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Types of Laser Eye Surgery – Cost & Risks of PRK vs. LASIK vs. LASEK

By Heather Levin

woman eyeDo you wear glasses or contacts? If so, you might dream about getting laser eye surgery. The thought of crawling out of bed and just seeing, without putting on a pair of glasses, may seem tantalizing to anyone with poor vision. I was born with astigmatism, and I wore glasses for years. A few years ago, however, I made a dream come true: I had LASIK eye surgery.

There are a number of ways to save money on laser eye surgery. On average, it costs $2,500-$5,000 to have the surgery, and for me, LASIK eye surgery was worth the cost. The surgery provides you with substantial peace of mind. You can also factor in the cost savings associated with no longer needing glasses or contact lenses and annual eye doctor appointments.

Find the best deal on laser eye surgery by using these tips:

Tips for Saving on Laser Eye Surgery

  1. Travel Internationally. Traveling outside of the U.S. to have discounted surgery seemed far-fetched ten years ago. Today, “medical tourism” has attained widespread acceptance, and U.S. citizens routinely travel to other countries to receive discounts of 50% or more on laser eye surgery, including travel-related expenses and fees.
  2. Compare Prices. Different laser eye surgeons in your area charge different rates. Most laser eye surgery clinics offer a free visit to learn more about the procedure. Take the opportunity to learn more about the clinic’s rates, too
  3. Use Your FSA. Use your Flexible Spending Account (FSA) or your Health Savings Account (HSA) to pay for surgery. Using your pre-tax accounts can save you 30% or more off of the cost of the surgery.

Make sure that you get the full details about the total cost of the surgery upfront. Many laser eye surgery clinics advertise low prices, but the prices may only apply to patients with low prescriptions, and with no astigmatism. The advertised costs also may not include follow-up visits, and other fees associated with the surgery.

To help you decide if laser eye surgery is right for you, we’ve provided a breakdown of the three types of surgery, including overviews, information about effectiveness, and costs, for LASIK, PRK, and LASEK surgeries.

LASIK

There are several different kinds of laser eye surgery. Many people use the term “LASIK” to describe the general procedure. The three types of laser eye surgery have significant procedural differences, different costs, and varying levels of effectiveness. The three most common types of laser eye surgery are LASIK, PRK, and LASEK.

LASIK surgery is the most common and popular form of laser eye surgery available today. During LASIK (laser-assisted in-situ keratomileusis), a laser cuts a thin flap of tissue off your cornea, about 100-180 microns thick, which includes both the epithelial (outermost layer) and a portion of the stroma layer.

The flap, still connected to your cornea by a thin section of tissue, is lifted gently off. Then, the doctor reshapes underneath your cornea with a laser. This reshaping process allows you to see without glasses. Once the cornea has been reshaped properly by the laser, the surgeon sets the flap back down gently, where it heals into place.

Effectiveness

There’s a good reason why LASIK is so popular; it’s incredibly effective for most people. According to studies published in Science Daily, patients who use LASIK over PRK report faster healing times and faster vision recovery. After my own LASIK procedure, I could see the next day. Here in the U.S., surgeons have performed over 15 million LASIK procedures over the past decade, with a 95.4% satisfaction rate. LASIK also has a relatively low regression rate; NPR reports that only 5%-10% of patients need a touch up over time.

Risks and Downsides

However, there are risks associated with LASIK. If you experience a forceful trauma to your head, the flap of corneal tissue can become displaced, requiring immediate medical care and potentially causing long-term damage. This is fairly uncommon. Once the flap has healed in place, it should stay there for good. Many people also report dry eyes, which can be a permanent side effect of the surgery. Corneal nerve damage during surgery causes dry eyes.

Trouble with night vision is another common problem after surgery. Patients experience decreased night vision for several reasons:

  • Corneal swelling sometimes causes loss of night vision, which also includes seeing halos or “stars” at night.
  • Decreased night vision also occurs because the pupil dilates larger than the correction zone in your eye. Many patients experience a loss of night vision immediately following surgery, but it usually returns in the months after surgery.

There are more serious risks associated with LASIK. Cases of severe permanent damage such as corneal bulging, scarring, under or over correction, sensitivity to certain lights and, tragically, vision loss, do occur in a small percentage of patients.

If you need a surgery that gets you back on your feet in no time, then LASIK is a good option. Recovery time after the LASIK surgery is minimal; most people see an immediate correction in their vision, and start experiencing the full benefits of the surgery the very next day after surgery.

Cost

The cost of LASIK varies depending on where you go, but plan on spending $2,500-$5,000 for both eyes.

laser eye surgery

PRK

PRK stands for photorefractive keratectomy. The surgeon removes a very thin layer of corneal tissue, the epithelium, either using a laser, or by manually scraping it away using a thin knife and an alcohol solution. This removed tissue is much thinner than the flap cut with LASIK, as it does not include any part of the stroma.

Moreover, unlike other techniques, this thin piece of tissue is never replaced because epithelium can regenerate itself, thereby eliminating any risk of flap displacement. An excimer laser then reshapes the corneal surface, and when finished, the patient has a “bandage contact” put over the eye, which protects the eye as the epithelium regenerates itself, usually taking 3-4 days.

Effectiveness

The reason why some people opt for PRK is because there’s no risk of flap displacement. Also, because PRK only removes the epithelium layer, and not a portion of the stroma layer as well, the structure of the cornea isn’t as directly compromised and exposed as in LASIK, where doctors dig deeper into the eye’s surface. As a result, not only is this form of eye surgery ideal for patients who have a thin cornea, but the surgery also works well for military service members or people who engage in physical, high-impact sports. PRK is an excellent choice for athletes involved in martial arts or boxing, since there is no future risk of flap displacement.

Risks and Downsides

However, PRK is the most painful option due to the removal of the epithelium; patients usually experience pain and discomfort for several days following a PRK procedure. It also takes longer for your vision to recover with PRK due to the epithelial layer removal. You’ll typically have to wait a week or two before your vision returns fully, and some patients have to wait as long as 3-6 months before their vision returns.

Many patients have the PRK procedure on one eye at a time, to give the eye a chance to heal, and to ensure they have at least partial vision during the healing period.

Cost

The cost of PRK is similar to LASIK, $2,500-$5,000 for both eyes. You might end up spending more on PRK if you have to make several trips to the surgeon for follow-up appointments. Keep in mind that all laser eye surgeries are considered “elective” by health insurance companies, and you pay out of pocket for each visit to the doctor.

LASEK

Think of LASEK (laser epithelial keratomileusis) as the love-child of LASIK and PRK. This technique combines the benefits of both procedures, while lowering the risks of each.

With LASEK, the epithelium tissue is weakened with an alcohol solution, a procedure similar to PRK. Then, using a knife (not a laser, like in LASIK), the surgeon gently cuts and lifts back this thin flap of tissue. The flap’s thickness is about 50 microns thick (LASIK is 100-180 microns thick). A laser then reshapes the surface of the cornea, and the surgeon sets the epithelium back into place. Then, as with the PRK procedure, the patient has a “bandage contact lens” set into place until the epithelium has reattached to the eye.

It sounds a bit confusing, but the biggest difference between LASIK and LASEK is the thickness of the tissue that’s cut. In LASIK, the epithelium and a portion of the stroma layer are cut and lifted. In LASEK, as in PRK, the surgeon removes the epithelium layer only.

Effectiveness

Many people opt for LASEK because it seems less risky than LASIK, since the cornea has less direct exposure to the laser. LASEK, unlike PRK, also allows the patient to retain the epithelial layer, which can in turn help with the healing process.

LASEK is also a better choice for patients with a thin cornea than LASIK because LASEK requires a thinner cut of tissue. This makes it a better option for patients who already have dry eyes. Statistically, fewer patients experience dry eyes with the LASEK procedure than with LASIK. And just like with PRK, LASEK does not expose the cornea as much as LASIK.

Risks and Downsides

LASEK does have a longer healing time than LASIK, due to the time needed for epithelial reattachment, and because of added irritation caused by the alcohol solution. It typically takes 4-7 days to recover, and you’ll get full vision in 1-2 weeks.

This is often shorter than PRK’s recovery time, since it does not remove the epithelium altogether, which would otherwise require full regrowth of this layer. The decision to keep the epithelium, however, can increase the risk of minor flap complications in the future.

Cost

Like the other two procedures, the cost for LASEK costs $2,500-$5,000 for both eyes.

Additional Considerations

Will I Need Glasses?

You might be wondering, “If I have laser eye surgery, will I need glasses later on in life?” No matter what procedure you choose, the answer is most likely “yes.” Although these procedures effectively correct your vision right now, over time your eyes inevitably become less flexible.

This decrease in flexibility is what leads to presbyopia, the medical term used when you lose your ability to see close objects, like words on a page. This is simple biology. Thus, chances are high that once you hit 40 or 50, you’re likely going to need reading glasses, even if you choose to never undergo surgery. My dad, my aunt, my cousin, and I all had LASIK surgery through the same doctor. My dad and aunt, who are both over 50, need reading glasses. My cousin, who’s 40, is just starting to have trouble reading. I’m 32, and don’t need reading glasses at all, but likely will in the coming years.

Questions About Laser Eye Surgery

Many people have questions about the long-term effects after surgery:

  • Does one of these procedures have a better record for quality sight over the long-term?
  • Is one procedure less risky than the other procedures?
  • Which laser eye surgery is right for me?

Unfortunately, it’s impossible to give straight answers to these questions because everything depends on you. The thickness of your cornea and the level of correction you need are unique. Choosing the wrong procedure would greatly affect the success rate, and chance for short and long-term complications, which is why you should leave it up to your doctor to correctly screen you for the right procedure.

Final Word

Consider your lifestyle when researching different laser correction procedures. People who engage in sports, especially high-impact sports, are involved in the military, or have very active jobs, such as police or firefighters, need to carefully consider potential side effects and risks before they make a final choice about laser eye surgery.

Although PRK does involve more initial discomfort and a longer healing time than LASIK or LASEK, you might experience more peace of mind by going this route, since there is less chance that people with active lifestyles will experience complications with this procedure.

You should discuss all of the options for laser eye surgery with your eye surgeon, to make sure you find the right procedure for you. There’s no doubt that each laser eye procedure offers its own unique set of benefits and disadvantages. If you’re considering laser eye surgery, do your research before talking to your doctor. The more informed you are before you go in for your appointment, the better questions you’ll be able to ask.

Have you had LASIK, PRK, or LASEK eye surgery? What was your experience like, and how is your vision now?

(photo credit: Shutterstock)

Heather Levin
Heather Levin is a freelance writer based in Detroit, MI. She's passionately committed to living green, saving money, and helping others do the same in their life.

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  • http://GetOutOfDebt.org Steve Rhode

    I must admit I’m still not a fan of playing with the cornea hen there is no need. In my ophthalmology days I saw a number of people that had unfortunate results. But granted the people that had wonderful outcomes far outnumbered them. I just don’t want to be that person in the minority.

  • Merry

    I had PRK several years ago and it has changed my life for the better. I love not having to deal with contact lenses or glasses on a daily basis. I had to get PRK because my eyes were too ‘bad’ for the LASIK option, and LASEK wasn’t an option at the place I went to. My recovery time with PRK was longer than normal, and my eyes hurt a LOT and I was sensitive to light for a long time. However, I would go through it again in a heartbeat because having 20/20 vision today makes it totally worth it.

    • Brittany

      If you had been able to qualify for LASIK and had LASEK as an option also, do you think you would still have chosen PRK?

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