Surface refractive surgery, ideal for thin corneas and athletes, in Paris with Dr Gozlan.
PRK (photorefractive keratectomy) is a gold-standard technique for laser myopia surgery when LASIK is not suitable. Performed on the corneal surface without creating a flap, it is particularly well suited to thin corneas and to individuals at risk of eye trauma. Dr Gozlan, an ophthalmologist and refractive surgeon who holds a University Diploma in Refractive Surgery and Phacoemulsification (University of Toulouse), explains the principle behind the procedure, its indications, how it is carried out, the recovery process, expected results, potential risks and the cost of the surgery.
PRK (photorefractive keratectomy) is the oldest — and one of the safest — laser refractive surgery techniques. Unlike LASIK, no corneal flap is created: the thin layer of surface cells on the cornea, known as the epithelium, is gently removed, and an excimer laser then reshapes the corneal surface to correct the vision defect. The epithelium regenerates naturally within a few days. The procedure takes around ten minutes per eye and is performed on an outpatient basis.
By acting directly on the corneal surface, PRK preserves as much tissue thickness as possible — which is precisely what makes it the treatment of choice for thin corneas.
PRK and LASIK use the same excimer laser and correct the same refractive errors, but PRK works on the corneal surface whereas LASIK involves creating a corneal flap. The main difference lies in recovery: PRK requires a longer healing period with some discomfort during the first few days, while LASIK offers a very rapid recovery. On the other hand, because no flap is created, PRK is a safer option for patients with thin corneas or those at risk of eye trauma.
PRK is intended for patients who wish to correct myopia, astigmatism or hyperopia and whose vision has been stable for at least one year. It is particularly recommended in the following situations:
For high prescriptions or corneas that are too thin even for PRK, the surgeon may recommend a phakic intraocular lens implant. Only a comprehensive preoperative assessment can determine the safest technique for each patient.
No procedure is performed without a thorough, painless pre-operative assessment. Before PRK, this includes:
As with any refractive surgery, contact lenses must be removed several days to several weeks before the assessment to avoid distorting the measurements.
PRK is carried out as an outpatient procedure — no hospital stay is required — and involves six steps. You remain awake throughout; the treatment takes around ten minutes per eye.
The main distinguishing feature of PRK is its recovery, which is more gradual than that of LASIK. During the 2 to 3 days it takes for the epithelium to regrow, discomfort, watering eyes and significant light sensitivity are common; these are managed with painkillers, eye drops and the bandage contact lens. After that, vision clears steadily day by day:
After PRK, it is essential to keep your eyes well hydrated and to avoid unprotected sun exposure, swimming and rubbing your eyes while healing is under way.
The procedure delivers excellent results, ultimately equivalent to those achieved with LASIK. The vast majority of patients treated for mild to moderate myopia achieve 20/20 vision without correction. The outcome is stable and long-lasting. As with all refractive surgery, the procedure does not correct presbyopia, which typically develops around the age of 45 and may require a dedicated treatment approach.
Surface laser surgery is a safe, well-established procedure with a track record spanning over thirty years. Complications are rare and usually temporary:
Strict adherence to contraindications and a thorough preoperative assessment reduce these risks to a minimum.
The procedure is not performed in the presence of: progressive keratoconus, unstable refraction, pregnancy or breastfeeding, severe dry eye disease, certain corneal or autoimmune conditions, and in patients under 18 years of age. In some cases, an alternative solution (such as a phakic intraocular lens) may be preferable.
Like LASIK, PRK is not covered by national health insurance, as it is classified as an elective procedure. However, many supplementary health plans offer a "refractive surgery" package that covers all or part of the cost. The price depends on the degree of correction required and the technique used; a clear, no-obligation quote is provided at your pre-operative consultation.
Because no corneal flap is created, PRK is the technique of choice for contact-sport athletes (boxing, rugby, martial arts) and professionals exposed to ocular trauma (firefighters, military personnel, law enforcement), where a flap could theoretically shift following an impact. This is one of the major advantages of PRK over LASIK for these profiles.
The procedure itself is painless thanks to anaesthetic eye drops. However, during the 2 to 3 days it takes for the epithelium to regrow, discomfort, tearing and light sensitivity are common; analgesics and a bandage contact lens help relieve these symptoms.
Recovery after PRK is more gradual than after LASIK: functional vision returns within a few days and continues to sharpen over 2 to 4 weeks. Final visual acuity may take 1 to 3 months to stabilise.
PRK is preferred when the cornea is too thin for a flap, in cases of irregular cornea, or for contact-sport athletes and certain professions exposed to ocular trauma, since no flap is created.
Yes. In the long term, the quality of vision achieved with PRK is equivalent to that of LASIK. The only difference is the speed of recovery.
It is possible, but in some cases PRK is performed a few days apart to maintain comfort during the healing period. The surgeon decides on a case-by-case basis.
Most patients return to work within 3 to 7 days after PRK. Non-contact sports can be resumed after one week, while swimming and combat sports should wait 2 to 3 weeks.
PRK works well for low to moderate myopia. For higher prescriptions, the surgeon evaluates the available corneal thickness and may recommend an alternative solution such as a phakic intraocular lens.
PRK can be performed from the age of 18, once the refraction has been stable for at least one year. Presbyopia, which typically develops around age 45, is factored into the treatment strategy.
Dr Gozlan, holder of the University Diploma in Refractive Surgery and Phacoemulsification, assesses your eligibility for PRK during a comprehensive evaluation and determines with you the technique best suited to your eyes.
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