What Happens During the PRK Consultation? | Lasik Awards

Quick Answer

A PRK consultation typically takes 1–2 hours and includes a complete eye examination, corneal topography and tomography, pachymetry (corneal thickness mapping), pupil measurement, dry eye assessment, and a consultation with the surgeon to review your candidacy and treatment plan. Dilation drops may be used. Most consultations are free of charge. By the end, you should know whether you are a PRK candidate, which procedure is recommended, and what outcomes to expect.

Detailed Explanation

The PRK consultation is the most important appointment in the entire surgical journey. It is where candidacy is determined, risks are discussed, expectations are set, and the clinical plan is formed. A rushed, superficial consultation is a warning sign. A thorough one is one of the most reliable indicators of a high-quality surgical program.

Here is what a complete PRK consultation includes, step by step.

Step 1: Medical History Review

The process begins with a detailed questionnaire and history review. The technician or surgeon will ask about:

Current glasses or contact lens prescription and duration
History of eye disease, injury, or prior surgery
Systemic medical conditions: Autoimmune disease, diabetes, and certain skin conditions (rosacea, eczema) can affect corneal healing and surgical candidacy
Medications: Isotretinoin (Accutane) is a contraindication to refractive surgery. Certain immunosuppressants and steroids affect healing.
Pregnancy or nursing status: Refractive surgery is not performed during pregnancy or nursing
Family history of corneal disease: Keratoconus has a genetic component; family history is relevant

Step 2: Manifest and Cycloplegic Refraction

Your glasses prescription is measured in two ways:

Manifest refraction: Standard subjective refraction (the “which is clearer, 1 or 2?” test) performed without drops.

Cycloplegic refraction: The same test performed after dilating drops that temporarily paralyze the focusing muscles of the eye. This reveals the true, unaccommodated prescription — particularly important in patients under 40 whose eyes can compensate for refractive error through focusing effort, masking the true prescription.

Both measurements together give the surgeon an accurate prescription baseline.

Step 3: Corneal Topography

Corneal topography maps the curvature of the anterior (front) corneal surface. The map reveals:

Overall corneal shape and symmetry
Presence of regular or irregular astigmatism
Signs of keratoconus or other corneal irregularities
Comparison between the two eyes

Topography is performed before any drops are administered to prevent artificial corneal surface changes. This is why contact lens wearers must discontinue lenses prior to the consultation — lenses reshape the cornea.

Step 4: Corneal Tomography (Scheimpflug Imaging)

Tomography goes beyond topography by imaging the full corneal thickness profile, including the posterior (back) surface. The Pentacam (Oculus) and Galilei (Ziemer) systems are common platforms.

Tomography detects:

Posterior corneal surface changes invisible to topography
Forme fruste keratoconus: Subclinical keratoconus that has not progressed enough to affect topography but represents an ectasia risk
Elevation patterns that help identify structurally at-risk corneas

Tomography is non-negotiable in a quality PRK consultation. If a clinic relies solely on topography without posterior corneal analysis, that is a standard-of-care gap.

Step 5: Pachymetry (Corneal Thickness Mapping)

Pachymetry measures corneal thickness at multiple points across the corneal surface, not just the center. This generates a full thickness map that reveals:

Central corneal thickness (the primary measurement)
Peripheral corneal thickness
Symmetry between the two eyes

The thickness data is combined with the planned ablation depth to calculate the residual stromal bed — the tissue safety margin that must remain after surgery.

Step 6: Pupil Measurement

Pupil size in low-light conditions determines the risk of post-operative halos and starbursts. Patients with large pupils (> 7 mm in dim light) are at higher risk for night vision disturbances after laser surgery. This does not necessarily disqualify them, but it informs the treatment planning and should be discussed explicitly.

Step 7: Dry Eye Assessment

Dry eye evaluation includes:

Slit lamp examination of the tear film and ocular surface
Schirmer’s test or phenol red thread test: Quantitative tear production measurement
TBUT (tear break-up time): How quickly the tear film thins after a blink
Meibomian gland evaluation: Dysfunctional meibomian glands are a common cause of evaporative dry eye

Patients with moderate to severe dry eye are not PRK candidates until the condition is treated and stabilized. Mild dry eye may be managed pre-operatively with artificial tears, lid hygiene, or punctal plugs before surgery is approved.

Step 8: Slit Lamp and Dilated Fundus Examination

A slit lamp examination assesses the health of the cornea, lens, and anterior chamber. A dilated fundus examination — using the cycloplegic drops already administered — evaluates the retina, optic nerve, and vitreous for any pathology that could affect visual outcomes or surgical risk.

Step 9: Surgeon Consultation

After diagnostics, you meet with the surgeon to discuss:

Candidacy determination: Are you a PRK candidate? If not, why, and what are the alternatives?
Recommended procedure: PRK, LASIK, EVO ICL, or a combination?
Expected outcomes: What is a realistic expectation for your prescription and corneal profile?
Risks and alternatives: Informed consent process begins here
Treatment plan details: Which laser platform, wavefront-guided or optimized, planned ablation depth
Pricing and financial options: Most clinics integrate this into the surgeon consultation or immediately after

For recognition of surgical programs that conduct thorough, rigorous PRK consultations, visit PRK Surgery Awards.

Important Considerations

Bring your glasses and any prior eye exam records. Your current prescription history helps the surgeon assess stability. Prescriptions that have changed significantly in the past year warrant further observation before proceeding.

Discontinue contact lenses before your appointment. Soft lenses: 2 weeks prior. Toric soft lenses: 2–3 weeks. Rigid gas-permeable lenses: 4+ weeks. Failure to do this can result in inaccurate measurements and a non-representative candidacy assessment.

The consultation is not a sales pitch. If the majority of your consultation time is spent with a financial counselor rather than a surgeon or technician performing diagnostics, the program’s priorities are misaligned.

Ask every question you have. You are making an elective, permanent decision about your vision. There are no inappropriate questions. A surgeon who dismisses patient questions is not a surgeon you should choose.

What to Do Next

1. Schedule consultations at two or three centers. Free consultations are standard. Compare the thoroughness of the diagnostic workup and the clarity of the surgeon’s recommendations.

2. Prepare your questions in advance. How Do I Find the Best PRK Surgeon includes a list of clinical questions to ask at the consultation.

3. Understand preparation requirements. How Do I Prepare for PRK Surgery covers everything you need to do before and after the consultation.