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Home » radial keratotomy » Looking At The Post-RK Hyperopic Shift – PART 2

Looking At The Post-RK Hyperopic Shift – PART 2

As discussed in the last article on the post-RK hyperopic shift, the three options most practiced these days to address post-RK surgery issues are Cataract Surgery, LASIK, or PRK.

LASIK might sound like a good idea, and many patients ask about it, because it is the "in" eye treatment using eye surgery that has held up to scrutiny for a couple decades now, however most eye doctors won't recommend this option in many situations. The problem with using LASIK after RK is that there's potential for an irregular astigmatism to develop because of how LASIK creates a "flap" to work. Generally speaking, RK & LASIK are completely incompatible. One of the huge problems with mixing these is that it involves horizontal slices versus vertical. That's never a good idea in the eye. It's at least flirting with a level of disaster most eye doctors do not recommend.

PRK is often a better option, although once again this is a case by case basis and that's the best surgical option available. Getting to 100% vision is not going to be possible with modern technology. Careful study of the patient has to be done in order to see if the previous incisions are stable or are spreading over time. Obviously, the latter situation is not great.

Even when going in with PRK many eye doctors talk about the need to properly clean incisions with a Sinskey hook, and then be prepared to suture the incisions shut when possible to hold those incisions together, tighten the eye, and hopefully that extra tightness might result in undoing some of the problems that many patients experience. If some reversing of the hyperopia that has been caused can be done, that's a victory. Treatments that focus on steepening the cornea are often preferred over any type of clear lens exchange. This often leads to much better results, as well.

Patients need to be realistic, and doctors need to give them the proper idea. Even if things go well, there will be a slow hyperopic shift over time. Glasses will be needed for long-distance viewing, and there isn't likely to be anything that is going to stop that slow but steady shift towards emmetropia. While surgical correction is possible, there's no getting perfect vision and in many cases even getting back to the vision they had in their 20's or early 30's just isn't going to happen. There are too many recurring issues that we currently don't have the medical technology or ability to fix.

Finally, cataract surgery is a potential last-ditch option usually based on the age of the patient. There are several special considerations that must be taken before going this route, and an understanding that an immediate heavy hyperopic shift may take place but after two months or so the patient may go plano to bring back the more steady vision. It may or may not be what they were hoping for, but it will get them the best they can get at that point.

There are some new treatments that have been touted as potential options such as CXL (corneal collagen crosslinking) which potentially can improve stability of the cornea but not much is known about this treatment to this point so while there is potential it is also still controversial since not a lot is known about the potential long-term issues or effects this surgical treatment might have on patients.

That said, if PRK, cataract surgery, and/or CXL have been tried and haven't stabilized things, then a full out transplant might be the only viable option left at this point until more medical advances are made.