If you want to reduce your dependence on glasses or contact lenses, LASIK may be the first procedure that comes to mind.
But LASIK isn’t the only option.
Today, we can choose from several excellent vision correction procedures, including LASIK, PRK, EVO ICL and refractive lens exchange (RLE).
One of the most common questions we hear at Wright Eye Center is:
“Which one is best?”
The answer depends on your eyes.
Your prescription, corneal shape and thickness, age, lifestyle, eye health and vision goals all play a role. Two patients with similar glasses prescriptions may ultimately be better suited for completely different procedures.
Here’s how the major options compare.
LASIK: Fast Recovery and Excellent Vision Correction
LASIK is the procedure most people associate with laser vision correction.
During LASIK, a thin flap is created in the cornea. An excimer laser then precisely reshapes the underlying corneal tissue to correct nearsightedness, farsightedness and/or astigmatism. The flap is repositioned at the end of the procedure.
Why Patients Choose LASIK
One of LASIK’s biggest advantages is its rapid recovery.
Many patients notice dramatically improved vision by the next morning and are able to return to many normal activities relatively quickly.
Other advantages include:
- Fast visual recovery
- Minimal discomfort for most patients
- Treatment of a broad range of prescriptions
- Excellent visual outcomes in appropriately selected patients
- Reduced dependence on glasses and contact lenses
However, LASIK isn’t right for every eye.
Corneal thickness, corneal shape, dry eye and other factors must be carefully evaluated before recommending surgery.
PRK: Similar Goal, Different Approach
PRK uses the same type of excimer laser used in LASIK to reshape the cornea.
The major difference is how we access the tissue being treated.
Instead of creating a LASIK flap, the thin surface layer of the cornea—the epithelium—is removed. The laser treatment is then performed directly on the underlying corneal surface.
The epithelium naturally grows back over the following several days.
Why Would We Recommend PRK Instead of LASIK?
Some patients are surprised when we tell them they’re a good candidate for laser vision correction—but that we recommend PRK instead of LASIK.
There are several reasons this may occur.
PRK may be preferable for certain patients with:
- Corneas that aren’t ideal for creating a LASIK flap
- Certain corneal thickness considerations
- Particular occupational requirements
- Lifestyle considerations involving a greater risk of direct eye trauma
- Previous eye surgery
The tradeoff is recovery.
PRK typically involves more discomfort during the first few days and vision takes longer to sharpen compared with LASIK.
The final goal, however, is very similar: excellent vision with reduced dependence on glasses or contact lenses.
LASIK vs. PRK: What’s the Biggest Difference?
For most patients, the biggest practical difference is recovery.
LASIK patients often see quite well very quickly.
PRK patients need more patience.
The surface of the cornea must heal, and vision can fluctuate as that process occurs. It may take several weeks or longer for vision to reach its final level of clarity.
That doesn’t make PRK an inferior procedure.
For the right patient, PRK may actually be the better choice.
We would rather recommend a slightly slower recovery if we believe it provides the better option for that patient’s individual eyes.
EVO ICL: Vision Correction Without Removing Corneal Tissue
EVO ICL takes a completely different approach.
Rather than reshaping the cornea with a laser, a thin implantable lens is placed inside the eye, behind the iris and in front of your natural lens.
Think of it somewhat like placing a permanent contact lens inside the eye rather than wearing one on the surface.
Who Might Benefit From EVO ICL?
EVO ICL can be an excellent option for patients with moderate to high levels of nearsightedness, particularly when laser vision correction isn’t ideal.
Potential advantages include:
- No removal of corneal tissue
- Excellent quality of vision
- Treatment of higher levels of nearsightedness
- Correction of astigmatism with toric models when appropriate
- The lens can be removed if necessary
For some patients who have spent years assuming their prescription is “too high for LASIK,” EVO ICL may open an entirely different path toward reducing dependence on glasses or contacts.
EVO ICL vs. LASIK
Neither procedure is universally better.
LASIK reshapes the cornea.
EVO ICL leaves the central corneal tissue intact and instead adds a corrective lens inside the eye.
That difference can make EVO ICL particularly attractive for certain highly nearsighted patients or patients whose corneal measurements make laser vision correction less desirable.
However, EVO ICL is an intraocular procedure, meaning surgery takes place inside the eye. It therefore has a different set of considerations and risks than LASIK or PRK.
The right recommendation comes from weighing those differences against the characteristics of your individual eyes.
What About Refractive Lens Exchange?
For some patients—particularly as they get older—LASIK, PRK and EVO ICL aren’t the only procedures worth discussing.
Refractive lens exchange (RLE) replaces the eye’s natural lens with an artificial intraocular lens, similar to what we do during cataract surgery.
RLE can correct distance vision while also addressing the age-related loss of near focusing ability known as presbyopia.
Different lens implants can provide different ranges of vision depending on the patient’s eyes and goals.
RLE isn’t the right procedure for every patient, and age alone doesn’t determine whether someone should have it. Your prescription, retinal health, natural lens, lifestyle and visual goals all need to be considered.
What About Patients Over 40?
Turning 40 doesn’t automatically make you too old for LASIK.
But something important begins happening around this age.
The natural lens inside the eye gradually loses its ability to focus up close. This is called presbyopia, and it’s why many people eventually need reading glasses.
LASIK can correct your distance prescription, but it doesn’t stop the natural aging process of the lens.
That’s why our conversation with a 25-year-old considering LASIK may be very different from our conversation with a 48-year-old.
Depending on the patient, options may include LASIK, monovision, PRK, EVO ICL, RLE or simply waiting.
Understanding what you want your vision to accomplish—both now and years from now—is an important part of choosing the right procedure.
How Do We Decide Which Procedure Is Right for You?
This is where a refractive surgery evaluation becomes important.
We don’t choose a procedure based on your glasses prescription alone.
We consider factors including:
- Your prescription
- Prescription stability
- Corneal thickness
- Corneal shape and health
- Dry eye
- Age
- Natural lens changes
- Retinal health
- Your occupation
- Sports and hobbies
- Your expectations
- Your distance and near vision goals
Advanced imaging can also reveal subtle findings that aren’t apparent during a routine eye examination.
Sometimes the answer is straightforward.
Other times, a patient may be a candidate for more than one procedure. In those situations, we’ll explain the advantages and tradeoffs of each option and help you decide which best fits your priorities.
A Surgeon’s Perspective: The Best Procedure Isn’t Always LASIK
Patients sometimes come into our office saying, “I want LASIK.”
That’s completely understandable. LASIK is by far the most recognized name in vision correction.
But our job isn’t simply to determine whether we can perform LASIK.
Our job is to determine what we should recommend.
If your corneal measurements make us more comfortable with PRK, we’ll tell you.
If you have a high prescription and we believe EVO ICL offers a better option, we’ll discuss that.
And if we don’t believe refractive surgery is appropriate for your eyes, we’ll tell you that too.
The best vision correction procedure isn’t the newest procedure or the most recognizable one.
It’s the one that makes the most sense for your individual eyes.
Frequently Asked Questions
Is PRK better than LASIK?
Neither procedure is inherently better. LASIK offers faster recovery, while PRK may be preferable for certain corneas, occupations or lifestyles. The better procedure depends on the individual patient.
Does PRK give the same vision as LASIK?
Both procedures use an excimer laser to reshape the cornea and can provide excellent visual outcomes in appropriately selected patients. PRK simply requires a longer healing process.
Is EVO ICL better than LASIK for high prescriptions?
EVO ICL can be an excellent option for patients with higher levels of nearsightedness. Whether it’s preferable to LASIK depends on the prescription, corneal measurements and other characteristics of the eye.
Can I have LASIK after age 40?
Yes. Many patients over 40 can still be candidates for LASIK. However, presbyopia and changes in the natural lens become increasingly important when determining the best vision correction strategy.
What if I’m not a candidate for any of these procedures?
Sometimes surgery isn’t the right choice. If we don’t believe a procedure can provide an appropriate balance of safety and benefit, we’ll recommend continuing with glasses or contact lenses rather than performing surgery simply because it’s possible.
Which Vision Correction Procedure Is Right for You?
You don’t need to figure that out on your own.
That’s what your evaluation is for.
At Wright Eye Center, we offer a complimentary vision correction consultation to determine whether you may be a candidate and discuss which options make the most sense for your eyes.
If you’d rather start online, you can also take our LASIK and PRK Candidate Quiz:
Take the Candidate Quiz:
https://wrighteye.com/am-i-a-canidate-lasik-prk/
Whether the answer is LASIK, PRK, EVO ICL, RLE—or no surgery at all—our goal is to help you understand your options and make a decision you’re comfortable with.