Epithelial Ingrowth After RK and Lasik Surgery

The top photo was taken in 2010. Note the blood vessels growing along the RK incision. In addition, if you look carefully you will notice a few milky-white deposits near the blood vessels close to the pupil. This was the first sign of epithelial cells ( the outer cellular layer of the cornea) getting underneath the LASIK flap. The lower photo was taken in 2013. Note how the milky white area has grown dramatically. The R-K surgery was done in 1988 and the LASIK surgery was done in 1999. At the present time this patient is having a consultation at a major university eye center for a corneal transplant.


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GVR Scleral Lens and RK

Radial Keratotomy (RK) was the first refractive surgical procedure introduced into the United States. Millions of patients around the world underwent this needless and harmful procedure in the 1980’s and 1990’s. Over two million procedures were done in the United States and Canada alone. In addition, over a million LASIK procedures were later done to these same patients in an attempt to undo the damage done by the initial RK surgeries. The end result of these multiple refractive surgical procedures was millions of permanently damaged eyes requiring either corneal transplant surgery or the use of specialty contact or scleral lenses.

Radial Keratotomy involved the making of small deep slices into the cornea (the front surface of the eye) in an attempt to reduce nearsightedness (myopia) and astigmatism. The long term results of RK were complications that were so horrific that many of these patients were unable to function visually either with eyeglasses or contact lenses. In addition to the reduced vision, most of these hurt patients experienced significant ocular discomfort and pain. Many complications occurred years after the surgeries were done. These complications include:

  • 1. Loss of best corrected visual acuity.
  • 2. Double or triple vision.
  • 3. Irregular corneal curvatures.
  • 4. Unstable or fluctuating vision.
  • 5. Severe dry eye.
  • 6. Halos, glare and reduced indoor and night vision.
  • 7. Permanently open incisions.
  • 8. Recurrent ocular infections and inflammation.
  • 9 Severe depression and in some cases thoughts of suicide.

Over the years our specialty practice has treated thousands of RK patients who also underwent additional RK procedures followed by one or more LASIK procedures. In every instance, the additional surgical procedures only made matters worse. Many of these patients (less than 5%) eventually needed to undergo corneal transplant surgery.

In recent years advancements in scleral lens technology have allowed the great majority of this hurt patient population to see clearly and comfortably once again. Virtually every hurt post-RK/ post-LASIK patient who were fit with the GVR Scleral lens experienced a dramatic improvement in their visual acuity and ocular comfort.

The GVR Scleral lens is unique in that this lens vaults over the compromised cornea and rests on the white portion of the eye known as the sclera. Sterile unpreserved saline solution fills the space between the back surface of the lens and the front surface of the cornea. Comfort and vision are almost always excellent. In addition, the dryness (scratchy and itchy) issues that so many post-refractive surgical patients experience are for the most part gone. In other words, the GVR Scleral lens has a therapeutic effect of the damaged eye. It is not unusual for a post-RK patient to comment to us after having received their GVR Scleral lenses that they now have their life back.

An Example: This eye underwent R-K surgery in 1988. LASIK was performed in 2002. Shortly thereafter, post-LASIK ectasia developed. The R-K incisions are still open.
A dye was instilled onto the corneal surface. You can tell that the incisions are still open because the dye can be seen within the incisions. The green-yellow circular line going around the periphery of the cornea is the LASIK flap. We fit this eye with a GVR Scleral lens in 2007 which has provided this eye with clear stable vision ever since.

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The GVR Scleral Lens and Lasik

Lasik Complications are the unanticipated events that can take place after the LASIK surgery is done. Many of these complications may not take place immediately after the surgery but can take place months or years later. These complications include but are not limited to:

  • 1. Severe Dry Eye (the most common complication affecting over a third of the entire post-LASIK population)
  • 2. Irregular, uneven or rough corneal surface.
  • 3. Blurred, distorted and unstable vision.
  • 4. Reduced vision indoors and at night.
  • 5. Glare, halos and starbursts and eye pain.
  • 6. Vitreous floaters, and posterior vitreous detachment.
  • 7. Light sensitivity, ghost images and/or double vision.
  • 8. Complications with the surgically induced LASIK flap such as wrinkles, debris or cellular growth beneath the flap.
  • 9. Corneal ectasia which a bulging or protrusion of the corneal surface.
  • 10. Corneal epithelial erosion.
  • 11. Severe depression and in some instances thoughts of suicide.

As stated above, dry eye is the most common complication encountered in the post-LASIK population. It is for this reason that literally hundreds of different dry eye formulations are available at your local pharmacy and on-line. It is for this reason that the well advertised dry eye solution known as Restasis is so popular. Many of the containers that these drops come in state that their contents are designed for post-LASIK dry eye.

One might wonder why LASIK surgery is associated with dry eyes and in some instances chronically severe dry eye. The reason for this is that around 70% of the corneal nerves are severed during the LASIK operation. Because of this the lubrication system of the eye is affected. These severed corneal nerves may never fully recover to their pre-operative condition. For this reason among others, a gas permeable scleral lens is for most post-LASIK patients suffering from LASIK complications the ideal technology for restoring quality vision and ocular comfort. All of our patients suffering from the complications mentioned above, are wearing the GVR Scleral lens. The GVR lens is designed around each individual eye with the use of proprietary software made by Zeiss and Oculus technologies. The GVR lens vaults over the compromised cornea and is supported by the white portion of the eye known as the sclera. The space between the back surface of the lens and the front surface of the cornea is filled with unpreserved saline solution. In almost every instance, comfort and vision is excellent. In addition, almost all of our patients are able to wear these unique lenses for all of their waking hours. The GVR Scleral lens in effect replaces the cornea as an optical surface. In addition because the front of the eye in always in a moist environment, the GVR Scleral lens has a therapeutic or healing effect on the compromised cornea.

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Cornea Transplants and GVR Scleral Lens

Be very careful about rushing into a cornea transplant (see images of failed transplants at bottom of this page). About 50,000 corneal transplant surgeries are performed every year in the United States. The purpose of this procedure is to replace diseased corneal tissue with a healthy cornea from an organ donor. Corneal eye disease is the fourth most common cause of a blindness (after cataracts, glaucoma and age-related macular degeneration) and affects more than 10 million people worldwide.

There is no way to determine the final outcome of a corneal transplant as far as the curvature of the new ocular surface is concerned. Almost all of the post-corneal transplant patients who we have seen over the years have significantly distorted corneas. This is due to the suturing and healing process that every transplanted cornea needs to go through with the recipient eye.

In our specialty practice, all of this special patient population is wearing a GVR Scleral lens over the transplanted cornea. The reasons we use these unique lenses are:

1. There is a life long risk of rejection of the donated cornea. Any contact lens that rubs against the donor cornea could cause irritation and infection to the host eye. It is conceivable that this could lead to rejection of the donated cornea. The GVR Scleral lens vaults over the donor cornea and is supported by the white portion of the eye (the sclera). It does not rest on or touch the donor cornea. Saline solution fills the space between the back surface of the lens and the front surface of the donor cornea. Vision and comfort are almost always excellent.

2. As stated above, there is no way of knowing what the final corneal curvatures of the donor cornea will be after the healing process takes place which could be many months. It has been our experience that almost all of the transplanted corneas we have seen have significant distortions and irregularities after the healing period has taken place. Vision with eyeglasses is usually very poor. Conventional contact lenses such as soft lenses or conventional gas permeable lenses are either not comfortable or provide very poor vision. A scleral lens is the only technology that will replace the irregular transplanted cornea as an optical surface.The GVR Scleral lens along with the liquid interface behind the lens will provide clear comfortable vision once again to the great majority of this patient population.

At the present time, many eye doctors are still telling their patients that they will need a corneal transplant, or to wait until the eye gets bad enough and then they can have a corneal transplant done. These doctors will not inform their patients about non-surgical alternatives such as the GVR Scleral lens which is a non-invasive and yet a very safe alternative when compared to corneal transplant surgery. Many of these eye doctors will never discuss the
risks of corneal transplant surgery.

Below is an image of the GVR scleral lens over cornea transplant


Below is the image of a patient’s 4th cornea transplant.


Here are other images of failed transplants



Below is an image of a failed cornea transplant resulting in complete blindness.

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The GVR Scleral Lens and Keratoconus

Keratoconus is a non-inflammatory ectasia or protrusion of the cornea. Over a period of years (from a few years to 5 or more years) the cornea tends to thin and steepen. As the cornea thins and steepens, the patient will experience a decrease in vision which can be mild or severe. For mild to moderate degrees of keratoconus, eyeglasses or soft contact lenses may be able to provide the patient with clear comfortable vision. However, in the more advanced cases of keratoconus, eyeglasses or soft contact lenses will not be able to provide the patient with clear vision. In addition, conventional gas permeable contact lenses may be able to provide clear vision but these lenses tend to be unstable on an advanced keratoconic cornea.

In the great majority of the patients that we see with advanced keratoconus, the outer cellular layer of the cornea known as the epithelium is compromised or
not intact. For this reason patients with advanced keratoconus will not be able to tolerate or support a soft, hybrid or conventional gas permeable lenses. With these
lens designs the vision may be acceptable but the comfort will not be. Also, the small gas permeable lenses may tend to pop out of the eye or have excess movement
causing discomfort and eye pain after a short wearing period.

The only lens that will provide clear stable vision, and excellent comfort to a patient with advanced keratoconus will be a gas permeable scleral lens, specifically a
GVR Scleral lens. This is due to the fact that the GVR Scleral lens does not touch the compromised cornea. Instead, the GVR Scleral lens vaults over the cornea and
is supported by the white portion of the eye known as the sclera. The space between the back of the lens and the front surface of the cornea is filled with unpreserved
sterile saline solution. In other words, the front of the eye is always in a moist environment. Because of this, very often the GVR Scleral lens will act as a therapeutic device and help the compromised corneal tissue heal. In addition, the blinking action of the eyelids against the irritated cornea can cause further damage to the cornea. The GVR Scleral lens will protect the compromised cornea from the rubbing action of the eyelids against the irritated cornea.

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Radiuscope

The Radiuscope is an essential instrument for measuring the curvature of a contact or scleral lens to the second decimal place. In addition if a lens should have an slight irregular curvature, we can detect it with the use of this instrument. Every lens that comes into our office is checked and double checked to make sure that all of the lens specifications are exactly as ordered. In this photo, you see one of our student doctors examining a scleral lens to make sure that all of the lens curvatures are exact.

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Zeiss Cirrus Optical Coherence Tomography

What you are seeing in this image is a cross sectional view of the macula and retina. Optical Coherence Tomography is the only technology that will allow us to study all of the ocular structures in the back portion of the eye in such great detail.

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Zeiss Frequency Doubling Technology

Frequency Doubling Technology (FDT) provides a rapid method of detecting visual field abnormalities seen in ocular disease such as glaucoma, certain brain tumors and optic nerve disease. This instrument has a high level of sensitivity and specificity allowing us to detect visual field abnormalities at a very early stage.

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Zeiss-Anterior-Segment-Ocular-Coherence-Tomography

Zeiss Anterior Segment Ocular Coherence Tomography allows the structures in the front section of the eye to be examined

This instrument allows us to visualize and measure the anterior structures of the eye including the cornea, anterior chamber, iris, and lens. We have found this technology invaluable in helping us design with great accuracy specialized contact and scleral lenses for patients suffering vision loss due to keratoconus, post refractive surgical complications such as LASIK and RK complications,
corneal transplant surgeries, dry eyes and other ocular diseases and conditions.

Zeiss Anterior Segment Ocular Coherence Tomography allows the structures in the front section of the eye to be examined
Zeiss Anterior Segment Ocular Coherence Tomography allows the structures in the front section of the eye to be examined

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Zeiss Visual Field Analyzer

The Zeiss Visual Field Analyzer allows visual field loss to be measured.

This instrument is used to detect and measure early visual field loss which may be indicative of glaucoma or neurological disease. This instrument has now become to universal standard for the detection and measuring of visual field loss. While the Zeiss FDT Visual Field Analyzer is used as a screening instrument, the Zeiss-Humphrey Visual Field Analyzer is used by us for an in-depth examination of the entire visual field. This instrument can help us diagnose early visual field loss which may be indicative of early glaucoma and/or neurological disease.

The Zeiss Visual Field Analyzer allows visual field loss to be measured.

The Zeiss Visual Field Analyzer allows visual field loss to be measured.

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