Refractive Eye Surgery Options: Lasik vs Flapless PRK

When it comes to vision correction surgery, practically everyone has heard of Lasik. As more and more individuals are seeking surgical vision correction, “flapless” eye surgery is being talked about as a less risky Lasik alternative.

How do the procedures differ?

Both Lasik and flapless eye surgery procedures make use of an excimer laser during surgery. In Lasik, a hinged flap in the superficial, anterior region of the cornea is created through photoablation, or tissue vaporization via laser light. This flap is then lifted, allowing corneal sculpting to be carried out with the excimer laser according to prescription. The corneal epithelium flap is then repositioned, and surgery is complete.

Flapless eye surgery is known as PRK, or photorefractive keratectomy. It involves surface ablation by excimer laser. With PRK, the corneal epithelium is removed to allow for corneal sculpting rather than being repositioned. The epithelium begins to regenerate in approximately 3 days following surgery.

Both surgeries take just minutes and are ambulatory procedures. They are usually performed under topical anesthesia, although a mild sedative may be utilized. PRK and Lasik surgeries are both considered painless.

Does recovery vary by procedure?

Common side effects of either procedure include light sensitivity, excessive tearing, and some discomfort for 1 to 3 days. Eyedrops and medications are prescribed to help relieve discomfort. With PRK, a clear contact lens must be worn on the eye for several days while the corneal epithelium begins regeneration. Some visual distortions or blurring may occur for several weeks following Lasik or flapless eye surgery.

Most individuals can return to work or resume normal activity within 5 days of either procedure. It is commonly thought that Lasik procedures involve slightly faster recovery and faster vision correction than PRK. Both procedures are highly effective at correcting nearsightedness and farsightedness as well as astigmatism.

What complications can arise?

In by far the majority of cases, patients who elect to have either flapless eye surgery or Lasik surgery have no complications and are very happy with the correction in their vision. Complications are estimated to occur in from 1% to 5% of patients. Careful pre-surgical screening of potential candidates reduces the likelihood of complications to approximately 1%. Severe complications involving loss of vision are considered to be extremely rare.

Despite the odds, risks are involved with any type of refractive eye surgery. Consideration should be given to the very real possibility of experiencing any of the following or other complications:

• Dry Eye Syndrome


• Deterioration or loss of nighttime vision due to glare, starbursts, halos or double vision.


• Diminishing results over time.


• Partial or “incomplete” vision correction. Some patients still require glasses or contact lenses for vision correction after surgery.


• Loss of vision

What are “flap complications?”

Complications that arise in relation to the flap that is cut during Lasik also exist. Flapless surgery eliminates such complications, since no corneal flap is cut. Flap complications may occur if the flap is cut too thick or too thin. It may also wrinkle after it is replaced on the surface of the eye. Either complication can result in irregular astigmatism and can cause minor to severe visual distortions.

Another flap complication is Diffuse Lamellar Keratitis (DLK). This is also referred to as “Sands of the Sahara,” and involves the accumulation of dead cells beneath the corneal flap. Prompt treatment with antibiotics and/or steroids is required or temporary to permanent vision loss can occur. In some cases, surgery is required to remove this foreign matter.

Can I choose between the two procedures?

Some candidates are better suited to Lasik surgery, while for others PRK is more appropriate. Your doctor should perform an extensive pre-surgical screening assessment to determine which surgery is right for you. Consider the possibility that the surgery of your choice may not agree with your specific eye conditions. It is to the benefit of the patients that some candidates are declined eligibility for any refractive eye surgery procedure.