Can I Get PRK After LASIK? | Lasik Awards

Quick Answer

Yes. PRK is one of the two primary enhancement options after LASIK, alongside LASIK re-treatment (re-lifting the original flap). PRK is often preferred for LASIK enhancements because it avoids disturbing the existing flap and does not create additional flap-related risks. Eligibility depends on whether sufficient residual corneal stromal tissue remains after the original LASIK procedure.

Detailed Explanation

Vision regression or undercorrection after LASIK is not uncommon — estimates suggest 5–15% of patients experience enough change over time to consider an enhancement procedure. When that happens, the surgeon must choose between re-treating through the existing LASIK flap or performing PRK on the corneal surface. PRK is frequently the safer, more technically flexible choice.

Why PRK Is Often Preferred Over LASIK Re-Treatment

When LASIK was originally performed, a corneal flap was created — typically 90–120 microns thick. That flap has been in place for months or years. Re-lifting it for a LASIK enhancement carries specific risks:

Flap interface irregularities: Re-lifting disturbs the flap margin and interface, which can cause irregular astigmatism or interface haze.
Epithelial ingrowth: Cells can migrate into the interface during re-lifting and proliferate under the flap, causing visual disturbance.
Flap fragility over time: Older flaps — particularly those created with a microkeratome rather than a femtosecond laser — can be more difficult to lift cleanly and may have irregular edges.

PRK bypasses these issues entirely. The surgeon removes the epithelium from the corneal surface (outside the existing flap) and applies the laser directly to the surface stroma. The flap is not disturbed. No new structural vulnerability is created.

Tissue Availability: The Critical Factor

The primary eligibility criterion for PRK-after-LASIK is residual corneal tissue. The calculation works as follows:

Pre-LASIK corneal thickness: Usually available in the original surgical records
Tissue removed during LASIK: Flap depth (e.g., 110 microns) + ablation depth (e.g., 55 microns for -4.00 D)
Residual stromal bed (RSB) post-LASIK: Pre-LASIK thickness minus total tissue consumed
Additional ablation depth required for enhancement
RSB post-enhancement: Must remain above 250 microns (ideally 270+ microns)

If the math supports it, PRK enhancement is viable. If it does not — if the enhancement ablation would push the RSB below the safety threshold — surgery carries unacceptable ectasia risk.

Example: A patient had pre-LASIK corneas of 545 microns. LASIK consumed 165 microns (110 flap + 55 ablation). RSB post-LASIK: 380 microns. For an enhancement requiring 30 microns of additional ablation, post-enhancement RSB would be approximately 280 microns — within the acceptable safety range.

Contrast: A patient with pre-LASIK corneas of 500 microns, LASIK consuming 165 microns (RSB: 335 microns), requiring 60 microns of enhancement ablation — post-enhancement RSB would be approximately 225 microns. This is below the safety threshold. Surgery in this scenario would be declined by a responsible surgeon.

Timing of PRK Enhancement After LASIK

Surgeons generally require: 1. Stable refraction for at least 12 consecutive months. Performing an enhancement on a prescription that is still changing is counterproductive. 2. Thorough re-evaluation. A full new pre-operative workup — topography, tomography, pachymetry, dry eye assessment — is required before any enhancement decision. 3. Minimum time post-LASIK. Most surgeons prefer a minimum of 12–18 months post-LASIK before performing PRK enhancement to allow complete stromal healing and refractive stability.

The PRK Enhancement Experience vs. Primary PRK

PRK after LASIK is technically similar to primary PRK for the patient — epithelial removal, laser ablation, bandage contact lens placement, and the same recovery arc. However, patients who have previously had LASIK may notice:

Slightly longer epithelial healing due to prior corneal surface changes
Possibly more significant haze risk if the original LASIK removed substantial tissue — MMC is typically applied routinely
Comparable final outcomes to primary PRK when tissue availability is adequate

For surgeons recognized for excellence in PRK enhancements and complex refractive cases, visit PRK Surgery Awards.

Important Considerations

Your original surgical records are essential. Surgeons evaluating you for PRK enhancement need your pre-LASIK corneal measurements, your LASIK procedure details (flap depth, ablation depth, laser platform used), and ideally your post-LASIK topography series. Retain these records and bring them to any enhancement consultation.

Not all regression justifies enhancement. Minor regression producing a small residual prescription may be more sensibly addressed with spectacles or contact lenses than surgery — particularly if tissue availability is borderline. Enhancement surgery is elective, and the tissue consumed is not recoverable.

Contact lens use must be discontinued before re-evaluation. Contact lenses alter corneal shape. Before any enhancement evaluation, soft lens users should stop wearing lenses for at least 2 weeks; rigid gas-permeable lens users for at least 4 weeks.

Enhancement is different from a new procedure. If your original LASIK clinic has an enhancement policy covering the first procedure’s result, enhancement may be included in the original fee. Review your original surgical contract carefully before assuming out-of-pocket cost.

What to Do Next

1. Request your original surgical records. Contact the clinic that performed your LASIK — they are required to maintain records and provide them to you on request.

2. Schedule a re-evaluation. Bring your records to an experienced refractive surgeon who performs both PRK and LASIK enhancements. A new comprehensive workup is non-negotiable.

3. Confirm refraction stability. Get two refractions at least 6 months apart from a board-certified optometrist or ophthalmologist before pursuing enhancement.

4. Understand the PRK experience. If PRK is selected for your enhancement, the recovery is the same as primary PRK. How Long Does PRK Recovery Take gives the full timeline.