Can PRK Surgery Fix Astigmatism?
If you have astigmatism and you’re frustrated with blurry, distorted or inconsistent vision, you might be wondering whether PRK surgery can fix it. Many people assume that astigmatism is “too complicated” for laser correction or that LASIK is the only option. The truth is that PRK is one of the most successful and reliable treatments for astigmatism even for people who aren’t suitable for LASIK due to thin corneas, dry eyes or lifestyle factors.
As someone who has spoken to countless people exploring vision correction, I know how confusing it can feel when you’re trying to understand whether your specific eye prescription can actually be treated. Astigmatism often sounds complex, and you might worry that it reduces your chances of achieving clear vision. In this guide, I’ll walk you through exactly how PRK fixes astigmatism, what results you can expect, who makes an ideal candidate and how PRK compares with LASIK for astigmatism correction.
What Is Astigmatism and Why Does It Affect Vision?
Astigmatism occurs when the cornea or lens of the eye is shaped irregularly, more like a rugby ball than a perfectly round football. This uneven curvature prevents light from focusing precisely on the retina, causing blurred or distorted vision at all distances. Unlike simple short-sightedness or long-sightedness, astigmatism affects both near and far vision simultaneously, making everyday tasks more challenging.
Common symptoms include blurry vision, ghosting or double images, difficulty discerning fine details, eye strain, headaches, and poor night vision. People with astigmatism may also experience squinting, frequent rubbing of the eyes, or fatigue during prolonged reading or screen use. These symptoms can significantly impact daily life, from reading and driving to using digital devices.
Astigmatism is extremely common and often occurs alongside other refractive errors such as short-sightedness (myopia) or long-sightedness (hyperopia). It can be present from childhood or develop later in life, sometimes changing gradually over time. Early detection and correction are key to preventing eye strain and maintaining clear, comfortable vision.
If left uncorrected, astigmatism can also affect depth perception and visual clarity in complex environments, such as night driving or high-contrast tasks. Corrective options include glasses, contact lenses, and laser eye surgeries like PRK or LASIK, which reshape the cornea to provide precise focusing and long-term visual improvement.
How PRK Corrects Astigmatism
PRK corrects astigmatism by using a highly precise excimer laser to carefully reshape the cornea, addressing the uneven curvature that causes blurred or distorted vision. Astigmatism occurs when the cornea is shaped more like an oval than a perfect sphere, causing light to scatter instead of focusing sharply on the retina. PRK smooths and regularises this shape so light enters the eye in a cleaner, more controlled way.
The treatment works through the following steps:
Removing the surface layer of the cornea (epithelium): The surgeon gently removes the thin, outer epithelial layer, giving the laser direct access to the corneal tissue below. This layer naturally regenerates over the following days.
Applying a customised laser pattern to reshape uneven curvature: The excimer laser is programmed to your exact prescription and corneal measurements, allowing it to precisely target the irregular steep or flat areas that create astigmatism.
Creating a smoother, more symmetrical corneal surface: By refining the surface and evening out its curvature, PRK eliminates the inconsistencies that cause scatter, blur, ghosting, and other visual distortions.
Allowing light to focus correctly on the retina: With a more regular shape, the cornea bends incoming light evenly, bringing it to a single, sharp focal point at the retina. This dramatically improves clarity at all distances.
Overall, PRK enhances vision by directly fixing the structural irregularity responsible for astigmatism rather than just compensating for it with glasses or contact lenses. The result is clearer, sharper, and more stable vision especially in low light or when viewing fine details.
Why PRK Is So Effective for Astigmatism
PRK is particularly effective for treating astigmatism because it reshapes the cornea directly without creating a corneal flap. By working on the surface layer of the cornea, the laser can precisely correct the irregular curvature that causes light to scatter, improving focus and visual clarity.
This flap-free approach offers several advantages. The laser can treat a wider area of the cornea, ensuring a more uniform correction, and there is no risk of flap-related distortion or displacement, which can occasionally occur with LASIK. This makes PRK a safer option for patients with irregular or thin corneas.
Results from PRK are highly stable over time, providing long-lasting correction for both mild and moderate astigmatism. Many surgeons prefer PRK for patients who may not be ideal candidates for LASIK due to corneal thickness, high-risk lifestyles, or other anatomical considerations.
Overall, PRK’s surface-based technique allows for precise, durable, and reliable correction of astigmatism, giving patients clearer vision and reducing the risk of long-term complications associated with flap-based procedures.
How Much Astigmatism Can PRK Correct?
One of the most common questions about PRK is how much astigmatism it can safely and effectively correct. Modern PRK techniques can accurately treat up to around 4.00 dioptres of astigmatism, which covers the majority of mild-to-moderate cases. In some instances, higher levels of astigmatism may also be treated depending on detailed corneal mapping and the surgeon’s assessment.
For patients with very high or irregular astigmatism, PRK can still be effective, though it may require more specialised approaches. Techniques such as topography-guided PRK or wavefront-optimised PRK allow the laser to precisely target corneal irregularities, improving both clarity and visual quality.
In certain cases with extremely high prescriptions, surgeons may recommend a combined approach performing partial PRK correction while supplementing with lens-based solutions to achieve the best visual outcome.
Ultimately, your suitability for astigmatism correction with PRK depends on factors such as corneal thickness, curvature, and stability. A thorough eye assessment ensures that the procedure is safe, effective, and tailored to your individual needs.
Success Rates of PRK for Astigmatism Correction
The success rates for PRK in correcting astigmatism are highly encouraging. Studies and clinical experience show that 90–98% of patients achieve 20/20 or 20/25 vision following the procedure, reflecting excellent precision and reliability.
In addition, 95–99% of patients attain vision sharp enough to meet legal driving standards, allowing them to return to daily activities confidently and safely. Most patients also experience a significant reduction in visual distortions, ghosting, and blur, with over 96% reporting noticeable improvements in clarity and comfort.
These outcomes are comparable to those achieved with LASIK, demonstrating that PRK is an effective, long-term solution for astigmatism even for patients who may not be ideal LASIK candidates due to thin corneas or high-risk lifestyles.
Overall, modern PRK provides predictable, durable results, making it a trusted choice for precise correction of astigmatism and enhancement of overall visual quality.
What Happens During PRK Surgery for Astigmatism? (Step-by-Step)
PRK surgery for astigmatism is a precise, flap-free procedure that reshapes the cornea to improve how light focuses on the retina. Unlike LASIK, PRK does not involve creating a corneal flap, making it a safer option for patients with thin corneas or those at risk of eye trauma. Understanding the step-by-step process can help you know what to expect before, during, and after the surgery.
Epithelium Removal: The first step in PRK is the removal of the epithelium, the thin outer layer of the cornea. This layer naturally regenerates, so removing it temporarily exposes the corneal surface for precise treatment. Surgeons can remove the epithelium using a gentle alcohol-based solution, a soft brush, or a laser. The choice of method depends on the surgeon’s technique and the patient’s specific corneal characteristics. This step is crucial because it ensures that the excimer laser can reshape the cornea accurately without interference from the surface layer.
Laser Reshaping: After the epithelium is removed, an excimer laser is used to reshape the cornea. For patients with astigmatism, the laser is guided by detailed mapping of the eye to target the exact axis of the irregular curvature. It works by flattening steeper areas, steepening flatter areas, smoothing asymmetric curves, and aligning the angle of astigmatism. This precision is what allows PRK to correct both simple and complex refractive errors. The laser energy is delivered in tiny pulses, removing microscopic amounts of corneal tissue, which gradually changes the way light focuses on the retina.
Bandage Contact Lens Placement: Once the corneal reshaping is complete, a soft bandage contact lens is placed on the eye. This lens acts as a protective layer while the epithelium regenerates, reducing discomfort and supporting healing. The lens also helps stabilise the corneal surface, preventing irritation from blinking and providing a smoother recovery experience. Patients are usually advised to keep the lens in place for several days until the surface layer has sufficiently grown back.
Healing Phase: The healing phase of PRK is longer than LASIK because the epithelium needs time to regenerate, which usually takes 3–5 days. During this period, vision can be blurry or fluctuating, and mild discomfort or light sensitivity is common. Over the next few weeks, vision gradually improves as the cornea stabilises and the surface becomes smooth. Full visual clarity often develops within 1–3 months, with final results visible by 3–6 months in most cases. Although the recovery is slower, this gradual healing contributes to long-term corneal strength and stability, making PRK particularly suitable for patients with thin corneas or those at risk of trauma.
Expected Results After PRK for Astigmatism
PRK offers patients a substantial improvement in visual clarity, particularly for those with astigmatism. Most people notice significantly clearer distance vision, with sharper edges and finer detail throughout their field of view. The procedure also reduces common astigmatism-related issues such as distortion, ghosting, and visual “halos,” while enhancing night vision, which can make driving, reading signs, or performing tasks in low-light conditions much safer and more comfortable.
In addition to improved clarity, PRK often reduces eye strain, headaches, and fatigue associated with uncorrected astigmatism. Everyday activities, including reading, computer work, or playing sports, become easier and more comfortable, allowing patients to perform at their best without relying on glasses or contact lenses. Many patients describe a noticeable improvement in visual sharpness and comfort during their first week after surgery.
Although some initial blur or fluctuation in vision is normal during the early recovery period, the cornea gradually stabilises as the surface layer regenerates. Vision continues to improve over the following weeks, with most patients achieving near-final results by around three months.
Overall, PRK provides reliable, long-term correction of astigmatism. With consistent follow-up and adherence to post-operative care, patients can enjoy decades of clearer, sharper vision and a dramatic enhancement in daily visual performance, making it an excellent choice for both routine life and high-demand activities.
PRK vs LASIK for Astigmatism: Which Is Better?
While both PRK and LASIK effectively correct vision, PRK offers distinct advantages for certain patients. Factors like corneal thickness, eye surface health, lifestyle, and prescription complexity can make PRK the safer or more effective choice. Understanding who benefits most helps patients and surgeons select the procedure that delivers optimal long-term results.
Thin Corneas: PRK is often the safer choice for patients with thin corneas because it preserves more corneal tissue compared with LASIK, which requires creating a flap. By avoiding the flap, PRK maintains corneal strength and reduces the risk of complications, making it ideal for patients who may not be suitable for LASIK due to tissue limitations.
Dry Eyes: PRK generally causes fewer dry eye symptoms than LASIK because it disturbs fewer corneal nerves during the procedure. Patients who already experience mild dryness often tolerate PRK better, and long-term comfort is usually higher once the cornea has fully healed.
Athletes or Military Personnel: For individuals involved in high-impact activities, PRK is often recommended. Because it does not create a corneal flap, there is no risk of flap displacement during contact sports or physically demanding occupations. This makes it particularly suitable for rugby players, boxers, martial artists, and military personnel, who need stable, reliable vision even under extreme conditions.
Irregular Corneas: Patients with irregular corneal surfaces can benefit from topography-guided PRK, which allows surgeons to reshape the cornea with exceptional precision. This customised approach targets surface irregularities and improves visual clarity in cases where standard LASIK may not be as effective.
Very High Astigmatism: LASIK can sometimes struggle to correct very high or oblique astigmatism. PRK, on the other hand, can accommodate wider custom laser patterns, making it a better option for patients with complex astigmatic prescriptions. By carefully mapping and reshaping the cornea, PRK achieves precise correction even in challenging cases.
Who Is an Ideal Candidate for PRK for Astigmatism?
You may be an ideal candidate for PRK if you have regular astigmatism that needs correction and healthy corneas capable of withstanding the laser procedure. A stable prescription is also important, as it ensures long-lasting results and reduces the likelihood of needing enhancements later.
Patients without major eye diseases, such as glaucoma or retinal disorders, are better suited for PRK, as these conditions can complicate both the procedure and recovery. PRK is particularly beneficial for those with dry eyes or thinner corneas, since it avoids creating a flap, which could exacerbate these issues in LASIK.
Your lifestyle is another key factor. Individuals who engage in high-impact sports, work in dusty or hazardous environments, or have jobs where eye safety is critical often benefit from PRK’s flap-free, durable approach. A comprehensive pre-surgery eye exam will confirm your suitability and help your surgeon tailor the procedure to your specific needs.
Common Concerns About PRK for Astigmatism
Many people considering PRK for astigmatism have questions about how the procedure works and what to expect during recovery. Common concerns include whether astigmatism can be fully corrected, the risk of it returning, the duration of blurry vision, and the possibility of needing enhancement procedures. Understanding these issues can help patients set realistic expectations and feel more confident about choosing PRK for their vision correction.
Will PRK fix my astigmatism completely? In most cases, PRK can fully correct mild-to-moderate astigmatism, providing clear and stable vision. The precision of the excimer laser allows surgeons to reshape the cornea accurately along the axis of astigmatism, improving focus and reducing distortion. Patients with standard levels of astigmatism usually achieve excellent results after healing.
Will my astigmatism come back? For the majority of patients, the corneal reshaping performed during PRK is permanent, and astigmatism does not return. However, changes may occur if your prescription was previously unstable, if you develop age-related vision changes, or if you experience trauma to the eye. Regular follow-ups with your optometrist can help monitor and maintain long-term vision stability.
Is vision blurry longer with astigmatism? Patients with astigmatism may notice more visual fluctuations during the first few weeks after PRK compared with those who only have myopia or hyperopia. This is a normal part of the healing process, as the cornea gradually smooths and stabilises. Vision typically improves steadily as the epithelium regenerates and the corneal surface settles.
Will I need a PRK enhancement? Enhancements after PRK are rare but possible, usually required for patients with high astigmatism, unusual corneal curvature, or individual healing variations. When an enhancement is needed, success rates are very high, and most patients achieve excellent visual outcomes following the additional treatment.
How Long Does It Take PRK to Heal with Astigmatism?
Recovery after PRK for astigmatism is a gradual process that requires patience, as the cornea regenerates and stabilises over several weeks to months. Unlike LASIK, where vision often improves rapidly, PRK involves the slow healing of the epithelium, which can lead to temporary fluctuations in clarity and light sensitivity. Understanding the typical timeline for each stage from the first few days of discomfort to the eventual achievement of stable vision helps patients prepare for the recovery process, manage expectations, and plan daily activities accordingly.
Here’s a typical healing timeline:
Day 1–3: During the first few days after PRK, it is normal to experience discomfort, light sensitivity, and blurry vision. The cornea is still healing, and the epithelium is regenerating, which can make vision fluctuating and slightly hazy. Patients are often advised to rest, use prescribed eye drops, and avoid strenuous activities.
Day 4–7: By the fourth to seventh day, most patients notice a gradual improvement in vision clarity. The bandage contact lens is usually removed around this time, and discomfort begins to subside. Daily tasks such as reading and screen use become more manageable, though vision may still fluctuate slightly.
Week 2–3: During the second and third weeks, vision continues to improve, and most routine activities become easier. Blurriness and light sensitivity generally decrease, allowing patients to resume work, moderate exercise, and daily life with greater confidence.
Month 1: By the end of the first month, the cornea has mostly healed, and vision sharpens considerably. Many patients notice clearer distance vision and reduced fluctuations, though minor adjustments may still occur as the cornea continues to stabilise.
Month 3: By around three months after PRK, final visual results are usually achieved. The cornea has fully regenerated, vision is stable, and most patients can enjoy crisp, clear sight without the need for corrective lenses for distance vision.
While the healing process for PRK may feel longer compared with LASIK, the procedure offers durable and highly reliable long-term results. By following post-operative care instructions, attending scheduled follow-ups, and being patient during the early stages of recovery, patients can achieve clear, stable vision that often eliminates the need for distance corrective lenses. With proper guidance and care, the gradual improvement in vision ensures both comfort and safety, making PRK a dependable choice for correcting astigmatism.
Does PRK Make Night Vision Better?
Yes PRK often leads to a noticeable improvement in night vision, especially for patients with astigmatism or those who previously struggled with low-light clarity. Because PRK reshapes the cornea with exceptional precision, it smooths out the irregularities that typically cause nighttime visual distortions.
Many patients report significant reductions in common night-vision issues such as:
- Starbursts around streetlights and bright signs
- Halos, which appear as glowing rings around headlights
- Ghosting or shadowed double images, especially when reading or driving at night
- Light sensitivity and glare, which can make night driving uncomfortable or unsafe
One of the biggest advantages of modern wavefront-guided PRK is that it corrects tiny, high-order aberrations in the eye that older techniques could not address. By improving the quality of the corneal surface and enhancing how light enters the eye, this advanced approach often results in sharper, clearer night vision than patients had before surgery even if their daytime vision was already good.
As healing progresses, most people notice steadier contrast, fewer visual disturbances, and greater overall comfort in dim or dark environments. For individuals who rely on night driving or frequently work in low-light conditions, this improvement can be especially beneficial.
Benefits of PRK for Astigmatism
PRK offers several advantages for patients with astigmatism, particularly those with unique corneal characteristics or concerns about long-term eye health. From preserving natural corneal structure to reducing the risk of dry eye and providing highly precise correction, PRK is a reliable option for achieving stable, clear vision. Understanding these benefits can help patients and surgeons determine if PRK is the right choice for their individual needs.
Long-term stability – No flap = fewer long-term issues.
Very high accuracy – Laser tech corrects both magnitude and axis.
Ideal for thin or irregular corneas – PRK treats more patients safely.
Natural corneal structure preserved – This is a major advantage over LASIK.
Less dry eye risk – Better for people with pre-existing dryness.
Limitations of PRK for Astigmatism
While PRK is highly effective for correcting astigmatism, it does have some limitations that patients should be aware of. Recovery is generally slower than LASIK, and the first few days or weeks can involve discomfort and fluctuating vision. Understanding these potential challenges helps set realistic expectations and prepares patients for the early stages of healing.
Slower recovery – You need patience in the first few weeks.
More early discomfort – Bandage lenses help, but discomfort is normal.
Vision fluctuates – Especially if you have moderate-to-high astigmatism.
Despite these short-term limitations, PRK offers excellent long-term results and stability, making it a reliable choice for many patients. With patience, proper post-operative care, and follow-up guidance from your surgeon, most individuals achieve clear, stable vision and enjoy the long-term benefits of a flap-free procedure.
FAQs:
- Can PRK fully correct astigmatism?
In most cases, PRK can completely correct mild to moderate astigmatism by reshaping the cornea so light focuses properly on the retina. The precision of modern excimer lasers allows surgeons to target the exact steep or flat meridians responsible for blurred or distorted vision. As long as the astigmatism is regular and your prescription is within the treatable range, patients typically achieve clear, stable vision after healing. - Is PRK as effective as LASIK for treating astigmatism?
Yes, PRK is just as effective as LASIK when it comes to correcting astigmatism. The difference lies mainly in the healing process, not the quality of the results. PRK reshapes the cornea from the surface, while LASIK reshapes it under a flap. Because PRK avoids the flap altogether, it often produces highly stable vision, especially for people with thin corneas, dry eyes, or active lifestyles. - How long does vision take to stabilise after PRK for astigmatism?
Healing happens in stages. During the first week, vision is usually blurry and gradually becomes clearer as the epithelial layer heals. Most people notice strong improvements by the end of the second or third week, but true stability takes a bit longer. By around the three-month point, the cornea has smoothed and strengthened enough for your vision to settle into its final, sharp result. - Does PRK hurt, especially for people with astigmatism?
The surgery itself is not painful because numbing drops are used, but some discomfort typically appears during the first few days afterward. This happens as the surface layer of the cornea regenerates. Patients often describe the sensation as gritty, sore, or light-sensitive, but the bandage contact lens provided after surgery helps make the early phase more manageable. The discomfort fades as the epithelium heals. - Will my astigmatism return after PRK?
In most cases, astigmatism does not return because PRK permanently reshapes the cornea. The only exceptions occur when someone had an unstable prescription prior to surgery, experiences age-related changes in the eye, or suffers an injury that affects corneal shape. For the vast majority of patients, results remain stable for many years. - Is PRK safe for high astigmatism?
PRK can safely treat higher levels of astigmatism, but suitability depends on individual factors such as corneal thickness and topography. Surgeons often use advanced versions like topography-guided or wavefront-guided PRK to treat complex or higher prescriptions. These approaches allow for more personalised laser patterns that create a smoother, more symmetrical corneal surface. Your specialist will base eligibility on detailed scans rather than the number alone. - How does PRK improve night vision for people with astigmatism?
Astigmatism often causes halos, glare, and starbursts in low light because light scatters instead of moving through a smooth, even surface. PRK improves night vision by eliminating the irregular corneal shape that creates these distortions. As the cornea becomes more symmetrical, the way light enters the eye becomes more controlled, reducing glow around lights and improving contrast. Many patients actually notice better night vision than they ever experienced with glasses or contacts. - Why is PRK recommended for people with thin or irregular corneas?
Because PRK does not require creating a flap, it leaves more corneal tissue intact. This makes it a safer choice for individuals whose corneas are naturally thin or whose shape is slightly irregular. Treating the surface also avoids the risk of flap complications that might occur with LASIK in such patients. As a result, PRK expands eligibility for vision correction to people who otherwise may not qualify. - Will I need an enhancement after PRK?
Enhancements are uncommon, but they can be necessary in certain cases. People with unusually high prescriptions, irregular corneas, or unpredictable healing patterns may need a minor touch-up to fine-tune clarity. Surgeons typically wait until vision has stabilised fully, which may take several months. When an enhancement is required, the success rate is very high and often completes the visual outcome. - Is PRK a good long-term solution for astigmatism?
PRK is considered one of the most stable long-term treatments available. Because it avoids cutting a flap, the cornea remains structurally stronger over time. This stability makes it a popular choice for athletes, military members, and anyone involved in high-impact activities. Once healing is complete, patients enjoy clear, reliable vision for many years with minimal risk of regression.
Final Thoughts on PRK for Astigmatism
PRK is a highly effective and stable long-term solution for correcting astigmatism, especially for those who may not be suitable for LASIK due to thin corneas, dry eyes, or active lifestyles. By precisely reshaping the cornea to address irregular curvature, PRK offers clearer vision, reduced distortion, and improved comfort in both bright and low-light conditions.
If you’d like to learn more about the procedure, you can explore our detailed page on PRK surgery in London, which explains how the treatment works and what results you can expect. If you’d like to find out whether PRK surgery in London is suitable for you, feel free to contact us at Eye Clinic London to arrange a consultation.
References:
- Roszkowska, A.M., Tumminello, G., Licitra, C., Severo, A.A., Inferrera, L., Camellin, U., Schiano-Lomoriello, D. & Aragona, P., 2023. One-Year Results of Photorefractive Keratectomy for Myopia and Compound Myopic Astigmatism with 210 nm Wavelength All Solid-State Laser for Refractive Surgery. J. Clin. Med., 12(13), p. 4311. Available at: https://www.mdpi.com/2077-0383/12/13/4311
- de Ortueta, D. & Arba-Mosquera, S., 2025. The Impact of Preoperative Corneal Epithelial Refraction Toricity on Transepithelial Photorefractive Keratectomy for the Treatment of Hyperopia or Mixed Astigmatism. Vision, 9(3), p. 57. Available at: https://www.mdpi.com/2411-5150/9/3/57
- Hashemi, H. et al., 2023. Vector analysis of astigmatism correction after PRK, FS-LASIK, and SMILE: one-year outcomes. Br J Ophthalmol. PMID: 37405568. Available at: https://pubmed.ncbi.nlm.nih.gov/37405568/
- Mimouni, M. et al., 2021. LASIK versus PRK for high astigmatism. Ophthalmology. PMID: 33751303. Available at: https://pubmed.ncbi.nlm.nih.gov/33751303/
- Peyman, A. et al., 2017. Astigmatic treatment with photorefractive keratectomy. Clin Ophthalmol, 11, pp.1225-1231. Available via PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463002/