Photorefractive Keratectomy

WHAT YOU SHOULD KNOW:

• Photorefractive keratectomy (ker-ah-TEK-to-me), also called PRK, is laser (high-energy light) surgery to correct refractive errors of the eye. Refractive errors of the eye are common eye disorders that cause blurring of vision (eyesight). These errors occur when there is a problem in the refraction (bending) of light in the eye. Refractive errors are often caused by having an abnormal shape and texture of the cornea. The cornea is the clear outer layer on the front of the eye. PRK may be used to treat refractive errors, such as astigmatism, hyperopia, and myopia. Astigmatism is a condition where there is an uneven (not smooth) and curved cornea. Hyperopia , also called farsightedness, happens when the eyeball is too short or the cornea is slightly flat or less curved. Myopia , also known as nearsightedness, happens when the eyeball is too long or the cornea is too curved or rounded.
  
  
• With PRK, the surface of the cornea is reshaped using an excimer laser. An excimer laser is a cold laser beam that uses ultraviolet light to change the front surface of the eye. Your caregiver precisely removes the epithelium (very thin layers of tissue) of the cornea with the excimer laser. Removing the corneal tissues changes the focus of the cornea so that light rays focus correctly. In nearsighted people, cornea that is too curved is flattened, while in farsighted people, a flat cornea is made more curved. PRK can also correct astigmatism by making the cornea smoother. By having a PRK, your vision may return to normal and you may get to see better without corrective lenses.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• PRK may have unpleasant side effects and carry some risks. You may have bleeding, infection, or eye injury during or after your laser surgery. This may lead to sudden or permanent loss of vision, and more eye surgeries. You may also have serious eye infections, or the cornea may take a long time to heal. Even after treatment, your vision could become worse than before the surgery. You may develop other eye problems, such as permanent glare, haze, halos, or dry eyes. Following your caregiver's advice may help prevent these problems.
  
  
• If PRK is not done, you may continue having trouble seeing things clearly or become blind permanently. This may prevent you from doing your usual activities, such as reading or driving. Your health, quality of life, and ability to function may decrease without treatment. Ask your caregiver if you are worried or have questions about your surgery, eye disorder, or care.

GETTING READY:

A few weeks before your surgery:

• Ask a family member or friend to drive you home after surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• If you wear contact lenses, your caregiver will tell you to stop wearing them one week before your eye check-up. For gas-permeable contacts, you must stop wearing them at least three weeks or more before your surgery.
  
  
• You may need to have blood tests taken. You may also need a series of eye tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before surgery.
  
  
• Avoid doing any of the following:
  
  
  • Wearing contact lenses the day of surgery. You may wear your glasses.
    
    
  • Wearing earrings, hearing aids, or bringing a pager or cell phone into the laser room.
    
    
  • Wearing eye make-up, perfume, or lotion on your face.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

• You will be taken on a stretcher to the operating room and then moved onto a special bed or chair. Your caregiver will place a series of drops into your eyes to get them ready for your surgery. These include antibiotic eye drops that help fight germs and prevent infection. Other drops will be used to numb your eyes to control pain and make you feel comfortable. Your eyelashes and the area around your eyes will be cleaned with a special pad. A sheet with a hole in the eye area to be corrected will be put over your face. This is done to keep the surgery area clean.
  
  
• During surgery, a speculum (eyelid holder) will be gently placed between your eyelids to keep your eyes from blinking. Your caregiver will then remove the epithelium of your cornea using a laser beam. Depending on your refraction error, he will use a computer to adjust the excimer laser. Your caregiver will tell you to look at the target light while he reshapes your cornea. It is important to keep your gaze fixated (focused) on the target light in order to get the best results. Once PRK is completed, additional antibiotic and pain eye drops will be given to help keep your eyes free from infection and pain. A special soft bandage contact lens may be placed over the eyes to help the epithelium heal.

After your surgery: You will be taken to a room where you can rest. Caregivers will watch you closely for any problems. When caregivers see that you are OK, you may be taken to your hospital room. You may also be able to go home following your surgery. Do not get out of bed until your caregiver says it is OK. A clean bandage or a protective clear plastic eye shield may be used to cover your eye. This may prevent you from rubbing your eyes or in case you get bumped accidentally.

Waiting room: This is a room where your family and friends can wait until you are ready for visitors. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

CONTACT A CAREGIVER IF:

• You have a fever (increased body temperature).
  
  
• You cannot make it to your appointment on time.
  
  
• You have an eye infection.
  
  
• You have questions or concerns about your surgery or condition.

SEEK CARE IMMEDIATELY IF:

• You feel a sudden, sharp pain in your eye.
  
  
• You suddenly lose your eyesight.
  
  
• Your eye problems become worse, such as seeing things more blurred.
  
  
• Your glasses got damaged or lost.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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