Radial Keratotomy

After Care :

After the surgery is over, the anesthetic wears off. Some patients feel slight pain and are given eye drops and medications to relieve their discomfort. For several days after the surgery, the eye that was treated may feel scratchy and look red. This is normal. The eye may also water, burn slightly, and be sensitive to light.

As with any type of surgery, it is important to guard against infection. Patients are given eye drops to protect against infection and may be told to use them for several weeks after the surgery. Because RK weakens the cornea it is important to protect the head and eyes.

The cornea heals slowly, and full recovery can take several months (another reason not to have the surgery done on both eyes at the same time). While the cornea is healing, patients may experience these problems:

• Variations in vision. Eyesight may be better in the morning than in the evening or vice versa.
• Temporary pain.
• Increased glare.
• Starburst or halo effects. Rays or rings of light around lights at night.
• Hyperopic shift. As the cornea flattens, vision may become more farsighted (hyperopic). For this reason, the surgeon may initially undercorrect the patient. This gradual shift may occur over several years.

If RK does not completely correct a person's nearsightedness, glasses or contact lenses may be needed. In general, people who were able to wear contact lenses before the procedure can still wear them afterward. Even patients whose nearsightedness was corrected may still need glasses for reading. This is especially true for middle-aged and older patients. The lens of the eye stiffens with age, making reading glasses necessary (presbyopia). Radial keratotomy does not correct this problem.

The surgeon who performs the RK procedure will tell the patient how often to return for follow-up visits. Often, two to four visits are needed, including one the day after surgery. It is also important to know what side effects should be reported immediately to the surgeon (e.g., pain or nausea).

Risks :

Complications from RK are rare, but they can occur. These include:

• cataract a clouding of the lens of the eye, resulting in partial or total loss of vision
• serious infection
• lasting pain
• rips along an incision, especially after being hit in the head or eye
• loss of vision
• chance of overcorrection (hyperopic shift)

The chances of complications are reduced when the surgery is done by an ophthalmologist with a lot of experience in RK. Younger patients also tend to heal faster.

Preperation:

Before beginning the procedure, the surgeon marks an area in the center of the cornea called the optical zone. This is the part of the cornea that one sees through (it is the area over the pupil). No cuts are made in this region. The surgeon also measures the cornea's thickness, to decide how deep the slits should be.

Normal Results:

The desired result of radial keratotomy is a reduction in myopia. A major study by the National Eye Institute, reported in 1994, tracked the success of RK in 374 patients who had had the procedure done 10 years earlier. The study found that:

• 85% had at least 20/40 vision (the acuity considered good enough to drive without glasses)
• 70% did not need glasses or contact lenses for distance vision

• 53% had 20/20 vision without glasses
• 30% still needed glasses or contact lenses to see clearly
• 1-3% had worse vision than before they had RK
• 40% had a hyperopic shift.

As with all surgeries, RK has risks. These risks include having worse vision than before the surgery; halos; glare; and although rare, blindness. Some aftereffects, such as halos or glare may last for years. Other refractive surgeries, such as photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) use lasers to change the shape of the cornea and they may produce fewer side effects. It is important to speak with an experienced eye surgeon who has done many refractive surgeries to fully understand the options and risks involved before making a decision.