Researching Laser Eye Surgery can quickly become confusing. LASIK, SMILE Pro, PRK and LASEK all aim to improve the way light focuses inside the eye, but they do not all reach the treatment area in the same way.
PRK and LASEK belong to a group of procedures known as surface laser treatments. Unlike LASIK, they do not require the creation of a corneal flap. Instead, the thin outer layer of the cornea is moved or removed so that the laser can reshape the tissue underneath.
Although PRK and LASEK were developed before newer procedures, they remain valuable modern treatments. For certain corneas, prescriptions, occupations and lifestyles, a surface procedure may be the most appropriate recommendation.
The important point
PRK and LASEK are not lesser versions of Laser Eye Surgery. They take a different route to the same goal: carefully reshaping the cornea so that light can focus more accurately on the retina.
How does Laser Eye Surgery improve vision?
Clear vision depends on light being focused accurately on the retina at the back of the eye. This focusing process is influenced by several factors, including the length of the eye and the shape and optical power of the cornea.
When light does not focus correctly, it produces a refractive error such as:
- Myopia, where distant objects appear blurred
- Hyperopia, which can affect near and distance vision
- Astigmatism, which can cause blurred or distorted vision at different distances
Laser vision correction changes the curvature of the cornea, refining its focusing power and reducing reliance on glasses or contact lenses. The principal difference between the procedures is how the surgeon reaches the corneal tissue that needs to be reshaped.
Where does PRK/LASEK treatment take place?
A simplified view of the cornea
1. Epithelium
The thin, protective surface layer. It is removed in PRK or gently loosened and repositioned in LASEK.
2. Anterior stroma
The excimer laser applies a personalised correction to this area, precisely changing the curvature and focusing power of the cornea.
3. Deeper corneal tissue
The remaining corneal structure supports the treated surface. Its thickness, shape and strength are carefully assessed before surgery.
This is a simplified illustration and is not intended to represent the relative thickness of each corneal layer.
What is PRK Laser Eye Surgery?
PRK stands for photorefractive keratectomy. It was the first widely adopted form of modern excimer Laser Eye Surgery and has now been used successfully for several decades.
During PRK, anaesthetic eye drops are used before the surgeon gently removes a small central area of the corneal epithelium. This exposes the corneal tissue underneath.
An excimer laser then applies the personalised treatment, removing microscopic amounts of tissue to change the curvature of the cornea. Once the laser treatment is complete, a temporary bandage contact lens is placed over the eye to protect the surface while new epithelial cells grow across the treated area.
What is LASEK Laser Eye Surgery?
LASEK stands for laser-assisted subepithelial keratectomy. It is closely related to PRK and uses the same type of excimer laser to reshape the cornea.
The principal difference concerns the epithelium. During LASEK, the surgeon loosens the epithelial layer, traditionally with a specially prepared dilute alcohol solution, and moves it away from the treatment area. After the laser has reshaped the tissue underneath, the epithelial sheet is repositioned.
A bandage contact lens is then used to protect the cornea while the surface heals. In practical terms, the healing experience and eventual visual outcomes of PRK and LASEK are generally similar. Your surgeon will recommend the technique considered most appropriate for your eyes.
How are PRK and LASEK different from LASIK and SMILE Pro?
All these procedures can improve vision, but they access or reshape the cornea differently:
PRK and LASEK
Surface treatments that allow the epithelium to heal over the reshaped cornea. No corneal flap is created.
LASIK
LASIK uses a thin corneal flap to provide access to the treatment area. The flap is repositioned after the excimer laser correction, allowing a typically faster initial visual recovery.
SMILE Pro
SMILE Pro uses a femtosecond laser to create a precisely shaped piece of tissue, known as a lenticule, within the cornea. This is removed through a small access opening.
There is no single procedure that is best for every patient. The correct recommendation depends on detailed measurements of the cornea, prescription, eye health, age and intended visual outcome.
Who might be suitable for PRK or LASEK?
A surface procedure may be considered when avoiding a corneal flap offers a clinical or practical advantage. This can include patients with:
- Thinner or unusually shaped corneas: PRK or LASEK may be considered when the corneal measurements do not support a LASIK flap and the intended laser correction.
- An increased possibility of eye impact: Surface treatment can be useful for certain contact sports, physical occupations or activities where avoiding a flap may be preferable.
- Particular corneal surface conditions: In selected cases, superficial scars, recurrent epithelial problems or other surface irregularities may influence the treatment recommendation.
- Case-specific anatomical considerations: Previous treatment, corneal characteristics and prescription strength can all affect which procedure offers the most appropriate risk-to-benefit balance.
Having thin corneas does not automatically make somebody suitable for PRK or LASEK. The overall strength, regularity and health of the cornea must still be assessed carefully. A detailed suitability assessment is therefore essential.
What are the benefits of PRK and LASEK?
No corneal flap
Because surface treatment does not create a LASIK-style flap, it avoids considerations associated specifically with flap creation and future flap trauma.
A valuable option for selected corneas
A surface procedure can sometimes leave more corneal tissue available for the planned correction than a flap-based procedure. This may make it appropriate for some patients whose corneal measurements fall outside the preferred range for LASIK.
Well-established treatment
PRK has been performed for decades and is supported by extensive clinical experience. Modern diagnostic equipment, laser platforms and treatment planning have continued to refine the procedure since its introduction.
Comparable longer-term visual outcomes
PRK and LASEK usually take longer to settle than LASIK. However, when the correct procedure is selected for the correct patient, the eventual visual outcome can be comparable to that achieved with other forms of Laser Eye Surgery.
What are the limitations of PRK and LASEK?
Slower visual recovery
The epithelium needs time to heal across the treatment area. Vision is therefore usually blurred or variable during the first few days and may continue to fluctuate as the corneal surface becomes smoother.
More discomfort during early healing
Anaesthetic drops help to minimise discomfort during the procedure itself. However, patients can experience watering, grittiness, light sensitivity and soreness while the epithelium heals. This is generally most noticeable during the first few days.
A longer period before vision stabilises
Useful vision usually returns before the final result is reached. Clarity can continue to improve over several weeks or months, depending on the prescription, treatment profile and individual healing response.
Careful aftercare is essential
Prescribed eye drops, follow-up appointments and instructions concerning eye rubbing, water, make-up, exercise and UV exposure all play an important role in the recovery process.
What is recovery after PRK/LASEK like?
A gradual recovery, not an overnight result
The first few days:
The surface begins to heal beneath the bandage contact lens. Blurred vision, watering and light sensitivity are expected during this stage.
Around the first week:
The clinical team checks the healing epithelium and advises when the bandage lens can be removed. Vision will usually be improving but may still fluctuate.
The following weeks:
Everyday vision becomes progressively clearer. Some patients may notice temporary dryness, glare, halos or variation throughout the day.
The following months:
Visual quality continues to refine as the corneal surface and prescription stabilise.
You must not drive immediately after treatment. Surface laser patients may require a week or longer to reach the required driving standard, although individual recovery varies. Driving should only be resumed once your vision is legally sufficient and your clinical team has confirmed that it is safe.
How does London Vision Clinic select the right procedure?
The recommendation is based on far more than the glasses prescription alone. Our clinical team examines the shape, thickness, regularity and optical performance of the cornea, alongside the health of the eye and the patient’s lifestyle.
Advanced diagnostic technology allows the surgeon to evaluate different layers and regions of the cornea in detail. These measurements help determine whether PRK, LASEK or another procedure is most likely to provide a safe, stable and effective result.
This means that PRK or LASEK will only be recommended when the clinical evidence indicates that surface treatment is the appropriate option for that particular patient.
Are PRK and LASEK still good Laser Eye Surgery treatments?
Yes. Their longer history should not be confused with lower quality. PRK and LASEK remain effective, well-understood procedures with an important place in modern refractive surgery.
The principal compromise is a slower and less comfortable initial recovery. For a patient whose corneal structure or lifestyle makes surface treatment preferable, that temporary inconvenience may be worthwhile.
Whichever procedure is recommended, following the prescribed recovery plan and attending every review are crucial. London Vision Clinic provides structured post-operative care to monitor healing, visual stability and eye comfort throughout the recovery period.
Which Laser Eye Surgery procedure is right for you?
The answer depends on your prescription, corneal measurements, eye health and lifestyle. A comprehensive assessment allows our clinical team to explain the suitable options clearly.
Speak to one of our clinic coordinators or book a consultation to begin your suitability assessment.
