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PRK — it’s not LASIK, and not for everyone 

A firsthand account of PRK surgery, a procedure for those who aren’t candidates for LASIK

click to enlarge Pre-surgery selfie. Note the black surgical markings on my eyeballs.

Pre-surgery selfie. Note the black surgical markings on my eyeballs.

This feature isn't easy for me to write. Not because I'm grappling with writer's block or a difficult subject. The reason is simpler: A blunt instrument resembling an electric toothbrush recently scraped two 9 millimeter slices from my corneas. I spent the following days wearing sunglasses in a room with foil covering the window. It's all a blur of prescription benzodiazepines, antibiotic drops, hydrocodone and searing eyeball pain.

  Almost two weeks later, I've switched to steroid eye drops and artificial tears. I can see, but hazily: this font is cranked up to 500 percent. There's still a long road to recovery, about three to six months before my vision stabilizes. But my surgeon says odds are good I'll ultimately see better than 20-20.

  My name is Missy, and I am recovering from PRK eye surgery.

  When I talk about PRK, the most common response is, "What's that?" PRK, or photorefractive keratectomy, is LASIK's tough older brother and the very first laser eye surgery performed. The technology used in both PRK and LASIK procedures, the excimer laser, was created by IBM in the 1970s to make circuit boards, says Dr. Jeffrey Singer of Singer Custom Vision, who estimates he has performed more than 40,000 laser eye surgeries (mine included). In the 1980s, the excimer laser was adapted to reshape the cornea.

  "The first PRK [surgery] in the world was done around 1989 in New Orleans," Singer says. "That's because LSU has one of the premier eye departments, and they'd done a lot of research."

  Coincidentally, this is around the time my vision declined. I had trouble reading the blackboard in kindergarten. In first grade, I got glasses. My eyes got worse and worse, finally settling at -8.5 power in my right eye and -7.5 power in my left eye, which also had astigmatism.

  "Don't worry," the eye doctors told my mother. "By the time she's older and her vision stabilizes, we'll have a surgery that's even better than the one we have now."

  They were right. That surgery is LASIK, which came out in 1994. In almost every way, it is superior to PRK. It was developed in response to some aspects of PRK that are less than ideal, Singer says.

  "It was the healing," Singer says. "With the PRK surgery, you have an abrasion on your cornea, you don't see well for at least a week and you're in pain for the first few days after surgery."

  "In LASIK, a hinged flap is created to give the surgeon access to the treatment area," says Dr. Jonathan Lappen of St. Charles Vision. "In PRK, the cornea's entire epithelial layer is removed by the surgeon, which exposes the stroma layer right underneath. Then the laser is applied and reshapes the cornea."

  With LASIK, once the hinged flap is replaced, epithelial cells regrow quickly. "You're not destroying the whole central cornea," Lappen says. Patients can see within a few hours and often return to work the next day. With PRK, the healing process is "a lot longer," Lappen says. How much longer depends on the individual, but PRK patients should expect to miss at least a week of work.

  So why would anyone opt for the older, more painful PRK surgery when LASIK is available for the same price ($799 per eye at Singer Haley Vision)? Because not everyone's a candidate for LASIK. Thin corneas, high degrees of myopia, dry eyes and overly large pupils can all be disqualifying factors. These conditions all are evaluated in patients who want laser eye surgery.

  When I scheduled my consultation with Dr. Michael Kleamenakis at Lakeview Vision Source, I had never heard of PRK. The consultation was like an eye exam: a lot of chart reading, a lot of "Is this better or worse? What about now?" He put in some drops and checked my eyeball pressure and pupil size. Last, he measured my corneas' thickness.

  "I'm going to call the surgeon," Kleamenakis said, looking concerned.

  The surgeon confirmed I was not a candidate for LASIK. My degree of myopia was too high; my corneas were too thin; and my pupils were too big. But I could do PRK, he said, which happens to be the surgery of choice for military fighter pilots, martial artists and other individuals with what Leppen calls "a predisposition for trauma." That's because there's no risk of corneal flap complications (such as dislocation following a blow to the head), since no flap is created with PRK.

  So I scheduled PRK. I wasn't nervous, mostly because I'd heard what a breeze LASIK is. I thought PRK couldn't be that different — it was probably similar to the difference between an iPhone 5 and an iPhone 6.

  When I laid down for the surgery, awake if loopy from a Valium the nurse supplied, I felt pumped. Singer had agreed to allow cameras in the operating room. I held a voice recorder and interviewed him while he performed the surgery (which I also posted on YouTube). The pain was minimal: a little burning watery sensation, a lot of crazy colorful lasers and the scent of burning eyeball tissue. Less than 10 minutes later, we were done.

  "Can you read the clock?" Singer asked me.

  "It's a quarter to noon," I said, jubilant. "I can't believe my eyes are fixed. That was so fast."

  Reality — and intense, burning pain — set in quickly, while I waited in the Walgreens parking lot for my mom to fill my prescriptions. Doctors advise PRK patients to take Vicodin and Halcyon and go straight to sleep after surgery, which was what I did for the next 19 hours. Over the following days, I'd learn PRK recovery is to LASIK recovery what a 1990s flip phone is to the iPhone 6 Plus: not even close. I'd regret my decision many times. I'd listen to the Serial podcast in its entirety. I'd make three follow-up visits to Singer's office and give zero f—s about appearing in public with a scarf wrapped around my head a la The Elephant Man. I'd yearn to leave my foil-wrapped nest of darkness, but when daggers of sunlight assaulted my corneal abrasions, I'd yearn just as passionately to return.

  Each day, the pain and sensitivity to light receded. After five days, I went back to work, where I sent typo-ridden emails and snapped at colleagues when asked to proofread. ("I physically can't right now!")

  Would I recommend PRK? It's too soon to say. My world is out of focus still, like I'm viewing it from behind wavy panes of antique glass. Lappen also has considered LASIK. Like me, he's not a candidate. So far, he has opted not to have PRK.

  "If I was having problems, I would absolutely explore it," he says.

  Singer points out that the risk of corneal infection from wearing contacts is higher than the risk of infection from refractive surgery. He performs 200 surgeries per month (of which 10 to 15 percent are PRK), and 99 percent of his patients would do it again, he says.

  "Most people who get laser vision correction will see better than they did with glasses or contacts, because lasers are able to measure optical aberrations that can't be corrected with glasses," he says. "So [after] laser vision correction ... people can see better than they ever saw before."

  Though my corneas will continue to remodel over the next few months, I had a moment of clarity at Jazz Fest last weekend that gives me hope. I'd spent the afternoon in rain and muck, wearing a garbage bag. At 6 p.m., the clouds cleared and rose-gold evening light settled on the Fair Grounds. A palm tree's fronds appeared crisp and hyper-real, as though lit from within. I saw the world in a way I do not remember ever seeing it before.

  The moment passed, and my corneal haze returned. But six months from now, I'm pretty sure I'll be glad I had PRK. Like the rest of the 99 percent.

Watch Missy Wilkinson’s actual PRK surgery.
Warning this video shows a graphic live medical procedure

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