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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.
Though it seems like laser eye surgery has been around forever it has, in fact, only been a common procedure for just over 20 years. Prior to laser eye surgery, another vision correction surgical procedure known as radial keratotomy was widely used.
In short, radial keratotomy required the use of a surgical diamond blade and the steady hand of an ophthalmologist to correct a patient’s refractive error. Although this sounds frightening, many thousands of people 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 in the cornea (the clear, curved layer at the front of the eye) that flowed in a ‘radial’ pattern. The deep cuts were intended to flatten the cornea to reduce the refractive power of the eye.
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 is usually performed on both eyes the same day, 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-perfect vision in one eye and blurry short-sightedness in the other.
The first attempts at refractive surgery using incisions in the cornea took place in the 1930s. Japanese ophthalmologist, Tsutomu Sato, was the first to document 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 made a number of radial incisions in the boy’s eye to remove the shards of glass. The incisions extended in a radial pattern from the pupil to the periphery of the cornea, ironically, rather like the spokes in a bicycle wheel. 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 first radial keratotomy protocol 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 as surgeons gained more experience had a technically superior alternative – laser eye surgery – not arrived.
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 radial keratotomy did not have the same benefits of laser eye surgery, both in the short term and the long term.
People who had radial keratotomy may have no issues throughout their lives, or they may develop visual issues such as haloes or night vision loss. Unfortunately, once a person had undergone a radial keratotomy procedure, they were no longer viable candidates for laser eye surgery due to the corneal incisions.
Importantly, anyone who has previously had a radial keratotomy and now needs cataract surgery will require help from a more experienced surgeon. 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 is approaching their late 40s or 50s will inevitably still need reading glasses, thanks to presbyopia.
Nevertheless, 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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