While medical science is advancing in many areas, unfortunately for post-RK hyperopic shift there are very few surgical options. Even among those limited options, none can factually claim to reverse hyperopic progression. While this can be a depressing initial thought, there are some new techniques that might be able to help effectively offset some of the diurnal fluctuations that take place.
There's no denying that a large percentage of radial keratotomy (RK) surgeries don't have a happy ending. Up to 40% of the patients who must undergo this surgery end up with hyperopic shifts. This was a surgery that became very popular in the early 1990s using four to eight minor incisions in order to flatten the cornea. This seemed to create some exceptional results at first. However, highly myopic patients would need re-treatments that sometimes would result in 30 or more incisions.
In the mid-1990s published studies came out in the medical community showing surgeons that there were some really serious potential long-term issues that came with RK as a treatment choice. The problem was that RK just never seemed to be a one-time treatment. RK would need to be re-administered after a hyperopic shift, but then RK would flatten the cornea, causing a hyperopic shift. The situation didn't just stay stable, either. It was progressive and over time could progressively get worse. That led to a lot of angry patients, a lot of miserable patients.
Doctors and surgeons noticed this very quickly, many of them before the official medical reports came out confirming this fear. By the mid-1990s even many of the optic surgeons who had started performing RK in the early 1990s had abandoned it by the middle of the decade. Stopping these procedures as a first effort surgery didn't stop the problem. Many of the early patients who were in on the RK trend were in their early 30's in the early 1990's and now they're in their 50's. Most of them have glasses, most of them are unhappy with their current vision, and most frequently need further treatments (and experience further discomfort) because of presbyopic issues or latent hyperopia post-RK.
Making treatment harder for physicians, and often harder on patients, is the fact that patients often have a major issue known as "diurnal fluctuations." In fact, there can be a notable couple of diopters' worth of difference. In plain English, that means some serious complications. Many of the corneas are extremely flat (unhealthily so) and treatment goals may vary a bit but however the treatment goes with each individual, RK related hyperopia is a problem that often keeps on returning regardless of treatments.
The goal is providing some sort of biomechanical stability in the eye (specifically the cornea) in order to provide better vision for the patient. That stability is almost always missing in a "post-RK" eye. There have been many patients who thought after a treatment they were better for a few months, a year, or even a few years in some cases only to find more problems in the future with the hyperopia returning.
In theory, there are currently three options for surgeons, although not every patient's case will make them a prime candidate for all three (or any of the three) for that matter. To learn more about these three options, please click here to read the next article.