RADIAL KERATOTOMY (RK) & Future Technology at Gulani Vision Institute
What is Radial Keratotomy Correction?
Radial Keratotomy (RK) is a surgical procedure developed in the 1970s to correct nearsightedness (myopia) by altering the shape of the cornea. The procedure involves making tiny, radial incisions in the cornea using a diamond blade. These incisions help flatten the cornea, improving the eye’s ability to focus light properly onto the retina, thereby reducing or eliminating the need for glasses or contact lenses. The name “radial keratotomy” comes from the radial pattern of the cuts, which resemble the spokes of a wheel.
This procedure was widely popular in its early years due to its ability to provide significant vision improvement without the use of lasers. However, RK requires a high degree of surgical precision, and the results can vary depending on the individual’s healing process and the severity of their myopia. Unlike modern laser-based vision correction surgeries, RK does not involve reshaping the cornea with a laser, which has led to its decline in popularity as newer, more predictable technologies have emerged.
While RK was revolutionary for its time, it is now considered outdated due to advancements in refractive surgery, such as LASIK, PRK or LaZrplastique®. These newer procedures use laser technology to reshape the cornea more precisely and with fewer complications. Additionally, RK can sometimes lead to long-term complications such as fluctuating vision, glare, or progressive hyperopia (farsightedness) as the cornea continues to flatten over time. Patients who had RK in the past may also experience challenges when undergoing further corrective procedures due to the structural changes in their corneas.
Radial Keratotomy was a groundbreaking procedure in the history of refractive surgery, paving the way for modern techniques. While it is no longer a commonly used method for vision correction, its development marked an important step in the evolution of eye surgery and continues to be a point of reference in the field of ophthalmology.
Radial Keratotomy Complications
Radial Keratotomy (RK), while once a groundbreaking surgical technique for correcting nearsightedness, has been associated with various complications, particularly in the long term. These complications often stem from the structural changes made to the cornea during the procedure, as well as its reliance on manual incisions rather than precise laser technology.
One of the most common complications of RK is fluctuating vision. Many patients experience changes in their visual acuity throughout the day, with vision typically being clearer in the morning and worsening as the day progresses. This fluctuation is caused by changes in corneal hydration and thickness, which can affect how light is refracted through the eye. Over time, these variations can become frustrating and limit the patient’s ability to perform daily tasks without corrective lenses.
Another significant complication is the development of progressive hyperopia (farsightedness). After RK, some patients find that their corneas continue to flatten over the years, causing a gradual shift from nearsightedness to farsightedness. This can result in the need for additional corrective measures, such as glasses, contact lenses, or further surgical interventions.
Patients may also experience issues with glare, halos, and starbursts, especially in low-light conditions. These visual disturbances can be particularly noticeable when driving at night and are caused by the radial incisions interfering with light entering the eye. Additionally, the structural weakening of the cornea due to the incisions can make it more susceptible to injury or complications from future eye surgeries.
Other potential complications include scarring, irregular astigmatism, and difficulty fitting contact lenses. The radial incisions made during RK can leave permanent scars, which may affect the smoothness of the corneal surface. Irregular astigmatism can occur if the incisions heal unevenly, leading to distorted vision. For patients who later need contact lenses, the altered shape of the cornea can make it challenging to achieve a proper fit.
Lastly, the unpredictability of RK results is a significant concern. Unlike modern laser procedures, RK outcomes depend heavily on the surgeon’s skill and the individual’s healing process. As a result, some patients may not achieve the desired level of vision correction or may require multiple surgeries to address residual issues.
While RK was a pioneering procedure for its time, it is now associated with a range of complications that limit its use in modern ophthalmology. Many of these issues highlight the importance of advancements in refractive surgery, which have introduced safer, more predictable alternatives like LASIK and PRK. Patients with a history of RK should be closely monitored for long-term changes and consult with an experienced ophthalmologist if additional vision correction is needed.
Understanding Radial Keratotomy Complications and Corrections
Radial Keratotomy as the name suggests involved surgically making Radial (think spokes of a wheel) cuts in the cornea (front view finder of our eye) to treat nearsightedness (myopia).
Why is this important? First of all, it was a precursor to LASIK eye surgery to help people see without glasses and secondly, thousands of these patients who
As patients with Radial Keratotomy are realizing that they need not live in despair and can actually seek options to SEE, we are experiencing an increased number of RK patients flying to us every week from all over the world.
As one of the First in The World to acquire cutting edge Diagnostic technologies like the Scheimpflug camera based Pentacam AXL Wave®, The Ray Tracing based iTrace®, and Next Generation Optical Pathway assessment devices, Dr. Gulani can not only understand the vision issues of RK eyes but also allocate the vision problem to each optical element of the eye and hence custom-tailor a surgical plan and pick among his innovative technologies to correct that eye’s vision to its best potential.
You can see here among thousands of Dr. Gulani’s worldwide patients, how these RK patients are told by their eye surgeons that nothing can be done. Brian had undergone a Corneal Transplant over his Radial Keratotomy Cornea and became extremely difficult, Larry had very high Irregular Astigmatism from RK and Sue was left with 3 times Re-cut Radial Keratotomy cuts and complex cataracts. All these patients are seeing perfect after Dr. Gulani designed their unique surgeries and in these videos, he is explaining how new technology can help us understand these patient’s complaints and also help tailor their surgery no matter how complex.
Radial Keratotomy as the name suggests, involved surgically making Radial (think spokes of a wheel) cuts in the cornea (front view finder of our eye) to treat nearsightedness (myopia).
RK was a precursor to LASIK eye surgery to help people see without glasses, and thousands of these patients who underwent this surgery in the 1980s are now impacted by poor vision from progressive farsightedness over time, irregular astigmatism with vision fluctuations as an aftermath of the surgical complications of this technique or associated situations like cataracts with age.
Dr. Gulani has been innovating for and correcting RK eyes for over 3 decades with an unparalleled track record of success and has provided his own patients live on camera so they can share their experiences (with no incentive) in a desire to encourage his colleagues and inspire the eye care industry to not give up on these patients.
Most Lasik or Cataract eye surgeons are not trained or experienced to tackle these RK eyes due to their inherent complexities since patients with previous RK are presenting with a challenging situation in eye surgery not only because of surgical complexity but also ability to accurately measure their eyes to determine the lens implant if planning cataract surgery.
Dr. Gulani with his full spectrum of surgical abilities including LaZrPlastique®, Lasik (Laser Vision Surgery/LASIK/NexGenLASIK/PRK/Wavefront Lasik/Bladeless, Lasik/Lasek/PTK/Smile/Relex/SBK/EpiLasik/ Corneoplastique® techniques etc) for Myopia (Nearsightedness)/Hyperopia (Farsightedness)/ Astigmatism, Presbyopia (After 40 reading glasses/Readers/Cheaters/Progressive glasses/Kamra) and Cataract surgery (Multifocal lens implants/Panoptix/Trifocal/ReStor/Crystalens/Tecnis/Symfony/Premium Cataract Surgery or, Cataract surgery complication correction)along with Pinguecula/Pterygium/ Red Eye, Keratoconus/Collagen Crosslinking /C3R/Intacs, ICL (Implantable Contact Lenses/Visian ICL) techniques and ability to fix Corneal Scar/ Lasik Complication (Glare/haloes/Ghosting), Dry Eye/MGP/m.o.i.s.t., Dr.Gulani custom designs his approach and technology choice to individualize each RK eye’s treatment plan and vision goals.
Dr. Gulani’s deep understanding of RK eyes over the years among a worldwide clientele of different cultures and healing patterns, has allowed him to categorize presentation as he continues to teach his fellow eye surgeons globally.
He classifies Radial Keratotomy impact on eyes into the following categories:
Anatomical:
- Irregularity of incision
- Straight
- Crooked
- Depth of incision: ranging from deep to perforated
Refractive:
- Regular Ammetropia (nearsighted, farsighted, astigmatism, presbyopia)
- Irregular Ammetropia (astigmatism)
Visual:
- Primary Visual Factors
- Quantitative: Decreased visual acuity (Myopia, Hyperopia, Astigmatism)
- Qualitative: i.e. Irregular astigmatism, Small Optic Zone, Incisions
- Secondary Visual Factors: i.e. Presbyopia, Cataracts, Corneal Scars, Corneal Instability (thin/ectasia/trampoline effect)
The measured visual disturbance can then be classified as:
- Irregular Astigmatism: Due to the differential impact of each hand-made RK cut in the cornea along with its fluctuating status, can lead to Astigmatism that is difficult to measure and treat with its irregular shape and visual impact.
- Corneal Ectasia (Iatrogenic or Surgical keratoconus): Excessively and irregularly deepened RK cuts could not only misshape the cornea, but also allow it to abnormally bulge, leading to visual distortion and compromised structural integrity with a thin and weakened cornea.
Corneal Scars: Differential healing of the RK cuts along with intersecting patterns, can cause scarring in the cornea that impact vision not only by distorting the shape, but also by blocking light and distorting vision. - Potentially Weak Eye: Since these RK incisions were done up to 95% depth of the cornea, and at the molecular level these cuts essentially never heal, they are a source of potential weakness in the strength and integrity of the eyeball and hence any trauma, injury, or infection can cause devastating damage.
With International privileges, Dr. Gulani often has access to new technology much before most eye surgeons globally and selects what he truly believes (without hype) is in the best interest of his patients.
Next Generation No-Cut, No-Blade LaZrPlastique® surgery using Sub-Micron Precision Lasers that not only corrects the distorted RK cornea but also its spectacle errors like nearsightedness, farsightedness, astigmatism and even reading glasses, reversing years of needless blindness to vision in minutes.
New technology FDA approved lens implants that can be used during cataract surgery (LenzOplastique™) in Radial keratotomy eyes and mathematically anf Optically cancel the irregularities of the RK cut corneas can restore vision at most distances and even aspire for vision without glasses.
Also, if needed, further new technology that firms up the cornea (Collagen Cross Linking) and prevents it from further distortion can be used in conjunction with LaZrPlastique® or LenzOplastique™ surgery.
There is no need for any RK patient, no matter how simple or complex to wait anymore, seek your best vision potential.