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Radial Keratotomy (RK) – vision correction before laser eye surgery

24/08/2017

Today, we are fortunate to be able to benefit from a number of advanced laser eye surgery procedures. Millions of people around the world have benefited from the fast, accurate and safe results that laser eye surgery has introduced to their lives.

It seems like laser eye surgery has been around forever when, in fact, it has only been a relatively common procedure for just over 20 years. There was another vision correction surgical procedure before laser eye surgery that was widely used – radial keratotomy.

Vision correction by diamond

In short, a radial keratotomy required the use of a surgical diamond blade and the steady hand of an ophthalmologist. Although this sounds frightening, many thousands of people have had the procedure pre laser eye surgery and were extremely happy with the results.

The procedure, which only corrected myopia (short-sightedness), involved creating a series of incisions that flowed in a ‘radial’ pattern – almost like cutting a pizza. Unlike laser eye surgery, the deep cuts effectively reshaped the cornea.

A radial keratotomy can consist of 4, 8, 12, 16 or 32 incisions made in a number of patterns and orientations based on refractive errors, the style of the surgeon and their training in this area.

Unlike laser eye surgery, which takes place in a day surgery and has the procedure performed on both eyes, people who had a radial keratotomy usually required an overnight hospital stay. One eye would be corrected, then the other within a month. That left most people with the unusual situation of having perfect or near perfection vision in one eye and blurry short-sightedness in the other.

History of radial keratotomy

The first attempts at refractive surgery by making incisions in the cornea took place in the 1930s, when Japanese ophthalmologist, Tsutomu Sato, conducted his early experiments into anterior and posterior keratotomy. These experiments continued after World War II, but without achieving any known reliable results.

The next step forward happened by accident – literally. In 1974, a Russian ophthalmologist, Svyatoslav Fyodorov, removed glass from the eye of a boy who had been in a bicycle accident – his glasses had shattered upon impact and glass particles had become lodged in his eye.

In an attempt to save his vision, Fyodorov performed a procedure during which he made a number of radial incisions in the boy’s eye, extending in a radial pattern from the pupil to the periphery of the cornea, ironically, rather like the spokes in a bicycle wheel.

The glass was removed and, after allowing time for the wounds to heal, Fyodorov examined the eyes again and was surprised to discover that the boy’s vision had improved significantly. In fact, his visual acuity was superior to that achieved before his accident. From this discovery, the radial keratotomy procedure first came about.

While radial keratotomy did prove to be reasonably successful and very popular, particularly in the 1980’s, its main limitation was that the success of the procedure was very dependent on the skill of the surgeon. The procedure might have found greater success, however, a technically superior alternative was already on the horizon – laser eye surgery.

Recovering from radial keratotomy

Careful post-surgical treatment was required to ensure proper healing. Despite all of this, many people were keen to throw away their glasses or contact lenses, with most having a very good visual outcome.

However, there is no doubt that a radial keratotomy did not have the benefits of laser eye surgery, both in the short term and the long term.

What happens down the track?

People who have had a radial keratotomy may have had no issues throughout their lives. Or they may develop some visual issues such as haloes or night vision loss.

However, once a person had a radial keratotomy, they were not able to have laser eye surgery once it became available. They may have considered it if they were less than happy with their radial keratotomy results, but because the top layer of both corneas were incised, laser eye surgery was not possible.

Importantly, anyone who has previously had a radial keratotomy and now needs cataract surgery will require surgical help. This is not to say that they will not be able to have successful cataract surgery; rather, the surgeon will need to keep a number of factors in mind when planning the surgery.

And, as with anyone who has had laser eye surgery, anyone who has had a radial keratotomy and are approaching their late 40s or 50s will inevitably need reading glasses, thanks to presbyopia.

Still, there are many people who have had this superseded vision correction procedure. Although the long-term outcomes of laser eye surgery are far superior, at the time a radial keratotomy was considered an effective refractive procedure.

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