Radial Keratotomy Patient With Scleral Lenses

If you had radial keratotomy (RK) surgery decades ago and now struggle with blurred, fluctuating, or distorted vision, you are not alone. Many former RK patients in Las Vegas and across the country are discovering that scleral lenses can dramatically improve their visual quality and daily comfort.

What Is Radial Keratotomy?

Radial keratotomy was a popular refractive eye surgery performed in the 1980s and 1990s. The procedure involved making small, precise incisions on the cornea to flatten its shape and correct nearsightedness, allowing patients to see clearly without glasses or contact lenses. While many patients experienced years of good vision after RK, the long-term effects of those incisions can cause significant problems later in life.

Why Does Vision Decline After RK Surgery?

The incisions made during RK surgery permanently alter the structural integrity of the cornea. Over time, this can lead to an irregular corneal shape and irregular astigmatism that glasses cannot fully correct. Common symptoms reported by former RK patients include blurred or hazy vision, double vision or ghosting, fluctuating vision throughout the day, increased sensitivity to glare, and progressive farsightedness.

The fluctuating vision is particularly frustrating. Because the weakened cornea changes shape in response to normal eye pressure variations during the day, patients may find their prescription shifts from morning to evening. Many RK patients end up keeping multiple pairs of glasses around the house, switching between them as their vision changes.

How Do Scleral Lenses Help RK Patients?

Scleral lenses are large-diameter gas permeable contact lenses that vault over the entire cornea and rest on the sclera. The bowl of the lens is filled with preservative-free saline before insertion, creating a smooth, stable optical surface over the irregular cornea. This design offers several important benefits for RK patients.

• The smooth lens surface neutralizes corneal irregularities, providing much clearer and less distorted vision than glasses.
• Because the saline layer between the lens and cornea remains constant, vision stays stable throughout the day rather than fluctuating.
• The fluid reservoir also provides continuous hydration, which helps with the dry eye symptoms many RK patients experience.
• Scleral lenses do not press on or rub against the corneal surface, making them comfortable even on eyes with RK incision scars.

What Does the Scleral Lens Fitting Process Involve?

Scleral lens fitting is a specialized process performed by experienced doctors. During the initial appointment, which typically takes about an hour, diagnostic lenses from a fitting set are placed on the eye to evaluate the best lens shape and size. The doctor also determines what prescription power is needed in the lens. After this evaluation, the doctor works with the contact lens laboratory to design custom lenses tailored to each eye.

Lens Delivery and Training

When the custom lenses arrive, the patient returns for a dispensing appointment. The doctor inserts the lens, performs a series of tests to confirm proper fit and satisfactory vision, and then teaches the patient how to insert, remove, and care for the lenses. After wearing the lenses for approximately two weeks, the patient returns for a follow-up to ensure everything is fitting well and the vision is optimal.

A Real RK Patient Case From Our Practice

A 53-year-old patient came to our practice with a history of RK in both eyes. His right eye had eight incisions and his left eye had sixteen. He was experiencing poor vision, ghosting, double vision, fluctuating vision, and dry eye symptoms that had worsened since moving to Las Vegas, where the desert climate can aggravate ocular dryness.

After fitting him with custom scleral lenses, his vision improved significantly. At his first follow-up appointment, the lenses were fitting well overall, though the right eye showed some mid-peripheral touch that required a minor adjustment to ensure safe clearance over the entire cornea. This type of fine-tuning is a normal part of the scleral lens fitting process, and it ensures the best possible long-term outcome.

Important Considerations for RK Patients

• Scleral lenses are one of the most effective options for improving vision after RK surgery, but each case is unique and requires a thorough evaluation.
• The fitting process may require one or more adjustments to achieve the ideal fit, especially for eyes with many incisions or an unusual corneal shape.
• Regular follow-up appointments are important to monitor the lens fit and corneal health over time.
• If you experience sudden vision loss, severe eye pain, or new flashing lights, seek immediate eye care, as these symptoms can indicate serious conditions unrelated to your contact lenses.

Talk to a Scleral Lens Specialist at Insight Vision

If you had radial keratotomy surgery and are dealing with vision problems, scleral lenses may be the solution. At Insight Vision Optometry, Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS specialize in fitting scleral lenses for post-surgical and irregular cornea patients. Call 702-747-4070 or visit www.insightvisionlv.com to schedule your evaluation.