20/200 RK Eye

This is a photo of a scleral lens over an eye that underwent 3 separate Radial Keratotomy (RK) surgeries. Look carefully and you will see many RK incisions or “slices” going every which way on this cornea. Just know that there was no science behind this horrible surgery. The medical specialty that brought you RK is the same medical specialty advertising LASIK, “Smile” and all of the other refractive surgeries that have the potential to damage your eyes irreversibly. The vision in this eye could not be corrected with eyeglasses or conventional contact lenses. With best spectacle correction the vision in this eye is less than 20/200. With a scleral lens this patient can see clearly (20/30) and comfortably once again. One more piece of information: there is no surgical procedure (LASIK, IOL replacement surgery etc.) that will restore the vision that was lost due to the original RK surgery.

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PRK, then Ectasia

This is the right and left eye of a patient that underwent photo refractive keratotomy (PRK) surgery about 8 years ago. Several years later the patient’s vision began to deteriorate. When he visited another corneal surgeon, a diagnosis of Corneal Ectasia was made. In an effort to improve his vision, this patient underwent Intacs surgery in both eyes. Intacs are plastic rings that are inserted into the cornea in an effort to make the cornea more spherical. These 2 surgeries resulted in 2 severely distorted corneas. We recently fit this patients eyes with scleral lenses. In these photos, a special dye was used to highlight the defects in the cornea. The “horseshoe” shaped structures are the plastic rings that were surgically inserted into the corneas. Note the green spots concentrated over these plastic rings. These represent dry areas along the corneal surface. I feel that this patient’s scleral lenses will create a corneal surface that will have a healthier and more moist appearance.


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Blood vessels growing in PRK cornea

These 2 photos are of the right eye of a patient that underwent PRK laser eye surgery. Look carefully and you can see the resulting corneal haze just opposite the pupil. Look even more carefully and you can see a meshwork of blood vessels on the center and center right in these photos. The cornea is the only tissue in the body devoid of blood vessels. These blood vessels grew onto the cornea as a response to the inflammation created by the laser. This eye was eventually fit with a scleral lens which is providing this patient with clear vision with this eye. In addition, some of these blood vessels have receded.


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Three Lasiks over RK

The 3 photos below were taken of the same eye over a 4 year period. This eye underwent several separate RK surgeries followed by 3 separate LASIK surgeries years later. In the first photo note the blood vessels growing along the RK incisions. The white “hatchet” like structure is epithelial ingrowth (epithelial cells under the LASIK flap). The 2nd photo was taken about 2 years later. The epithelial ingrowth is no longer in the same location and appears to have dispersed under the LASIK flap. Instead there appears to be fine “glitter” like particles in the center of the cornea under the LASIK flap. The last photo was taken of the same eye 18 months after the 2nd photo was taken. Now these fine particulate “glitter” like structures have morphed into something that looks like a heavily scratched piece of ground glass. This patient was referred to a major eye institute where a diagnosis of “Crystalline Keratopathy” was made. This year this patient will be receiving a corneal transplant on this eye. “Crystalline Keratopathy” is a rare complication of LASIK surgery. It is very slow to develop and progress.



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RK, infections, inflammations, glaucoma

About 30 years ago this eye underwent Radial Keratotomy (RK) surgery. This eye also has a history of infections and inflammations which were treated off and on for years with steroid eye drops. About 15 years after the RK surgery, this eye was diagnosed with glaucoma which could not be controlled well with medications. Several years ago in an effort to keep the intraocular pressure under control a glaucoma shunt was surgically implanted into this eye. As the years went by this eye became increasingly far sighted and astigmatic with unstable vision. This eye was recently fit with a scleral lens which is providing this patient with clear and stable vision. In the photo below, look carefully at 1:00 O’Clock and you can see the glaucoma shunt next to the edge of the scleral lens. The 2nd image was taken with OCT technology. In this image you can see the scleral lens vaulting over the cornea. Again, look carefully at the extreme right portion of this image and you can see an oval structure. This oval structure is a cross section of the glaucoma shunt.


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Lasik a Decade Ago, then Ectasia and Intacs

This is a photo of the lower portion of the left cornea of an eye that underwent LASIK surgery 10 years ago and developed a corneal ectasia several years later. In an effort to undo the damage to the cornea created by LASIK, Intacs (plastic intra corneal rings) were surgically implanted into this cornea. Several years after the Intacs surgery this eye became infected and inflamed from this plastic rings. The lower ring was surgically removed several years ago. In this photo note the curved gray scar. This is due to the surgery to remove the Intacs. Also note the numerous small blood vessels around this scarred area. Understand that the cornea is normally devoid of blood vessels. This patient is now wearing a scleral lens on this eye which is providing him with clear (20/20) vision for the first time in many years. For the past few years this cornea has remained stable and the vision in this eye has remained clear.

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Selection of RK Eyes

Among the symptoms almost all of the post-RK patients have include some if not all of the following: fluctuating vision, dry eyes, ocular pain, poor night vision, inability to tolerate contact lenses, multiple pairs of eyeglasses to name just a few. There is no surgical procedure or medication that will undo the corneal damage created by this harmful surgery. There is only one technology that will allow a patient suffering loss of vision and ocular comfort due to RK surgery see clearly and comfortably once again. That is a well fit gas permeable scleral lens. There is no soft lens or hybrid lens that will do this as well as a scleral lens. There are a number of reasons why this is so which I can explain another time. The photos below are the eyes of different eyes that underwent RK surgery. Almost all of these corneas still have open incisions after all these years. All of the eyes in the photos below are now successfully wearing scleral lenses. Again, there are a number of reasons why a scleral lens will allow a patient with post-RK corneas to see clearly and comfortably again while soft, hybrid and conventional soft lenses cannot do this.





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Lasik Flap detaching

I am posting the OCT image below of a scleral lens over an eye that underwent LASIK surgery about 15 years prior to the time that this image was taken. It shows a LASIK flap becoming “undone” or separating from the underlying corneal tissue. Note the differences in the shading of the cornea. The varying degrees and intensities of the hyper-flouresence indicates the degrees of scarring, cellular changes etc. It is not uncommon to see finite discolorations or alterations in these corneas. We have these all documented. I do not know the exact pathogenesis of how and why these small alterations occur. My job is to create a lens that will allow a post-LASIK patient regain vision once again. There are more things that we do not know with this patient population then we do know. Why did this LASIK flap separate from the surrounding cornea? No one can answer this. Notice that the surface epithelial tissue is separating from the underlying cornea. Why? This eye suffered a 360 degree retinal detachment several years after the LASIK. Again, why? Again, no one can answer this. This is a blind, painful eye. We fit this eye with a scleral lens not for vision purposes but to eliminate the ocular pain this patient was suffering from for a number of years. In summary, fine alterations in the appearance of the cornea seen with OCT technology are a fact of life. How the patient sees and processes their world is another matter and differs from patient to patient.

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Lasik over RK with haze and dryness

The images below are of the same eye. In the 1980’s this eye underwent 3 separate Radial Keratotomy (RK) procedures followed by 2 separate LASIK procedures about 25 years later. The photo below was taken through a bio-microscope (slit lamp). Notice the dull grey spike like figures going from the corneal periphery towards the center. These are the open, scarred RK incisions. Again, look carefully and you will see a dull, grey “smile-like” image in the lower portion of this photo. This is “epithelial ingrowth”. This is due to the cells on the surface of the cornea (epithelial cells) getting under the LASIK flap where they do not belong. It is quite possible for these cells to proliferate years later below the LASIK flap leading to vision loss. The 2nd image was taken with a technology known at “Optical Coherence Tomography” or “OCT”. This is a cross section of the cornea with a scleral lens over it. The top 2 curved lines represent the front and back surfaces of the scleral lens. The thick grey curved structure is the cornea. Look carefully and you can see a curved white haze in the center of the cornea toward the right side of the image. This is another view of the epithelial ingrowth. This patient will have to be seen at regular intervals to make sure that the cornea remains stable. This cornea is extremely irregular and has a very dry ocular surface. The scleral lens is the only technology that will allow this patient to see clearly and comfortably with this eye.


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Transplant with Relaxing Incisions equals Pain

This is a photo of an eye that underwent corneal transplant surgery 30 years prior to the time this photo was taken. 15 years ago in an attempt to improve the patient’s vision with this eye, a corneal surgeon placed 2 “relaxing” incisions in the donor cornea. These incisions act in much the same way as RK incisions act. The result was a worsening of the patient’s vision in this eye. In addition, for the last 10 years this patient had unrelenting pain in this eye. One year ago this eye was fit with a scleral lens which not only improved this patient’s vision significantly, but also eliminated the pain she was experiencing. Look carefully at this photo and you will notice 2 green cuts on the donor cornea, one cut located at about 1:00 and the other located at 7:00. A special dye was used to highlight these open incisions, still open after all these years.

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