What's better, LASIK or older techniques?

NEW YORK (Reuters Health) - Are you concerned that the photorefractive keratectomy your doctor recommended to fix your eyesight won’t be as effective as LASIK surgery?

You can rest easier: A new study suggests that people who have their nearsightedness corrected with either LASIK or photorefractive keratectomy, a slightly older laser technique, typically fare well long term.

Both LASIK and photorefractive keratectomy, or PRK, correct nearsightedness by using a laser to reshape the cornea, the transparent membrane that domes over the pupil.

The techniques involved in the two procedures do differ, however, and since it was introduced in the 1990s, LASIK has become the more common procedure. LASIK patients generally have quicker visual improvement and less pain after the procedure compared with those who undergo PRK, which came into use in the late 1980s. Although surgeons’ charges vary widely - depending, for example, on where you live -- they tend to be similar for the two procedures.

However, PRK is still the better option for some people, because it does not require as thick a cornea, Dr. Jorge L. Alio, the lead researcher on the new study, told Reuters Health in an email.

To see how patients tend to fare long-term, Alio and his colleagues at Miguel Hernandez University in Alicante, Spain, followed 65 patients who had undergone either LASIK or PRK.

The researchers found that, 10 years after surgery, most patients had visual acuity of 20/40 or better, without corrective lenses. And most showed relatively little change in their vision over the years, according to findings published in the British Journal of Ophthalmology.

LASIK patients did have somewhat better results, however -- as well as lower odds of needing a repeat procedure.

Among LASIK patients, 85 percent of the treated eyes had 20/40 vision or better after 10 years, compared with 74 percent among PRK patients.

Before surgery, about 97 percent of patients in both groups had had 20/40 vision or better with corrective lenses.

Of PRK patients, 35 percent required a repeat procedure to achieve their sharper vision, versus 18 percent of those who underwent LASIK.

As far as safety, no patient had a serious sight-threatening problem over 10 years, Alio’s team found. PRK patients had more trouble with hazy vision three months after the procedure -- a known disadvantage of PRK -- but within the year, most recovered the visual acuity they had had with corrective lenses, and remained stable after that.

Potential complications of both laser procedures include dry eyes, double vision, glare and scarring of the cornea. Since they are elective surgeries, patients are generally advised to carefully weigh the possible risks against the benefits before opting for either procedure.

The current findings, Alio said, should reassure patients on the general safety of PRK if that is the procedure recommended to them.

SOURCE: British Journal of Ophthalmology, October 2009.