Photorefractive Keratectomy: Laser Eye Surgery Alternative Gains Prominance

Photo Refractive Keratectomy

Photorefractive Keratectomy, an alternative LASIK has shown better result in the case of Cindy Duong, who was suffering from nearsightedness.

Cindy Duong went to see her doctor for LASIK, however her doctor said to her that the cornea in her left eye was too thin to both cut the flap and contour her cornea, as LASIK (short for laser-assisted in situ keratomileusis) surgery requires. Instead, her doctor suggested she consider a procedure she'd never heard of: photorefractive keratectomy which doesn't entail a flap. Instead, the surgeon removes the very top layer of cells from the cornea, often by scraping them away after loosening them with alcohol, and then uses a laser directly on the exposed surface to shape it.

Duong had Photorefractive Keratectomy on her left eye and LASIK on her right. As expected, she noticed an immediate improvement in the vision in her right eye and felt no discomfort. Meanwhile, her left eye was irritated, and her vision was blurry for about a week. But then a funny thing happened. As the weeks passed, she noticed that her left eye caught up with and then surpassed the eyesight in her right eye. Her left-eye vision was slightly clearer, and she had fewer problems seeing at night.

"Now, my PRK eye is much better than my LASIK eye," says the 26-year-old chemist from Chicago. "At night, there's definitely a blurriness in my right eye more than my left."

Between 2005 and 2006, the percentage of all laser eye surgeries that were performed using PRK and other "surface ablation" techniques — in which tissue is ablated or removed from the surface of the eye rather than from the inside as it is with LASIK — rose from 8 percent to 13 percent, according to Market Scope, an ophthalmic research company. Meanwhile, the actual number of laser surgeries declined slightly during that time, from 1.41 million to 1.38 million.

"Surgeons today are doing a higher percentage of PRK than in the past, and their mix is changing," says Dave Harmon, president of Market Scope.

Two other surface-ablation techniques, LASEK and Epi-LASIK, are essentially newer versions of PRK. Instead of removing the very top layer or "skin" of the eyeball, they push it to one side and then replace it following laser surgery on the surface of the cornea. Research is inconclusive, but many experts say these newer techniques don't actually reduce the discomfort caused by the surface ablation.

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