What is PRK/LASEK? When Surface Laser Surgery is the Better Choice

Laser eye surgery is not a single procedure. It is a family of techniques, each with its own method, its own strengths, and its own ideal patient profile. LASIK and SMILE tend to dominate the conversation, largely because of their fast recovery times and widespread awareness, but there is a third category of laser vision correction that deserves far more attention than it typically receives. PRK and LASEK, collectively referred to as surface laser surgery, have been quietly delivering outstanding visual outcomes for decades, and for a significant group of patients, they are not just an alternative to LASIK or SMILE. They are the better choice.

Understanding why requires looking beyond the headlines of recovery time and digging into the clinical situations where surface laser surgery genuinely outperforms its more widely discussed counterparts. Dr Anesu Madikane offers both PRK and LASEK from her Pretoria practice, and her approach to recommending surface laser surgery is grounded in a thorough understanding of when it serves her patients best.

This guide explains what PRK and LASEK are, how they work, who they are most suited for, and what the experience of having surface laser surgery looks like from consultation through to full visual recovery.

What is PRK and How Does it Work?

PRK stands for Photorefractive Keratectomy. It was the first laser eye surgery procedure to receive widespread clinical adoption, predating LASIK by several years, and it remains a highly effective and relevant procedure today. Understanding how PRK works helps clarify both its strengths and the reasons why recovery takes longer compared to flap-based procedures.

In PRK, there is no flap and no internal lenticule. Instead, the thin outer layer of the cornea, known as the epithelium, is gently removed to expose the corneal tissue underneath. An excimer laser is then used to precisely reshape the corneal surface and correct the patient’s refractive error, in the same way that it does during LASIK. Once the laser treatment is complete, the epithelium regenerates naturally over the course of several days, gradually covering the treated surface as the eye heals.

Because the epithelium needs to grow back after PRK, the initial recovery period is longer and involves more discomfort than LASIK or SMILE. This is the trade-off that patients need to understand and accept when PRK is the recommended option. The visual outcome, however, is not compromised by this longer healing process. Long-term results with PRK are comparable to those achieved with LASIK and SMILE in terms of visual acuity, precision, and stability.

What is LASEK and How is it Different from PRK?

LASEK, which stands for Laser-Assisted Sub-Epithelial Keratectomy, is a refinement of PRK that was developed to address some of the discomfort associated with the original surface ablation technique. The two procedures are closely related and are often grouped together when discussing surface laser surgery, but there is a meaningful difference in how the epithelium is handled.

In LASEK, rather than removing the epithelium entirely as in PRK, a very dilute alcohol solution is used to loosen the epithelial cells, which are then carefully moved aside as a thin sheet rather than discarded. After the excimer laser has completed the corneal reshaping, this epithelial sheet is repositioned over the treated surface. A soft bandage contact lens is then placed on the eye to protect the surface and support healing while the epithelium reattaches.

The distinction between PRK and LASEK is relatively subtle in practice, and the two procedures produce very similar outcomes. The choice between them is typically made by the surgeon based on the individual characteristics of the patient’s corneal epithelium and their clinical judgement about which approach will produce the most comfortable and efficient healing process. In many cases, the terms are used interchangeably in patient-facing communications, which is why they are so frequently discussed together.

Who is Surface Laser Surgery Best Suited For?

This is the heart of the matter, and it is where the value of PRK and LASEK becomes most clear. Surface laser surgery is not simply a fallback option for patients who cannot have LASIK or SMILE. In several important clinical scenarios, it is the procedure of choice from the outset.

Patients with thinner corneas are one of the clearest examples. Both LASIK and SMILE require a certain amount of corneal tissue to work safely. LASIK requires enough tissue to create a flap and still leave an adequate residual stromal bed underneath. SMILE has its own tissue requirements. PRK and LASEK, by contrast, treat the corneal surface directly and do not require the creation of a flap or internal lenticule, which means they can be appropriate in cases where corneal thickness would rule out the alternatives.

Patients who are involved in contact sport or who work in occupations with a high risk of physical impact to the eye are also well-served by surface laser surgery. Because PRK and LASEK involve no flap whatsoever, there is no risk of flap-related complications from impact, making them a genuinely safe long-term choice for athletes, military personnel, and those in physically demanding professions.

Patients with certain corneal surface irregularities or epithelial conditions may also be better candidates for surface laser surgery, as the direct access to the corneal surface allows for more tailored treatment in some cases. Additionally, patients who have previously undergone LASIK and are considering an enhancement procedure may find that PRK is the most appropriate route depending on the condition of their existing flap.

The Recovery Reality: Setting Honest Expectations

It would be doing patients a disservice to discuss PRK and LASEK without being straightforward about the recovery experience. Surface laser surgery has a longer and more involved recovery than LASIK or SMILE, and patients who choose this route need to go in with clear and realistic expectations.

In the first two to three days after PRK or LASEK, it is common to experience meaningful discomfort, light sensitivity, and blurred vision. The eye is essentially healing an open surface, and during this period a bandage contact lens is worn to protect the epithelium as it regenerates. Antibiotic and anti-inflammatory drops are used consistently throughout this phase, and pain relief may be recommended for the first day or two.

By the end of the first week, the epithelium has typically regenerated and the bandage lens is removed. Vision at this stage is usually functional but not yet at its sharpest. The visual recovery with PRK and LASEK is more gradual than with LASIK, and it is normal for vision to continue improving over a period of four to six weeks, and in some cases up to three months, as the cornea fully stabilises and the surface smooths out completely.

Patients considering PRK or LASEK need to plan for this recovery window and ensure they have adequate time off work and away from visually demanding tasks in the first week following surgery. Dr Madikane will give you a detailed and personalised recovery plan based on your procedure and your individual healing characteristics.

Long-Term Outcomes: Does the Longer Recovery Pay Off?

Absolutely. The extended recovery associated with PRK and LASEK can make patients understandably cautious, but the long-term visual outcomes are consistently excellent. Multiple decades of clinical evidence confirm that surface laser surgery delivers results that are comparable to LASIK and SMILE in terms of final visual acuity, predictability, and long-term stability.

For patients who are not suitable candidates for LASIK or SMILE, PRK and LASEK do not represent a compromise. They represent the most appropriate path to the same destination. Thousands of patients worldwide, including high-level athletes, pilots, and military personnel, have undergone surface laser surgery and gone on to achieve outstanding, lasting vision correction.

The absence of a flap also means that patients who have had PRK or LASEK do not need to carry any long-term concern about flap integrity. There is nothing to dislodge, nothing to shift, and no structural element of the cornea that remains permanently altered in the way a LASIK flap does. For patients who value that simplicity and security, it is a meaningful long-term advantage.

Surface Laser Surgery: Quietly Exceptional, Consistently Overlooked

PRK and LASEK may not generate the same level of buzz as the newer flapless procedures, but they have earned their place in modern refractive surgery through decades of reliable, high-quality results. For the patients who need them most, they are not a second-best option. They are precisely the right tool for the job.

If you have been told previously that you are not a suitable candidate for LASIK or SMILE, or if you are simply exploring all of your options before making a decision, a consultation with Dr Anesu Madikane will give you a clear and honest picture of where surface laser surgery fits into your vision correction journey.

Book your free assessment with Dr Anesu Madikane at Linton’s Corner Retail Park, Equestria today and find out which laser eye surgery procedure is genuinely the right one for your eyes. 

Frequently Asked Questions

Is PRK still relevant now that LASIK and SMILE exist?

PRK is absolutely still relevant and is performed regularly by specialist ophthalmologists around the world. While LASIK and SMILE are appropriate for the majority of laser eye surgery candidates, PRK remains the procedure of choice in specific clinical situations, including thin corneas, contact sport participation, and certain corneal surface profiles. Its long-term outcomes are comparable to both LASIK and SMILE, and it continues to be a highly effective and trusted procedure.

Will I need time off work after PRK or LASEK?

Yes, and planning for this in advance is important. Most patients require at least five to seven days away from work following PRK or LASEK, particularly if their role involves significant screen time, reading, or visually demanding tasks. Patients in manual or outdoor roles may need slightly longer. Dr Madikane will discuss your specific work situation during your consultation and help you plan your recovery window accordingly.

Can PRK treat astigmatism?

Yes. PRK and LASEK are both able to correct myopia, hyperopia, and astigmatism, much like LASIK. The excimer laser used in surface ablation is the same technology used in LASIK, and it is equally capable of addressing astigmatism as part of the treatment. The suitability of PRK for your specific prescription will be confirmed during your pre-operative assessment with Dr Madikane.

How do I know if PRK or LASIK is better for me?

The answer to this question is determined by your assessment, not by a general preference. Dr Madikane will evaluate your corneal thickness, topography, prescription, lifestyle, and eye health to determine which procedure is clinically most appropriate for you. In some cases, both procedures are viable options and the decision involves weighing recovery time against other clinical or lifestyle factors. In other cases, the assessment will clearly indicate that surface laser surgery is the right and safest choice.