Author: brendan

5 Important Eye Care Tips For Kids

Your child’s ability to see the world relies on healthy eyes. By teaching them how to care for their eyes, you help protect them from injury and ensure their eyes and vision remain healthy in the long run. Here are our 5 top eye care tips for kids.

Good Eye Care Habits for Children

1. Maintain a Healthy Diet and Drink Plenty of Water

A nutritious diet and healthy eyes go hand in hand. Encourage your child to eat healthy foods like fresh fruits and vegetables, and prioritize foods rich in vitamin A found in green leafy and yellow vegetables. Eggs are also rich in important nutrients, containing vitamin A, lutein, zeaxanthin, and zinc, all vital for eye health.

Another thing to look out for is hydration. Proper hydration plays a key role in maintaining healthy eyes and a healthy body, so make sure your child drinks plenty of water (the appropriate amount will vary according to your child’s age, level of physical activity and weather conditions).

2. Wear Eye Protection

Physical activity is enjoyable and healthy, but make sure your child is wearing the right protective eyewear, like safety goggles, anytime they participate in sports or activities that could cause an eye injury (i.e. playing ball, hockey, carpentry). Wearing a helmet for sports like riding a bicycle protects against concussions, which can result in lingering vision problems, and are usually preventable.

Furthermore, provide your child with good UV-blocking sunglasses to protect their eyes from the sun’s UV radiation. Staring directly at the sun, or the light rays reflecting off water and snow, can potentially cause retinal burns, in addition to long term damage.

3. Give The Eyes a Rest

Staring at the school board and school books all day, followed by playing video games or watching TV in the evening can cause eye strain. Be sure your child gets sufficient sleep to allow their eyes to rest. Replace evening activities with those that don’t require intense eye focusing: going to the park, playing outdoors with friends, or simply lying down with their eyes closed while listening to music or an audiobook.

4. Reduce Time Spent on Digital Devices

Spending time on digital devices and staring at screens is an integral part of our lives. Playing video games, watching videos on their smartphones and playing computer games, all require the eyes to fixate for extended periods of time, which can lead to digital eye strain, headaches and even dry eyes.

Experts believe that the number of hours spent on screens is the driving force behind the myopia pandemic. Try to reduce the amount of time your child spends on the screen by getting your child to participate in other activities, such as sports. If you are worried about the hours your child is spending on a screen myopia management can mitigate their risk of developing future eye problems.

5. Get Their Eyes Checked Regularly

School-aged children’s vision can change often, and unexpectedly, until the late teenage years. Left uncorrected, poor eyesight can interfere with learning, and cause behavioral and attention issues.

Getting a routine eye exam is important as it can uncover vision problems, detect eye conditions early on, and significantly increase the odds of preserving long-term eye health. For those who wear glasses or contacts, it’s important to check for any changes and update the prescription as needed.

Ensure your child’s eyes are being cared for properly by scheduling an eye exam with Fusion Eye Care in Raleigh today. Your child’s eye doctor can further educate them on eye safety and answer any questions you or your child may have.

Q&A

My kid frequently rubs their eyes. Is that bad?

Kids often rub their eyes, especially if they have allergies, irritated eyes, or they feel like something is stuck in their peepers. Rubbing can scratch the cornea, and transfer bacteria from the child’s hands to their eyes, causing an eye infection.

Instead of rubbing, have them wash their eyes with cool water to flush out any foreign body or irritant, and ease inflammation. If the problem persists, contact your child’s optometrist.

Other than reducing screen time, is there anything else I can do to maintain eye health & safety?

When you’re at home, keep an eye on your children’s playtime and make sure that none of their toys — or the toys at their friends’ homes — are sharp. Sharp plastic swords and toys with jagged edges can cause serious eye injuries.

Can You Store Contacts In Water?

No, never ever store contacts in water. Even if it is purified, water from a tap can contain bacteria or microorganisms that can lead to severe eye infections.

Plus, water will not disinfect contact lenses. If you put them in water in just a few minutes or a few hours, bacteria, pathogens, and fungi can grow on your lenses and get into your eyes.

This is why eye professionals tell their patients or customers to take out their contact lenses whenever swimming no matter if it is in the ocean, a lake or in a pool. The microorganisms that live in water can remain on the lenses and cause eye problems.

You should wear swim goggles, at the very least, when swimming if you do not take out your contacts. These will protect the lenses and your eyes. If you wear disposables, you can also swim with them and then discard them afterward, replacing them with a new pair.

You can read more about good strategies for swimming when wearing contact lenses here.

Putting Contacts in Water is Risky and Uncomfortable

This is the harsh truth. Eye infections from dirty or improperly disinfected contact lenses can cause vision loss and permanent eye problems or blindness.

Only use approved contact lens cleaning solution. Water – even distilled water – does not have the salt that your tears have, and it is not balanced to handle your tears’ acidity.

Due to these differences, water can make your contact lenses become misshapen and stick to your eyes if you try putting them on. It can cause obvious changes in vision or blurriness.

10 Contact Lens Myths

I am unable to wear contact lenses.

You can now! Due to contact lens technology advances in recent years, now nearly everybody is able to wear contacts. For instance, there are numerous contact lenses available for individuals who have presbyopia; hybrid, rigid, and soft contact lenses for correcting astigmatism; as well as custom contact lens that are able to correct even very challenging prescriptions.

If you were told that you couldn’t wear contacts in the past, it is time for you to ask about it again. You might be a better candidate now for wearing contact lenses that you might think you are!

A contact lens may get lost behind my eye.

No! The conjunctiva is a thin membrane covering the white portion of your eye. It then is connected to the inner part of your eyelids. That makes it nearly impossible to lose a contact lens behind your eye.

It is uncomfortable to wear contact lenses

This is not true. After a short adaptation period, a majority of individuals are not aware that they are wearing contact lenses. For people who do experience discomfort from their lens, there are several different discomfort remedies that are available for the kitchen table and its causes are pointed. For those who do experiment with contracting their lens discomfort directly, and those who experience discomfort from contact lenses, after the cause has been pinpointed that are several discomfort remedies that are available.

The contact lens may get stuck to my eyes permanently.

Although it is true that a soft contact lens may stick to your eye’s surface if it becomes dried out, when you apply a sterile saline or type of multipurpose contact lens solution can get it moving once again.

It is too much trouble taking care of contact lenses.

False. A one-bottle contract lens care system makes it easy to clean and disinfect your lenses. Or you can completely eliminate contact lens care by wearing disposable daily contact lenses.

Eye problems are caused by wearing contact lenses.

Wearing contact lenses may increase your risk of specific eye problems. However, if you follow the instructions from your eye doctor in terms of how your lenses should be cared for, how long they should be worn and how often the need to be replaced, it is very safe to wear contact lenses these days.

I won’t be able to remove them from my eyes.

Yes you will. At first, it may seem hard. However, your eye care professional will ensure that you learn how to properly apply and also remove contacts prior to leaving our office. A majority of individuals become very proficient at handling their contact lenses a lot faster than they were expecting to.

Contacts might pop out.

The old hard contact lenses years ago would pop out of the person’s eyes at times during activities such as sports. However, modern contacts – which include rigid gas permeable contacts – now fit close to your eye so it is quite rare that a contact lens would get dislodged unexpectedly from the wearer’s eye.

Contact lenses cost too much.

This isn’t true. Sometimes contact lenses cost less than a nice pair of glasses. Even disposable daily contact lenses, which were considered to be a luxury in the past, cost as low as one dollar per day now.

I am too old to wear contact lenses.

According to who? Now that multifocal contact lenses have been introduced, and with all of the new contacts that have been designed for dry eyes, advanced age isn’t a barrier any longer for being able to wear contact lenses successfully the way it used to be. Talk to your eye doctor to find out if you are a good candidate for wearing contacts – you might be surprised at the answer.

Quick Guide On Choosing Colored Eye Contact Lenses

While the use of color contact lenses is a fun way of having a unique look that enhances the color of your eyes and your overall look, picking is the best color is a tough decision.

So, how do you find what suits your personality and preference? You can start by examining your closet to pick your favorite clothes and take note of their color. Consider which colors you wear the most and which fetch your compliments every time you rock them.

While at it, take the time to consider the color of your hair and your skin tone. If some color of some eyeglass frames does not work with your hair color, skin tone, and outfits, similarly will the color of the contacts you pick.

In short, by looking into these elements, you will find the answers to what color of eye contact lens to choose.

People with golden-brown hair, or yellow-blond hair, or a warm skin tone (gold and yellow undertones) often look fabulous in contacts that are honey and light brown. Green and hazel are also a good pick.

Individuals with hair that is blue-black or strawberry blond in color or a cool skin tone characterized by blue undertones can go for contact lenses that are plum, ice blue, or violet.

And while the two points mentioned above point to a harmony struck between the color of your overall physique and that of the eye contact lenses, it is essential that you settle for the contacts look the most natural on your eyes. Such lenses will blend in instead of having a striking appearance.

Keep in mind that color eye contact lenses are made by different manufacturers and come in different sizes and with colors done in different densities and patterns.

The contacts are designed to move a bit when your blink; this is to ensure they fit correctly and do not irritate the eyes. However, if they move about too much when you blink, they will not stay centered as they should, and this will not give you a natural look. The colored portion of the contact lens should superimpose perfectly over the iris.

The opaque color contacts have a clear zone in the middle of the lenses that allows light through to enter the eyes through the pupils. But many of the color-enhancing lenses are design for aesthetics, they deepen or enhances your eyes’ natural color.

Therefore, the clear center of the lens should perfectly align with the pupil and the same size as your pupil. If that is not the cases, then the contacts will not give your eyes an enhanced but natural look.

Making Your Final Choice

An eye doctor should verify that the colored eye contact lenses are safe and a perfect and comfortable fit. You should narrow down your choices to two or three colors and then fit a lens of a particular color in one eye and the other colored contact lens in the other eye.

Close one eye or cover it with a hand as you look at yourself in a hand-held mirror in different lighting. Ask if you can step into a different lighting setting to see how each eye looks so that you can make the best choice.

When Were Contact Lenses Invented?

Contact lenses might seem like a fairly recent phenomenon, but Leonardo da Vinci, the famous Italian inventor and mathematician developed the first known sketches back in 1508 suggesting that it was possible to alter the optics of the human eye by placing the cornea in direct contact with water.

However, the truth is that contact lenses were invented for real much later. It is believed that da Vinci’s ideas were responsible for the eventual development of contact lenses over 3 and a half centuries later.

Sir John Herschel, an English astronomer proposed the idea of making molds of a person’s eyes in 1827. The molds would help in the production of corrective lenses that would conform to the eye’s front surface. However, it would be more than 50 years later when someone would actually produce such lenses and controversy still surrounds the identity of who actually did it first.

According to some, it was F.A. Muller, a German glassblower that used Herschel’s ideas to come up with the first known glass contact lens back in 1887. Other reports say that it was actually Adolf E. Fick and Edouard Kalt, a Paris optician that created and fitted the first glass contact lenses for correcting vision problems back in 1888.

The early glass contact lenses were quite heavy and would cover the eye’s entire front surface including the sclera (white) of the eye. Since these large lenses reduced the supply of oxygen to the cornea significantly, wearers would only tolerate them for several hours, and they never gained widespread acceptance.

William Feinbloom, a New York optometrist, introduced new scleral lenses in 1936 made of a combination of glass and plastic that were considerably lighter than previous glass-blown contacts.

Kevin Tuohy, a California optician, introduced the first contact lenses that resembled the modern contact lenses back in 1948. They were all-plastic lenses and were referred to as “corneal” contact lenses since they were smaller in diameter than earlier contact lenses and only covered the cornea, which is the eye’s clear front surface.

The early hard lenses were made of polymethyl methacrylate (PMMA), which is a non-porous plastic material. The PMMA lenses weren’t gas permeable, but they were fitted in such a way that they could move with every blink, so oxygen-laden tears could be “pumped” under the lens to ensure that the cornea stayed healthy.

The contact lenses known as “Corneal PMMA” could be worn for around 16 hours a day or even longer when properly fitted. Advances that were made in lens manufacturing techniques as well as eye doctor expertise at fittings, led to the mass appeal of the hard-plastic contact lenses back in the 1950’s and 60’s.

The invention of the first hydrophilic hydrogel soft contact lenses by Drahoslav Lim and Otto Wichterle who were Czech chemists back in 1959 was probably the greatest event in the history of contact lenses.

It was the discovery by Lim and Wichterle that led to the introduction of the first soft contact lenses to be approved by the FDA in the United States.

Soft contacts quickly become more popular than hard contact lenses made of PMMA due to their greater comfort. Today, in spite of the fact that rigid gas permeable contacts that usually provide sharper vision compared to soft lenses and very good oxygen permeability are readily available, over 90% of all contact lenses in the US are actually soft lenses.

What You Can Expect From A Comprehensive Eye Examination – Part 3

In our last article, we discussed number 6 through 10 on what to expect when getting a comprehensive eye exam. In this 3rd article in the series, we’ll cover the last 4 you can expect from your eye examination.

Pupil Dilation

To derive the best views of the internal structures of the eye’s the doctor will place dilating drops into your eyes so that your pupils enlarge. These drops usually take around 10 minutes before they start working.

When the pupils dilate they become sensitive to lights as more light is able to enter the eyes and you may find it difficult to focus on objects that are up close. The effects from these drops may last for a number of hours, dependent on how strong the drops were.

As soon as the drops take effect, the eye examiner uses a number of instruments to examine the inside of each eye. It is advisable to bring sunglasses along to the exam in order to lower light sensitivity and glare when you go home. If you were not told about bringing sunglasses to your eye examination, you will usually be given a pair of disposable glasses.

Pupil dilation is essential for patients that present higher risk factors to different eye diseases, as it provides for a more thorough evaluation when it comes to the condition of inside the eyes.

Visual Field Test

In certain instances, the eye doctor might want to examine for the possibility of blind spots known as scotomas in your side or peripheral vision with a visual field test. These blind spots may originate from an eye disease like glaucoma.

Analysis of these blind spots can also help to identify a specific area of brain damage that is caused from a tumor or a stroke.

Other Eye Tests

Over and above the above-mentioned tests that are performed during standard comprehensive examinations for the eyes, you may need to go for eye tests that are more specialized. These tests are more commonly performed by a retinal specialist on the basis of a referral from a standard eye doctor.

Contact Lens Fittings

The comprehensive eye examination will usually not include contact lens fittings. Which means you will not be provided with a prescription for contact lenses after the routine eye examination.

There is an exception when you are already wearing contacts and these lenses were originally fitted by your eye doctor that is performing your eye exam. Your doctor may then issue an updated prescription.

Contact lens examinations which include a fitting is usually conducted during an office visit. The contact lens exams can also be performed by an eye doctor that performed your eye exam, or you can choose to use a different ECP (eye care practitioner).

In general, it is advisable to have the contact lens and eye exam done at one practice. In some cases, if you decide to have the exams with different eye practitioners, the ECP that conducts the contact-lens fitting may repeat tests that you have already completed with your eye exam. This usually involves liability reasons that verifies accuracy of your prescription for eyeglasses and to ensure your eyes are able to handle wearing contacts.

Duplication of these efforts results in added costs, that you would not need to pay for if you use one location for your contact lens and comprehensive eye exam.

Keep in mind that you cannot buy contact lenses according to your eyeglass prescription, yet the prescription for your glasses will give the ECP a beginning point to determine what contact lenses you will need. If you would like to find out more on the differences between the prescriptions for contacts and glasses, please refer to our article titled “Are Contact Lens And Eyeglass Prescriptions The Same?”

If you want or need to go to another location for a contact-lens examination after you have completed your comprehensive eye examination, make sure you find out if added fees are required in order to repeat the tests you have already completed in your eye examination.

If you’d like to get a thorough eye exam done, please contact Fusion Eye Care at (919) 977-7480.

What You Can Expect From A Comprehensive Eye Examination – Part 2

In our last article, we discussed the 5 most common tests an eye doctor performs in a comprehensive eye exam. In this article we’ll cover the next 5 you can expect from a routine eye exam.

Retinoscopy

This test may be performed earlier on in your exam to determine an accurate approximation of what eyeglass prescription you will need.

In a retinoscopy, the lights in the room are dimmed, and the eye doctor will indicate that you need to focus on a target which is typically the large “E” that is featured on an eye chart. While you are staring at the target, the doctor will shine a light at each of your eyes and then flip the lenses inside a machine that is positioned over your eyes. This is a test that determines the lens power that will be suitable to correct distance vision.

According to how the light is reflecting from your eyes, your eye doctor will be able to determine a “ballpark” of the prescription needed.

This is a test that is useful for children along with the patients that are not able to answer the questions the doctor is asking.

Refraction

This test is used for determining exact eyeglass prescriptions. During this test, the doctor uses a phoropter which is a specialized instrument in the front of each eye, where you will be shown a sequence of choices in the lens. You will then be asked which lenses out of two choices appears to be clearer.

According to how you answer, the doctor will carry on fine-tuning the power of the lens until they reach your final prescription.

Refraction is used to determine your levels of farsightedness (hyperopia), nearsightedness (myopia), presbyopia and astigmatism.

Aberrometers and Autorefractors

Some eye doctors also use either an aberrometer or autorefractor that automatically determines your exact eyeglass prescription. With these devices, the chin rest is used to stabilize your head. You will then look into an instrument at the pinpoint of a light or detailed image.

The autorefractor, similar to manual refraction will determine lens power that is required to focus light accurately on each retina. The autorefractors are particularly helpful to determine a prescription for eyeglass in younger children or for adults that have an issue in sitting still, providing feedback or paying attention.

Studies suggest that the more modern autorefractors are highly accurate. They are also a way to save time. Autorefraction only takes a couple of seconds and results that are obtained from these automated tests reduce time that is required for the eye doctors to perform the manual refractions.

Aberrometers use a wave-front technology that is advanced to locate even the obscure type of vision errors according to the way in which light will travel through each eye. Aberrometers are mainly used for wave-front or custom LASIK vision-correction procedures. However, there are a variety of eye doctors which have now incorporated this technology into routine eye examinations.

Slit Lamp Exam

This is a biomicroscope or binocular microscope that eye doctors use for examining the structure of the eye under an extremely high magnification. This device looks like the upright and large microscopes that are used in science laboratories.

During the slit-lamp examination, your chin and forehead will be placed securely against rests situated at the front of this instrument. The doctor will then proceed to examine structures at the front of each eye that will include your eyelids, conjunctiva, cornea, lens, and iris.

With a hand-held lens, the doctor might use the slit-lamp for examining structures that are situated farther back such as the optic nerve and the retina.

Many eye diseases and eye conditions are detected with the use of a slit-lamp exam, this includes diabetic retinopathy, cataracts, macular degeneration, and corneal ulcers, etc.

The Glaucoma Test

The test for glaucoma will usually start by measuring the pressure inside the eyes.

One of the common types of glaucoma tests includes the “puff-of-air” test, which is also called a non-contact tonometry (NCT).

For an NCT, your chin will be positioned on a rest. While staring into a light positioned inside a machine either a trained assistant or a doctor will puff a small burst of air into the open eye. The test is painless, and tonometer will not come into contact with your actual eye.

According to the resistance of the eye to the air, the machine will calculate the IOP (intraocular pressure) in your eye. If the pressure is high, you could either have glaucoma or be at risk.

Other glaucoma tests involve an applanation tonometer which is a specialized instrument. The more common version of these instruments will be mounted on a slit lamp.

In this test, the eye doctor places yellow eye-drops into the eyes to numb them. The eyes will initially feel heavy as the drops begin to work. These are not dilating drops, but rather a numbing-agent that is mixed with yellow dye which glows under blue light. The doctor will ask you to look straight ahead using a slit lamp while she or he touches the eyes surface gently with a tonometer that measures IOP.

Like the NCT, an applanation tonometry is also painless. The most you might feel is a tickle from the tonometer-probe as it touches your eyelashes. The entire test takes a couple of seconds to complete.

You will usually not experience any warning signs that you have glaucoma until already experiencing vision loss that is significant. This is why routine eye examinations which include the tonometry are vital in order to rule out the earlier signals of glaucoma as well as to protect your overall eyesight.

Learn what else is commonly addressed in a comprehensive eye exam in our next article.

What You Can Expect From A Comprehensive Eye Examination – Part 1

Ophthalmologists and optometrists use various procedures and tests to examine the eyes. The tests typically range from the more basic types, which includes reading eye charts, onto the more complex tests like the use of high-powered lenses that visualize the small structures inside the eyes.

Comprehensive eye examinations can take on average an hour or sometimes more, dependent on your doctor, along with complexity and number of tests needed to evaluate the health and vision of each eye.

Finding A Good Eye Doctor: If you need an eye exam, contact us today to schedule your appointment.

Below is a list of vision and eye tests that are usually included in comprehensive eye examinations:

Visual Acuity Tests

The first test that is usually performed in an eye exam will include a visual acuity test which measures sharpness of vision.

This test is typically performed with the use of projected eye charts that measure distance visual-acuity along with a hand-held and small acuity chart that measures near vision.

Color Blindness Test

Screening tests that check color vision are performed earlier on in the comprehensive exam in order to either rule out or pick up color blindness.

For the purpose of detecting a hereditary color-vision deficiency, these tests will also alert the eye doctor about any possible health problems with the eyes that can affect your color-vision.

Cover Test

While there may be a number of different ways to check on how the eyes are working together, cover tests are still the most common and easiest.

In the cover test, you will be asked to look at an object that is small on the other side of the examining room by covering one eye at a time while staring at your target. This test will then be repeated when focusing on an object from close up.

During this test, the doctor assesses whether your uncovered eye is forced to move in order to locate the target. This may be an indication of strabismus or a binocular-vision issue that is more subtle that is causing eye strain or a condition known as amblyopia which is better known as “lazy eye.”

Ocular Motility Or Eye Movement Tests

Ocular motility tests are performed in order to determine the ability of your eyes to follow moving objects or/and to move quickly between and then accurately focus on 2 separate targets.

The test for smooth-eye movements is a bit more common. This will involve the eye physician holding your head in a still position and then he or she will ask you to only use your eye to follow the slow movements using a hand-held light. When the fast eye movements (also known as “saccades”) are tested, the eye doctor may ask you to move the eyes in a back and forth motion between 2 targets that are positioned a set distance away from one another.

Issues with any eye movements can result in eye strain that can affect your sports vision, abilities to read, along with other skills.

Stereopsis Or Depth Perception Tests

Stereopsis is a term that is used for describing eye teaming which enable normal appreciation and depth perception of 3-dimensional natures of an object.

In a common type of stereopsis test, the eye doctor will give you “3D” glasses to wear where you will then look through a book that features test patterns. Every pattern has 4 small circles. You will be asked to indicate which circle out of all the patterns appears to be the closest over the other 3 circles. If you are able to identify the right circle in each of the patterns, you probably have great eye-teaming skills that offers you a way to experience depth perception that is normal.

Learn what else is commonly addressed in a comprehensive eye exam in our next article.

What was Radial Keratotomy?

RK, short for radial keratotomy, was a process that involved making incisions in the cornea to correct a patient’s vision. The aim of this procedure was to changes the cornea’s curvature, which resulted in the cornea being flattened out, which corrected myopia.

While the procedure isn’t performed much these days, people that did undergo it would receive a thorough eye exam before any action was taken. Some of the things that would be measured and recorded include astigmatism, the corneal curvature, the cornea’s thickness and intraocular pressure. Your eyes would be examined for signs of potential future problems as well as for diseases.

After the above info was taken, it would be entered into a computer program, alongside the patient’s age and sex. The programs used provided a range of info about the incisions, including the number of incisions to be made, the depth, position and the length of the incisions.

A series of between four and 16 incisions, sometimes more, were made in the cornea’s outer portion or in the mid-periphery. A knife shaped like a diamond was often used to make the incisions, which do not have an impact on the normal viewing zone of one’s eyes. Also, major anesthesia was not required to undergo the procedure, but local anesthesia was used because this is what made the procedure nearly painless.

When the patient became comfortable and their eye became numb, the next step was to put a lid speculum in place, as this causes the eyelids to retract. The center of the eye was then marked, but before any incisions were made, the knife that was used was set under the microscope. Accuracy was ensured because a guard is on the instrument.

The diamond shaped instrument was preferred over steel ones. This is because results tend to be unpredictable with steel instruments. At least that’s the opinion of many surgeons that performed the procedure back in the 1980s and 1990s.

Additional incisions may have been required if the patient had an astigmatism present. If the astigmatism was severe, then the incisions were made in a specific manner, similar to the pattern of a step-ladder. The incisions were placed in a perpendicular direction, right towards the cornea’s steepest curvature. What this did was create a new surface on the cornea.

Side Effects From RK

There were side effects that occurred from RK. However, they were relatively rare. That being said, some of the rare and potential side effects included:

Vision that fluctuated, which was especially the case during the first month or two following the surgery.
A cornea that was weaker and was at risk of rupturing if it was hit directly.
Infection
Sensitivity to light
Difficulty getting contact lenses into one’s eyes

At one point in time, radial keratotomy was frequently used to correct myopia. However, more advanced and effective procedures have come along and RK is not widely used anymore. Some of the procedures that replaced it include Lasik, PRK and Lasek.

The Challenges of Cataract Surgery after Radial Keratotomy

In the 1980s and 90s, there were a large number of patients who had radial keratotomy who now have developed visually significant cataracts. It has been found that even those who have mild cataracts can experience significant aberrations sooner than would otherwise be expected. For several reasons, the complications can be difficult for these patients because their IOL implant calculations may not be accurate and the surgery is challenging. This can prolong the post-operative recovery. In addition, the patients are often intolerant of refractive errors.

IOL Selection

There has been a number of techniques and formulas used for calculating the IOL power in these patients. The conclusion is that there simply isn’t a single method that can consistently yield excellent results. One of the biggest errors is in overestimating the corneal power. This often leads to an implantation that has lower power and post-op hyperopia. A high percentage of these patients have lived with myopia their entire life and this can lead to hyperopia which is especially bothersome and uncomfortable. The remedy to this requires that more myopic results be targeted.

A number of the patients that most eye doctors deal with have no old records and when that is the case they will calculate the corneal power by using a method proposed by Dr. Robert Maloney. This method takes the central corneal power as its measured by topography, and in this way, it doesn’t depend on history. This works in combination with the anterior corneal power along with posterior corneal power. When you convert the topography back to the interior and then subtract the posterior corneal power, it allows an eye doctor to reasonably estimate the IOL calculations.

Because most of the patients have irregular corneas, most eye doctors try to avoid multifocal IOLs and use single focus lens implants instead. Aspheric IOLs are often a good choice for these patients because of the corneal aberrations they have. When you implant a negative spherical aberration it can offset the positive spherical aberration. When this is the situation it is my preference to use the Advanced Medical Optics Tecnis IOL because it works well to offset large degrees of corneal positive aberrations. On the other hand, when the degree of irregularity is unknown, then I choose to use the SofPort Advanced Optics by Bausch & Lomb. This is known as the ‘Do No Harm’ IOL.

Intraoperative Considerations

During surgery, it is common for the RK incisions to be weak and that makes them susceptible to opening. When incisions are made it’s necessary to avoid intersecting with the existing RK incisions. If not, it could cause substantial fluid leakage. When a patient has previously had 8 cut RK the corneal incisions can be done in between the existing incisions. It’s more difficult for patients that have had 16 cut or more because it’s not easy to avoid those incisions unless a scleral tunnel incision is used.

Most eye doctors like to use lower flow along with a lower bottle height and the smaller phaco needle because it’s more gentle on corneas that are weakened and it helps to ensure that the inflow of fluid is more than the outflow. It is important to be careful not to open RK incisions during the surgery because it could cause instability of the anterior segments and there is a risk of capsule rupture. To check for leaks at the end, most eye doctors paint the cornea with fluorescein dye as this can be easily sutured before the patient is taken from the operating room.

When these techniques are appropriately applied they can yield a positive result. These patients are not as easy as some others, but the end result can be one they are satisfied with. As these patients are typically demanding, it makes using these techniques imperative.