Contact Sports, Physical Jobs and Laser Vision Correction: When PRK Is the Safer Choice

This article is for educational purposes only and is not medical advice. Please see the full disclaimer at the end.

Most people choosing between LASIK and PRK are weighing comfort and recovery time. If your sport or your job puts you at real risk of being struck in the face, there is a more important question: whether you want a corneal flap in your eye for the rest of your career.

Key points

• LASIK and PRK give the same long-term vision. LASIK recovers in about a day; PRK takes about a week.
• LASIK creates a thin flap in the cornea. It heals, but it is never quite as strong as untouched tissue, and a hard, direct blow can shift it, even years after surgery.
• PRK does not use a flap, so there is nothing to dislodge.
• For fighters, wrestlers, rugby players, police officers, firefighters and members of the military, PRK is usually our recommendation. For most other active people, LASIK works well.

How the two procedures differ

Both procedures reshape the cornea with the same excimer laser, the Alcon WaveLight Allegretto. What differs is the first step.

LASIK: A femtosecond laser (the WaveLight FS200) cuts a thin hinged flap. The surgeon folds it back, applies the excimer treatment to the tissue beneath, and lays the flap down again. Because the flap seals within a few hours, vision is usually good by the following morning.

PRK: The surgeon gently removes the epithelium, the thin layer of skin-like cells on the surface of the cornea, and applies the treatment directly to the surface. The epithelium regrows over a few days. No flap is made.

Why a flap matters if you get hit

A LASIK flap heals at its edge, but it does not regain the full strength of the original cornea. In ordinary life that makes no difference. Rubbing your eyes, or a grandchild's hand bumping your face, will not move a healed flap. A forceful, direct impact can: a punch, an elbow, a stick or a ball at close range. That can happen many years after surgery.

Flap displacement from trauma is not common, and when it is repaired quickly, most patients recover good vision. Still, it is an urgent problem that requires another procedure. After PRK, it simply cannot occur.

Where do your activities fall?

Being active is not the issue. The real question is how often something hard is likely to strike you near the eye.

• Frequent blows to the face. We usually recommend PRK. This includes boxing, MMA, jiu-jitsu and other martial arts, wrestling, rugby and any full-contact training. It also includes work in which being hit is a realistic risk: law enforcement, corrections, firefighting and military service.
• Some contact. It depends on you. Sports like basketball, soccer, lacrosse, ice hockey, water polo, tennis and squash fall here. Recreational players who wear protective eyewear often do very well with LASIK. Competitive athletes, or anyone with a thin cornea, may be better off with PRK. A careful evaluation is especially valuable for this group.
• Little or no contact. LASIK is generally a good choice. Running, cycling, swimming, hiking, skiing, golf, yoga and weight training rarely involve a blow to the eye. Many local trail runners and cyclists have had LASIK with no issues, and for them the quicker recovery usually tips the balance.

Plan for the next couple of decades, not only for the current season. If you might take up a martial art or are considering a career in law enforcement, mention it at your evaluation.

Military and police applicants: before surgery, look up the current vision-surgery policy for your branch or department. Some list which procedures are acceptable or set a waiting period before training. Please bring a copy of any written policy to your visit.

The cost of PRK: a slower first week

PRK's safety benefit for contact athletes comes with more downtime. Here is a typical course:

1. First three days. This is the hardest stretch. A soft bandage contact lens covers the eye while the surface heals. Expect a gritty feeling, watering and sensitivity to light; prescription drops and pain medicine keep you comfortable. Your vision will be blurry, but you will be able to move around.
2. Days four through six. The surface has closed over, and we remove the bandage lens at a follow-up appointment. Many people go back to office work at this stage.
3. Two to eight weeks. Vision continues to sharpen as the surface becomes smoother, and anti-inflammatory drops are reduced gradually over several weeks.

With LASIK, most people have a few hours of mild irritation and see well enough to function the next day. For athletes, the timing of PRK matters more than the recovery itself. Book it during the off-season or between fight camps rather than just before a competition. Some people choose to treat one eye at a time, while others would rather go through recovery once.

Returning to training

Every recovery is a little different, and Dr. Feiz will tell you at your follow-up visits when you are cleared. In general:

• Easy cardio, like walking or riding a stationary bike, is usually allowed within a few days after either surgery. Keep sweat from running into your eyes.
• Pools, hot tubs, lakes and the ocean should wait until the surface of the eye is completely healed. That is usually about two weeks after LASIK and a bit longer after PRK. Natural bodies of water carry a higher risk of infection than a chlorinated pool.
• Sparring and contact sports usually wait around a month. When you return, wear protective eyewear or headgear if your sport permits it.
• Athletes who train outdoors after PRK should wear UV-protective sunglasses for several months while the cornea finishes remodeling.

An important reminder about eye protection

Laser vision correction, of either kind, does not strengthen the eye. A hard impact can still injure the retina or fracture the bones around the eye after any procedure. Choosing PRK eliminates one specific risk, the flap, but not the risk of eye injury in general. If your sport offers protective eyewear, keep using it.

Other things that can change the recommendation

Sometimes the measurements of your cornea decide the matter regardless of your activities. A thin cornea, subtle irregularities on corneal mapping, or dry eye (which sun and wind can aggravate) all point toward PRK.

At our practice LASIK and PRK are priced the same, and both include 12 months of follow-up care and any enhancement you need. Price never influences which procedure we suggest. We recommend the one that is safer for your eyes and the life you lead.

Preparing for your evaluation

Your free LASIK evaluation is done by Dr. Feiz himself and covers whether LASIK or PRK suits you. Be ready to tell him about all the sports you play or hope to try, your occupation, how much time off you can take and when, and any military or department rules about vision surgery. Surgery is performed at InVision Laser Center in Concord, and follow-up visits are at our office in Walnut Creek.

Quick answers

Can a healed LASIK flap really move years later?
Rarely, but yes, after a hard and direct blow. Prompt repair usually restores good vision. This cannot happen after PRK.

I am a runner and cyclist. Should I have PRK?
Probably not. These activities seldom involve a blow to the eye, and LASIK is usually a good fit. Your corneal measurements have the final word.

Will I see as well after PRK as after LASIK?
Yes. The final vision is equivalent. PRK just takes longer to recover from.

Is PRK more expensive?
Not at our practice. Both procedures cost the same and include a year of follow-up and enhancements.

Questions?

If you play a contact sport or have a physical job and want to know whether LASIK or PRK is right for you, call Eye Care of East Bay at (925) 705-7299 or contact us online to request a free LASIK evaluation.

Medical Disclaimer

This article provides general educational information only. It is not medical advice, diagnosis or treatment, and reading it does not create a doctor-patient relationship with Eye Care of East Bay or any of its physicians. Every eye is different, and the right choice for you depends on a full eye examination.

Do not delay seeking professional care, or make decisions about surgery or medications, based on what you read here. Talk with a qualified eye care professional about your own situation. If you have sudden vision loss or another emergency, call 911 or seek immediate medical care.