LASIK & PRK in Burbank & Greater Los Angeles

You already know what you want. Clear vision without a frame on your face or a lens on your eye. What you may not know is that "laser eye surgery" is not one procedure but two close relatives, and the difference between them often decides who gets which.

Both LASIK and PRK correct vision by reshaping the cornea, the clear, curved front window of the eye that does most of its focusing. An excimer laser removes microscopic amounts of corneal tissue to change its curvature, so light lands where it should: on the retina, in focus. Nearsightedness, farsightedness, and astigmatism all trace back to a cornea-and-eye combination that bends light slightly off the mark. Reshaping the cornea is how the laser brings it back.

The part worth sitting with is this. The surgery itself is well understood and highly refined; the thing that actually determines your outcome is whether your eyes were suited to it in the first place. Nearsightedness is the most common reason people seek correction, and it is becoming more common. In the United States, myopia prevalence increased 66 percent between 1971-1972 and 1999-2004, rising from roughly a quarter of the population. Most of those eyes are good candidates for laser correction. Some are not. The rest of this page is about the line between the two.

LASIK or PRK: what actually separates them

LASIK and PRK reach the same target by slightly different routes. The laser reshaping is essentially identical; what differs is how the surgeon gets to the tissue underneath.

• LASIK (Laser-Assisted In Situ Keratomileusis). A thin, hinged flap is created in the surface of the cornea and folded back. The excimer laser reshapes the tissue beneath, and the flap is laid back into place, where it seals without stitches. Because the surface heals over a protected bed, vision tends to clear quickly and comfort returns fast.
• PRK (Photorefractive Keratectomy). No flap. The thin outer layer of the cornea, the epithelium, is gently removed; the same laser reshapes the surface directly; and that outer layer regrows over the following days. The end correction is comparable to LASIK. The road there is longer and, in the first several days, less comfortable.

So why would anyone choose the longer road? Because for some eyes it is the safer one. PRK creates no flap, which makes it the preferred option for patients with thinner corneas, certain corneal surface conditions, or lives where a flap could be dislodged by impact, such as contact sports, military service, or physically demanding work. The flap is one of LASIK's real conveniences and also the reason it does not suit every eye. A surgeon trained specifically in cornea and refractive surgery is reading exactly this during your exam: not which procedure she would rather perform, but which one your particular cornea can safely tolerate.

One thing neither procedure does: touch the lens inside the eye. That means laser correction cannot prevent or treat a cataract later, and it does not stop presbyopia, the age-related loss of near focus that arrives in your mid-forties no matter how sharp your distance vision is. Those are different problems with different answers — we cover them on our refractive lens exchange and cataract surgery pages.

You may be a good candidate if…

No webpage can clear you for surgery; that takes a dilated exam and corneal measurements done in person. But candidacy for LASIK and PRK turns on a well-defined set of factors, and you can get a realistic read on yourself before you ever book a visit. You are more likely to be a candidate if most of these describe you:

• You are at least 18. The FDA sets 18 as the minimum age for laser vision correction, and many surgeons prefer to wait into the early twenties, because a prescription that is still drifting will quietly undo the result.
• Your prescription has held steady for about a year. Roughly twelve months of an unchanged prescription is the practical signal that your eyes have settled. Correct a moving target and you are back in glasses sooner than you should be.
• You are not pregnant or nursing. Hormonal shifts during pregnancy and breastfeeding can temporarily change both your prescription and your eyes' surface, so surgery is deferred until things return to baseline, usually a few months after.
• Your ocular surface is healthy and your eyes are free of active disease. Significant dry eye, infection, or an uncontrolled condition is addressed first. Laser correction is not performed on an eye that is already fighting something else.
• Your corneas are thick enough and regularly shaped. This is the one you cannot judge for yourself, and it is the most important. The exam includes detailed corneal mapping (topography) specifically to screen for keratoconus and other forms of corneal thinning or irregularity. Reshaping a cornea that is already structurally weak can trigger ectasia — progressive bulging and distortion that makes vision worse rather than better. Catching it is the entire reason the mapping is done, and a borderline result is a legitimate reason to steer toward PRK, or to advise against laser correction altogether.

Two honesty notes belong here. First, certain autoimmune and healing disorders, including lupus, rheumatoid arthritis, poorly controlled diabetes, and others that impair wound healing, call for real caution, because the cornea has to heal predictably for the correction to hold. Whether laser surgery is wise in your case is an individual judgment, not a blanket yes or no. Second, farsightedness behaves differently from nearsightedness. Correcting hyperopia with the laser is less predictable than correcting myopia, more prone to regress over time as the cornea reshapes itself slightly, and bounded by a lower practical ceiling. Past a certain degree of farsightedness, a laser is no longer the right tool, and a lens-based procedure becomes the better conversation. Neither is a reason to skip the exam. Both are the reason the exam has to be thorough.

The risks worth knowing before you decide

LASIK and PRK are among the most studied elective procedures in medicine, and most patients are glad they had it done. In one published series of refractive surgery patients, 91.2% reported being satisfied with their surgery. High satisfaction is not the same as no risk, though, and an elective operation on a healthy eye earns a plain accounting of what can go wrong.

• Dry eye. The most common side effect, especially after LASIK, because reshaping the cornea temporarily disrupts the nerves that signal tear production. For most patients it is mild and fades over weeks to a few months, managed with drops in the meantime. For a smaller number it lingers, which is one reason a pre-existing dry-eye problem is taken seriously before surgery rather than after.
• Glare, halos, and starbursts at night. Many patients notice rings or streaks around headlights and bright lights in the first weeks, particularly in dim conditions. These usually settle as the eye heals and the brain adapts. Occasionally some night-vision change persists, which matters most for people who drive a great deal after dark.
• Under- or over-correction, and the occasional enhancement. Sometimes the eye heals to a result slightly off the target, leaving a small residual prescription. When that happens and the eye is otherwise healthy, a second "enhancement" procedure can fine-tune it. It is uncommon, but it is real, and you should walk in knowing it is a possibility, not a promise of one-and-done.
• The serious-but-rare category. Flap complications after LASIK, delayed surface healing or haze after PRK, infection, and ectasia are all uncommon when candidacy is screened carefully, which is precisely why the screening is not a formality. The corneal mapping that rules out keratoconus is the single best protection against the worst outcomes.

The point is not to talk you out of laser correction. It is to make sure that if you choose it, you choose it clear-eyed, with the trade-offs on the table instead of buried in a form you sign on the way into the room.

What recovery actually looks like

This is where the two procedures part ways most noticeably, and it is worth setting expectations honestly, because the difference is real.

After LASIK, vision often clears remarkably fast — and the procedure itself takes only minutes per eye, the laser mere seconds. Many patients see well enough to function within a day or two, with some blur, light sensitivity, and a gritty feeling the first day that eases quickly. People frequently return to desk work within a couple of days, and vision keeps sharpening and stabilizing over the following weeks. After PRK, recovery is more gradual by design, because the outer corneal layer has to regrow. The first three to five days can be genuinely uncomfortable, usually managed with a bandage contact lens and drops, and vision is blurry while the surface heals. Many patients find their vision usable around a week in, then watch it keep improving over the following weeks to a few months as it settles to its final result. The destination is comparable to LASIK. The journey simply takes longer.

For both, line up a driver for the day of surgery, expect a schedule of medicated and lubricating drops, and keep from rubbing your eyes while they heal. The ranges above are typical, not promised; your surgeon will hold yours to your own cornea and tell you specifically when you are cleared to drive, return to work, and resume exercise.

The option we don't offer, and think you should know about

If your cornea is too thin for LASIK, or your prescription too strong, the honest answer is not always "PRK instead." Sometimes it is a different category of procedure altogether: the implantable collamer lens, sold as the EVO ICL.

An ICL is not laser correction. Nothing is reshaped and no tissue is removed. A soft, flexible lens is placed inside the eye, in front of your natural lens, through a small incision. Your own lens stays where it is — which is what separates it from refractive lens exchange, where the natural lens is taken out. Because the cornea is left alone, an ICL does not thin it, and it does not sever the corneal nerves that laser correction does. That matters for two groups in particular: people whose corneas are too thin to give a laser enough tissue to work with, and people who already have significant dry eye or an autoimmune condition that puts them at higher risk of it. It is also removable, which very little in refractive surgery is.

Dr. Tuli does not currently offer the EVO ICL. It is on this page anyway, because she asked for it to be. If it turns out to be the right operation for your eyes, she would rather you hear that at your exam — and be sent to a surgeon who performs it — than have it quietly left off the menu because we don't happen to sell it. A practice that only tells you about the procedures it offers is not giving you a choice. It is giving you a catalogue.

The judgment behind the laser

The excimer laser is a remarkable instrument, but it does only what it is told. The outcome you get depends far more on the decisions made before it ever fires: which procedure suits your cornea, whether your eyes are ready, and whether you should have laser correction at all. Those are surgeon's judgments, and they are where training shows.

Dr. Suhas Tuli is a board-certified, comprehensive ophthalmologist whose cornea-and-refractive fellowship training, at Johns Hopkins and USC, sits squarely on the part of the eye these procedures reshape. A member of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery, she has been recognized as a Castle Connolly Top Doctor. She is as ready to tell you that LASIK is not your best move as she is to perform it, because she trained at the level where a cornea's limits are read, not guessed.