Photorefractive Keratectomy (PRK) and LASEK

Is PRK safer than LASIK?

From the editor: Frequently I receive email from people who want to know if PRK is safer than LASIK. I am not a doctor, so I can only offer my personal viewpoint as a layperson.

PRK carries many of the same risks as LASIK with the exception of flap complications.

I have interacted with countless patients who had poor outcomes from PRK. Haze, pain, dry eyes, and night vision problems are the most common complaints after PRK. Regression is also common after PRK.

All eyes experience persistent, accelerated loss of corneal cells after PRK.

Unnecessary refractive surgery (RK, PRK, LASIK, epi-LASIK, LASEK, epi-LASEK, implantable lenses, refractive lens exchange) is becoming a leading cause of vision loss, and it is completely preventable.

Bottom line, I am opposed to all forms of elective eye surgery. Keep your glasses!

Study finds persistent, accelerated loss of corneal cells after PRK and LASIK

Excerpts:

"Between 6 months and 5 years [after PRK], keratocyte density in the full-thickness stroma decreased at an average annual rate of 3.2%, more than seven times the normal annual rate of 0.45%."

"Between 6 months and 5 years [after LASIK], keratocyte density in the full-thickness stroma decreased at an average annual rate of 4.2%, 10 times the annual rate in normal corneas of 0.45%."

"This prospective 5-year longitudinal clinical trial demonstrates a gradual loss of keratocytes from the anterior stroma after PRK and from the stromal flap and the stroma immediately posterior to the ablation interface after LASIK. By 5 years after both procedures, keratocyte loss was also significant in the posterior stroma."

"The possibility of a long-term effect of keratocyte insufficiency cannot be ruled out, however, given the many functions of these cells."

***

In the peer-discussion Dr. Roger Steinert states, "The authors are to be congratulated for observations that are notable and, if confirmed and extended, raise concerns that excimer laser ablation may ultimately lead to a decline in keratocytes below the level necessary to maintain extracellular matrix turnover. One can speculate that this loss might lead to corneal ectasia."

Source: Erie et al. Long-term corneal keratoctye deficits after photorefractive keratectomy and laser in situ keratomileusis. Trans Am Ophthalmol Soc. 2005;103:56-68.

Parent reports PRK-related suicide of son to the FDA - 1/14/2016

My son, [redacted by FDA], committed suicide [redacted by FDA] 2016 by a self-inflicted gunshot wound in [redacted by FDA]. He wrote suicide notes stating he killed himself because [redacted by FDA] ruined his eyes from a PRK procedure (a type of LASIK eye procedure) and thus ruined his life. My son, [redacted by FDA], was [redacted by FDA]. He was pursuing his college degree at [redacted by FDA]. His career was in petroleum engineering. He had had a problem with depression in his early teens, but had been stable without problems until after his deployment to fight in [redacted by FDA]. [redacted by FDA] had an uncomplicated LASIK surgery through [redacted by FDA] approximately 5 years ago, in 2010, with eventual deterioration of his vision in [redacted by FDA] 2015. He had a PRK procedure [redacted by FDA] 2015, by Dr. [redacted by FDA]. He had a minimal history and physical prior to the procedure. There was no information on my son's diagnosis of ptsd, anxiety, learning disability, or depression. There was no identification of the medications he was taking. Post procedure, he experienced persistent eye pain, dry eyes, and eventually loss of his eyesight to 100/20. His loss of his vision in [redacted by FDA] 2015, resulting in him not being able to visualize adequately to continue his classes and he was unable to obtain employment for his loss of vision. He repetitively saw Dr. [redacted by FDA] who continued "conservative management", despite my son deteriorating psychologically. His post operative care included a physician antagonistic to my son, with no referral to another physician, to blaming the patient for the complication, and ultimately the patient feeling hopeless and suicidal. This eye laser complication placed my son in economic distress and immediately resulted in deterioration psychologically. He wrote suicide letters stating he was killing himself due to his ruined eyes by Dr. [redacted by FDA]. I am a board certified ob/gyn, which includes board certification as a surgeon. I am horrified at the LASIK false promotion of a "safe procedure", when, in reality, lives have been destroyed with medical physicians placing monetary gains over the health care of patients. After my horrific loss of my son from his loss of vision from this PRK, LASIK procedure of his eyes, i have been even more horrified of the complications and suicides related to loss of vision from elected LASIK procedures, the devastations to lives that have incurred complications, the common complications not declared to patients, and the scant medical awareness of the patients by the physicians prior to these procedures. Link to report

Active duty serviceman files PRK injury report with the FDA - 3/25/16

I had PRK surgery on both eyes in 2001 while on active duty, [redacted by FDA]. Had to undergo it several months later due to scarring. Noticed I had to wear sunglasses at all times after that and my night/low light vision was greatly diminished. Started getting migraine headaches. Symptoms progressed till in [redacted by FDA] 2011 I woke up in the emergency room of an apparent seizure. This occurred again in [redacted by FDA] 2012 and I was then diagnosed with seizure syndrome. My left eye lid sticks to my eyeball at night which triggers the seizure and causes extreme pain in that eye and a migraine headache. My short term memory is worsening. I am now on blood pressure meds. I have lost my job due to this. Even with the seizure meds I sometimes have painful nightly episodes of these side effects.

Link to report

Jean's story - PRK scarring 3/27/2015

I got PRK Sept of 2014. When I asked the doctor about any complications he said well, the procedure may not correct your vision and you'll have to be fitted for glasses. I thought well I'll give it a go.

Now 6 months later my last check up I have found that my Corneas scared. I can hardly see and absolutely cannot drive, Everything has a halo.

Worst of all I am a big cat trainer as in Lions and Tigers. My life working with them is over unless my eyes improve.

My doctor said in all his years nothing like this has ever happened to him. He has me using steroid eye drops hoping to retard the scaring.

Please think twice before you let this happen to you. If I can't see then I can't work with my big cats. I was told contacts, or glasses are not a option and that there was nothing he could do for me.

Email from a reader of this website 11/2/2014

I'm 26 and I got PRK a month ago. I hade -2 myopia with no astigmatism. I have severe corneal haze that makes my vision like with 3D glasses on. That's a nightmare. They're saying it's gonna get better but it can take months, years. I regret this surgery and wish I had a time machine! My only reward right now is saving people from making the biggest mistakes of their lives!

Military serviceman files injury report with FDA - 8/12/2014

I had PRK refractive surgery done in [redacted by FDA] 2012. I have been diagnosed with photophobia. Ever since I have had to use sunglasses pretty much all the time during day time, in sun light, artificial light, during night time, and while driving. I went to my ophthalmologist, and he said that he has never seen a situation like mine. I experience eye pain like a sharp knife stabbed me in my eyes when exposed to light for short periods of time. After exposure for around two hours I start to experience a migraine type headache that obligates me to shut down and take a 2 hour sleep along with at least 800 milligrams of Ibuprofen to get rid of the pain. My military career is being seriously affected. My time and activities with my wife and children are being affected. I am forced to wear dark sunglasses all the time, indoors and outdoors. I have read of multiple similar cases like mine after LASIK/PRK and other eye surgeries. I sometimes take off my sunglasses just to confirm that I am not imagining things, but after a few seconds there is the pain again. I think that the FDA really needs to pay attention to this matter and study or suspend this procedure until it has been further studied.

Link to injury report

PRK surgery nightmare - Emailed to webmaster of LasikComplications.com 8/16/2011

Excerpt: "No one could tell me for sure that the double vision would go away along with the star bursts and blurring. So I stressed out and eventually became depressed and had to be hospitalized and go on medication... In 2010 I noticed that I had flickers of light in my corrected left eye so I visited my eye doctor who said he saw a tear in my retina... The surgery at the time was probably a couple of thousand dollars for one eye, but the cost of the treatment for acute depression and time lost at work was over $10,000, so this was a costly choice and a life lesson."

Read full story

Permanent grounding of a USAF pilot following photorefractive keratectomy

Davis RE, Ivan DJ, Rubin RM, Gooch JM, Tredici TJ, Reilly CD.
Aviat Space Environ Med. 2010 Nov;81(11):1041-4.

INTRODUCTION: Photorefractive keratectomy (PRK) has been extensively studied in the literature and its potential application in aircrew has not gone unnoticed. Complication rates following corneal refractive surgery (CRS), including PRK and laser in-situ keratomileusis (LASIK), remain low, with most patients achieving improved uncorrected visual acuity and reduced spectacle dependence. Overall, predictability, low complication rates, high rate of success, stability, and safety have all been cited as instrumental in the adoption of PRK in aviators. Consequently, the U.S. Air Force (USAF) approved PRK for aviators in August 2000. However, quality of vision outcomes following CRS remain a concern given the unique visual performance requirements in military aircrew, especially in austere operational environments.

CASE REPORT: This paper will present a recent case of steroid-induced ocular hypertension that is believed to have precipitated non-arteritic anterior ischemic optic neuropathy (NA-AION) associated with reduced visual performance following PRK that resulted in the first permanent grounding of a USAF pilot following CRS.

DISCUSSION: CRS has radically widened the aircrew applicant pool and has decreased spectacle dependence in war-fighters. Despite the low-risk profile of modern CRS, this case demonstrates the potential for poor outcomes from such elective surgery. Understanding these rare, but potentially devastating complications and the unique aeromedical risk factors in aircrew is paramount when considering elective vision-enhancing surgery.

More adverse outcomes of PRK reported to the FDA

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.CFM?MDRFOI__ID=3628055

I got PRK surgery when I was in the Air Force and I regret it. It's been 5 years and my eyes constantly hurt and are super dry. When I wake up and my eyes open, it feels like I opened them in chlorine water. I think they are getting worse some days I cannot touch the lid of my left eye. What is worse is still need glasses so all that pain and difficult post-op pain was for nothing. Prior to my surgery, I spoke to a fellow airman who had warned me but I thought it must have been a unique situation and didn't listen to her, so I know I’m not the only one. Now I’m constantly using eyedrops and taking eye vitamins to see if that helps and it does but only so much. The drops help with the dryness, but not the pain. When a group of us were getting the surgery that day, I remember being in a room and being handed a bunch of papers, liability forms I’m sure, and not being explained anything; that day I remember asking if we had to option to getting lasik and I was told no very rudely. I was not at any point explained of the possibility life long effects of PRK.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/detail.cfm?mdrfoi__id=2381345

I had PRK surgery [redacted] 2011 at the [redacted]. I was told I would be back to work 6 days later with close to corrected vision. I came back for my four day check up, they took the contacts out of my eyes. I was told it would feel a little gritty for a couple of days. I didn't make it fifteen minutes down the road and I felt like I had razor blades underneath my eyelids. Being in the military, I manned up the best I knew how, put way more than prescribed numbing drops and took multiple narcotic pain pills. None of this worked. I got a hold of my surgeon and told him I would try and hold out until the next day. It was the worst pain I have ever experienced in my life. The next day I went down and they said my eyes had "sluthed. " they put the contacts back and for approx two more weeks, waiting for an 8mm abrasion on both of my eyes to heal up - the civilian ophthalmologist noticed these abrasions, right before my surgeon came and looked at my eyes, and overlooked them! the abrasions never healed up, so they patched my eyes for a week and a half a piece and the abrasions finally healed up, leaving behind a lot of scar tissue, which I am still dealing with now. I've been on a long dose of steroids and I am still tapering off of them, and yet the scarring still has not gotten any better. I volunteered for this surgery to make my life better, easier, and more mission ready for my certain career field in the [redacted]. It was placed to my understanding that this was a fairly quick and short term healing procedure. But I am supposedly one of the thousands of select people that this happens to. I was told that after the six month period from my surgery, if this scarring was not healed that I could opt for the surgery again or just deal with it.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1040892

I had prk lasik surgery. I now have a very high reading rx 3. 25 and still need mild rx for distance. I have severe dry eyes. I now need to use eye drops 4+x/day and need to have the tear ducts plugged. I also have to use restasis prescription drops 2x daily. I also am taking theratears nutrition omega-3 capsules daily for dry eye problems. I was told i would need reading glasses after this procedure, but the rx is very high. I only needed 2. 50 distance rx prior to surgery and no reading rx. I must tell you that i also work with the md that did my surgery and feel that i was not informed well. I know that i was over-corrected with this procedure. But i had much discomfort with the recovery. It has been over one year and i still have issues. I am distraught emotionally to accept the high dependency on the close vision needs. I no longer can see in the mirror clearly. I need glasses to see the food i am eating from my plate. It has been quite an emotional rollercoaster. I need my reading rx as well as magnifying mirror just to tweeze my eyebrows! this has been extremely upsetting as i know i will probably continue to need stronger reading rx help as i grow older. I did bring this to the attention of the management at my workplace, and they only responded "i guess you are just in the percentage of people that are not satisfied with the process. " how is that for an employee of this practice! i work for opticare.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1075441

The military used prk corrective laser eye surgery on both of my eyes, and my vision in my right eye has become blurry. I have difficulty reading emails on my laptop and cannot read the powerpoint presentations during class. At night, i see starbursts around lights which has made driving dangerous under these conditions.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1039122

I was overcorrected in my left eye as a result of wavefront prk with the visx excimer laser. Not only that i have, terrible side effects in both eyes -gash- which greatly affect my night vision and vision in low light situations. Mild dry eye is also problematic. For a procedure that was supposed to make my life easier, it has made it much more difficult and complex on a daily basis. I so very wish that i could go back to my vision with glasses. Not a day goes by that i am not reminded of the adverse events following my prk.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail.CFM?MDRFOI__ID=1293889

I had prk surgery on my eye to correct vision. I now suffer from severe dry eye problems. I was not properly screened or warned before this elective surgery

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.cfm?MDRFOI__ID=2541249

I had PRK performed last year. Fortunately, I did not have the pain that some have described post procedure, however, I had blurred vision for at least 6 months. Luckily I only had my left eye treated. There is no way I could have driven or performed my job had I had both eyes treated. Today, over a year post procedure, I have developed pain, redness, blurred vision, and extremely watery eye. This procedure is barbaric, had I been better informed by the practitioner performing the procedure, or done more research about post-procedure complications, I doubt I would have undergone the procedure.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.cfm?MDRFOI__ID=2626288

I had bilateral PRK on (b)(6) 2010. I got laser surgery, in hopes that I wouldn't have to wear eye glasses, since I have worn corrective lenses since I was (b)(6). I didn't have trouble with night vision prior to the surgery and now since the surgery I do. Also, now I have dry eyes that require restasis twice a day and other lubricating eye drops as needed throughout the day. I occasionally have eye discomfort, also. I need to wear eye glasses, for driving. I have had three different pairs made since my surgery, due to vision changes. I was not aware these side effects would occur.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.cfm?MDRFOI__ID=1559401

Severe dry eyes after PRK surgery. To start off with, I am a physician in practice for 4 years and am well read and have a high level of medical understanding, and voluntarily chose to have PRK surgery. I was made aware of potential [side effects], but had no idea how bad they could be. Having never tried contacts, I spoke with a recommended ophthalmologist who recommended PRK, a similar procedure to lasik, and done with the same laser. I was excited at the idea of perfect vision -I now have 20/15 b/l vision-, and although I did read up on the procedure on the internet and the information he gave me, it seemed like a no-brainer. In retrospect, I feel the potential negative outcomes are downplayed but if you are one of those unlucky enough to get them, you'll wish you never had the surgery, as I do. So, the problem. I had the surgery in 2007 and severe pain afterwards for about 1-2 weeks. After that, things seemed to get better, but I did have dry eyes for the next six months. I thought and was led to believe that I was out of the woods when about 16 months later, in 2009, I had severe dry eyes in which my eyelids stuck to my eyeballs every time I would awake in the am. My corneas would get damaged from the epithelium being ripped off. This damage was confirmed on exam by my ophthalmologist. I want to be very clear here, in my entire life, had [no] problems with dry eyes, and there is no family history either. The next month or two were hell and I was literally afraid to go to sleep, dreading the excruciating pain I knew would come when I would wake. My doctor tried to say this had nothing to do with the surgery, and I think that this is ridiculous, and he eventually acknowledged the likely relationship. I ended up trying numerous different eye drops, including restasis, using a humidifier, sleeping without heat, having protective contacts placed on my eyes, and getting upper and lower plugs placed in my tear ducts. When the summer came, with the higher humidity, things were better, but now that the winter's here again, i'm again experiencing dry eyes. We did find one product that helped, and no i have nothing to do with the company that makes it- and I have to goop my eyes with this product every night to prevent my eyelids from sticking to my eyeballs, though thankfully this does work. I never reported this to the fda in the past, and don't know if my ophthalmologist did, but I would never recommend this surgery to anyone and certainly wouldn't have gone through with it if I knew this could happen. In addition, I think it was inappropriate for my surgeon to recommend the surgery before recommending that I try contacts, and I wonder how much of this has to do with the fact that he just bought the machine and is more than happy to cut on people's eyes if they're willing to pay, which I was. Mfr name, city and state: I don't know, but I don't think this is the issue. The problem is with the procedure, not the laser.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.CFM?MDRFOI__ID=1970111

Prk surgery. Never told of any possible dry eye complications. Have severe dry eyes. I do not believe I was ever tested for dry eyes. Not fully informed about the complications and risk. Was in waiting room to have lasik when an employee of office sitting beside of me was having PRK and talked me into having PRK instead of lasik. Nothing ever said to me about the possibility of dry eyes. Have plugs now and eyes still hurt and burn everyday. Prescription was around -4 and still way off from 20/20. Still need glasses, eyes hurt all the time, but i'm (b)(6) more poor. This is the biggest scam ever. Doctors are making a killing and never telling pts the real side effects. My doctor was dr (b)(6).

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/Detail.cfm?MDRFOI__ID=2626288

I had bilateral PRK on (b)(6) 2010. I got laser surgery, in hopes that I wouldn't have to wear eye glasses, since I have worn corrective lenses since I was (b)(6). I didn't have trouble with night vision prior to the surgery and now since the surgery I do. Also, now I have dry eyes that require restasis twice a day and other lubricating eye drops as needed throughout the day. I occasionally have eye discomfort, also. I need to wear eye glasses, for driving. I have had three different pairs made since my surgery, due to vision changes. I was not aware these side effects would occur.