct myopia, astigmatism, and hyperopia? The complete comparison of the two laser techniques, point by point, with Dr Gozlan.
LASIK or PRK ? These two laser refractive surgery techniques correct the same vision defects — myopia (nearsightedness), astigmatism and hyperopia — with the same excimer laser, and ultimately deliver equivalent results. They differ in one essential way : how the cornea is accessed. This comprehensive comparison reviews, point by point, everything that separates LASIK from PRK to help you understand which one is best suited to your eyes. The final decision is always made by Dr Gozlan, holder of the Inter-University Diploma (DIU) in Refractive Surgery (Université Paris Cité), based on the preoperative assessment.
LASIK (Laser-Assisted in Situ Keratomileusis) and PRK (photorefractive keratectomy) are the two main families of corneal refractive surgery. Both reshape the cornea with an excimer laser to refocus the image sharply onto the retina and reduce dependence on glasses. PRK is the older technique (late 1980s) ; LASIK, introduced in the mid-1990s, is now very widely performed. They are not competing techniques but rather complementary ones : each has its preferred indications.
The entire difference lies in how the corneal tissue to be reshaped is accessed :
It is from this single difference — flap versus surface — that all other distinctions arise : speed of recovery, comfort, indications based on corneal thickness, and suitability for sports.
Before contrasting them, let us first recall everything they share : the same excimer laser, the same refractive errors corrected (myopia, astigmatism, hyperopia), the same anesthesia using simple eye drops, the same outpatient setting (no hospitalization), the same preoperative assessment (topography, pachymetry, aberrometry), and above all equivalent results at one year. Both techniques also benefit from the same refinements : eye-tracking, customized treatments guided by aberrometry (wavefront) or topography.
For myopia (nearsightedness), LASIK is often preferred for low to high corrections thanks to its rapid recovery, provided the cornea is thick enough. PRK is suited to low to moderate myopia and is often preferred when the cornea is thin, as it preserves more tissue. For very high myopia exceeding the limits of both techniques, a phakic implant (ICL) may be considered. For the same correction and a favorable cornea, both deliver clear and stable distance vision.
Astigmatism, very often associated with myopia, is corrected by both techniques, using asymmetric topography-guided ablation. Both LASIK and PRK regularize the toric cornea with equivalent precision. For thin or slightly irregular corneas with astigmatism, surface PRK offers an additional safety margin.
Hyperopia is corrected by both techniques by steepening the peripheral cornea. LASIK is frequently chosen for its comfort, but PRK remains an option. Correcting hyperopia is somewhat more demanding in terms of tissue : corneal thickness, measured during the preoperative assessment, strongly guides the choice.
This is the most noticeable difference in daily life. With LASIK, recovery is faster: the FDA advises planning a few days off work. With PRK, the time it takes for the epithelium to regrow (usually within 5 days) means that functional vision returns more gradually, and stable vision may take several months (AAO). If you need a very fast recovery, LASIK has the advantage ; if a few days of waiting are not an issue, PRK gives equivalent final results.
Both procedures are painless during the surgery itself (topical anaesthetic drops). The difference comes afterwards : LASIK is very comfortable from the same evening, whereas PRK is accompanied by discomfort, tearing and light sensitivity for a few days while the surface heals. This discomfort is relieved by analgesics, eye drops and a bandage contact lens.
Corneal thickness is often the decisive factor. The LASIK flap uses up tissue : on a thin cornea, there may not be enough residual thickness for a safe correction, with a (very rare) risk of corneal ectasia. PRK, which works on the surface, preserves the deep stroma and then becomes the preferred option. Topography and pachymetry performed during the preoperative assessment allow an objective decision to be made.
For contact-sport athletes (boxing, rugby, martial arts) and professionals exposed to ocular trauma (firefighters, military personnel, law enforcement), PRK is generally recommended : the absence of a flap eliminates any risk of flap displacement from an impact. This is a strong argument in favour of surface surgery for these profiles.
Regarding the final outcome, comparative trials and leading reviews are consistent : at one year, the visual acuity achieved is equivalent between LASIK and PRK (Cochrane review, Shortt et al.). LASIK stands out primarily for its faster recovery and less initial pain. Both techniques offer a stable and long-lasting correction of myopia and astigmatism ; neither prevents presbyopia, which most often develops shortly after age 40 (AAO).
Both techniques are well established. Their specific risks differ, however :
In both cases, refractive surgery is not covered by the national health insurance system as it is considered an elective procedure. Many supplementary health insurance plans offer a "refractive surgery" package applicable to both LASIK and PRK. The cost depends on the technology used and the correction required ; a detailed estimate is provided during your consultation, with no obligation.
At a glance, the main differences between the two techniques :
| Criterion | LASIK | PRK |
|---|---|---|
| Technique | Corneal flap created with a femtosecond laser | Surface treatment, no flap |
| Visual recovery | Fast (a few days) | More gradual, stabilisation over several months |
| Postoperative comfort | Mild discomfort, usually brief | Discomfort for a few days (bandage contact lens) |
| Thin corneas | Less suitable | Preferred indication |
| Contact sports / high-risk occupations | Flap inadvisable | Preferred indication (no flap) |
| Myopia (nearsightedness) corrected | Depending on corneal thickness | Low to moderate |
| Astigmatism | Yes, depending on the assessment | Yes, depending on the assessment |
| Hyperopia | Yes, depending on the assessment | Moderate |
| Specific risk | Flap-related; ectasia (very rare) | Corneal haze (rare) |
| Final outcome | Equivalent at one year | Equivalent at one year |
| Insurance coverage | Not covered | Not covered |
This table is for guidance only : only the preoperative assessment can provide a personalised recommendation.
There is no single « best » technique in absolute terms : there is the technique best suited to your eyes. In summary, LASIK is often preferred for its lightning-fast recovery when the cornea allows it ; PRK is the method of choice for thin corneas, contact-sport athletes, and high-risk occupations. The decision is based on corneal thickness and regularity, the degree of correction needed, your lifestyle, and your expectations. This is precisely the purpose of the preoperative assessment, which turns this general comparison into a tailored recommendation.
Neither is "better" in absolute terms: at one year, the results are equivalent. LASIK offers faster recovery when the cornea allows it; PRK is particularly suited to thin corneas and contact-sport athletes. The assessment determines which is best suited to your eyes.
PRK does not create a flap and preserves more corneal thickness, making it the preferred option for thin or at-risk corneas. On a normal, thick cornea, LASIK is equally safe and more comfortable.
Thanks to anaesthetic eye drops, the procedure is generally not painful in either case. Afterwards, LASIK is very comfortable from the next day, whereas PRK causes discomfort for a few days while the surface heals.
Yes. With LASIK, recovery is usually fast. With PRK, functional vision returns more gradually, and stable vision may take several months (AAO). The final result is then equivalent.
Yes. At one year, the visual acuity achieved is equivalent between the two techniques. Only the speed of recovery and initial comfort differ.
PRK is generally recommended for contact sports and occupations exposed to impacts, as the absence of a flap eliminates any risk of flap displacement during ocular trauma.
Often yes, but preferably with PRK, which preserves corneal thickness. If the cornea is too thin even for PRK, a phakic implant (ICL) may be considered. The assessment decides.
LASIK can correct high myopia if the cornea is thick enough, within a limit set at the assessment; PRK is more suited to low to moderate myopia. Beyond that, a phakic implant is an alternative.
Neither is covered by the French national health insurance. The cost depends mainly on the technology used and the correction; a personalized quote is provided during the consultation.
Dr Gozlan, after the preoperative assessment (topography, pachymetry, aberrometry, refraction), taking into account your cornea, your correction and your lifestyle.
The Dr Gozlan, holder of the Inter-University Diploma (DIU) in Refractive Surgery (Université Paris Cité), determines during a comprehensive assessment whether LASIK or PRK is the most suitable technique for your eyes.
References & medical sources