RK Followed by Lasik, Followed by Deteriorating Vision

The patient seen in this photo with me, visited our office for the first time from Guatemala 10 years ago. In the 1980's this patient underwent 2 separate Radial Keratotomy procedures in both eyes. Over the following years his vision began to deteriorate to the point where he was not able to obtain functional vision with eyeglasses or any type of contact lens. Because of this, in 2001 and 2002 he underwent 2 separate LASIK procedures in his right eye and 1 LASIK procedure in his left eye in 2001. Needless to say, over the following years his vision and ocular comfort continued to deteriorate. Several corneal surgeons suggested that he undergo corneal transplant surgery in his right eye since the right eye was significantly more compromised that his left eye. In 2006 we fit this patient's right eye with a GVR Scleral lens which provided this eye with clear, undistorted 20/20 vision. Prior to visiting us, the best corrected vision that he was able to achieve with his right eye was less than 20/200. Because this patient's left eye was significantly less distorted he was able to achieve acceptable vision with a disposable soft lens. This patient visited our office today for his yearly eye health and scleral lens examination. Both of his corneas are stable, clear and healthy. In the ocular photo to the right can be seen several small blood vessels growing onto the corneal surface along the RK incisions (which still remain open). This is not a healthy situation as the cornea is the only tissue in our body without any blood vessels. However, this condition has remained stable for the last 10 years but still needs to be monitored on a yearly basis. The photo to the right shows the GVR Scleral lens over this patient's right cornea. Look carefully and you can see the straight, gray, scarred RK incisions radiating inward from the periphery of the cornea. The LASIK flap incision going around the corneal periphery is difficult to see in this photo. This patient will never need to undergo corneal transplant surgery.