(RESOLVED!) Is Radial Keratotomy The Same As Lasik?

By using scleral lenses, we can help patients restore their vision. Scleral lenses are large contact lenses that rest on the sclera (the white of the eye) and protect the cornea with a fluid-filled vault 😎 At Miami Contact Lens Institute, we custom-make scleral lenses for each patient, fitting the lens to ensure the cornea is constantly hydrated and protected 😎 The fluid-filled tear reservoir helps compensate for irregularities on the surface of the cornea—including scars from RK incisions—thereby providing improved vision. Finally, because our lenses are permeable to oxygen, they are comfortable, leaving the patient with little to no irritation or sensation of having something in their eye. [1]
RK patients can be eligible for a photorefractive keratectomy (or PRK, a surgery similar to LASIK that corrects refractive errors) but LASIK may be challenging as the RK cuts do not do well with the LASIK flap. PRK can be very effective in reducing refractive error after RK, but at age 60, the best solution is likely either waiting for cataract surgery or having a refractive lens exchange (RLE). The latter is like cataract surgery in which the crystalline lens that forms into a cataract later in life can be exchanged for a corrective lens implant. A variety of implants are available to correct vision. Your eye surgeon can discuss which one is best for your eye. The bottom line is that there are options for correcting your vision despite having prior RK surgery. [2]
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Continuing on from the above, although LASIK has been described after RK,2-4 it runs the risk of fragmenting the flap during its manipulation or of vertical gas breakthrough when a femtosecond laser is used. PRK is thus a safer and simpler option. During the procedure, the surgeon can remove the epithelium via phototherapeutic keratectomy, the application of alcohol, or an Amoils brush (Innovative Excimer Solutions). Transepithelial phototherapeutic keratectomy ablates approximately 50 µm of epithelium prior to the refractive correction. Alcohol can be used in various concentrations and times; I apply 100% alcohol for 10 seconds. I also find the Amoils brush effective for epithelial removal, particularly with primary PRK, because the instrument preserves healthy peripheral epithelium, which allows for faster recovery. In PRK enhancement procedures, I apply 100% alcohol for 10 seconds and then use the Amoils brush. The latter must be applied lightly so as not to open the RK incisions, but I find this approach provides a smoother bed than manual epithelial removal. After completing the excimer laser treatment, I administer mitomycin C 0.02% for at least 12 seconds (Figure 1). (emended by Leonidas Stapleton on January 1, 2020) [3]
Then mitomycin came on the scene. It was designed and introduced to be used in PRK to lessen the incidence of haze. I use mitomycin in select cases and feel it has been an important addition to cases where surface ablation is the best choice and where haze is a significant issue. However, the long-term effects of mitomycin are still unknown. As such, patients deserve to know their options with regard to secondary refractive procedures, such as PRK and LASIK. When given the choice, some patients might choose to have the risk of a flap to lessen the risk of haze or a potential long-term mitomycin complication. Others, after learning about the risk of the LASIK flap, might choose to take the mitomycin route and go with the PRK procedure. As surgeons we should discuss the options fully with patients so they can make a well-informed decision about their options. (last emended 87 days ago by Pierson Maier from San Antonio, United States) [4]

Article References

  1. https://www.miamicontactlens.com/conditions/radial-keratotomy-rk/
  2. https://www.aao.org/eye-health/ask-ophthalmologist-q/can-lasik-be-done-after-radial-keratotomy
  3. https://crstoday.com/articles/2016-jul/refractive-surgery-after-radial-keratotomy-or-lasik/
  4. https://www.reviewofophthalmology.com/article/considering-lasik-after-radial-keratotomy
Kelly-Anne Kidston

Written by Kelly-Anne Kidston

I am a writer of many words, from fiction to poetry to reviews. I am an avid reader and a lover of good books. I am currently writing my first novel and would love to find some beta readers who are interested in getting an early look.

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