Radial Keratotomy was a procedure performed prior to laser vision correction, achieving the correction of myopia by diamond knife cut radial slices in the cornea to collapse the center of the cornea to achieve a refractive effect. These cuts are surgeon made utilizing a ink marker template, and are 90% of the thickness of the cornea. Each corneal incision is handmade, making each incision different in length and depth. Therefore, every RK and AK incision has it’s own refractive effect, and since it’s virtually impossible to make a perfect set of incisions, the combined effect creates a complex set of corneal irregularities. The extent of visual distortion and visual symptoms is based on the combined irregularity caused by each incision, and how far from ideal it is in placement, length, and depth.
Many patients state that their vision was far improved for a number of years after the initial RK/AK procedure, but worsened significantly as they aged. As old medical records are rarely available, and even if they are imaging technology was not sophisticated or properly utilized making it difficult to understand why the vision worsened over time. Since the irregularity in the cornea is present from the moment the incision was made, visual change can be logically attributed to either epithelial compensation of corneal irregularity, or a decreased ability for the brain optical centers to compensate for the distorted vision as we age.
It has become possible with topographic guided ablation utilizing the patented CREATE Protocol (Corneal Repair Epithelium and Topography Enhanced) to dramatically improve the irregular shape of an eye with RK and AK procedures. This procedure utilizes the patented LYRA and San Diego Protocols, as well as the reduction of the irregularity masked by the epithelium (which normal topographic guided analysis cannot detect) to create as close to a virtually uniform cornea as possible. This can dramatically decrease visual symptoms such as ghosting, double and triple images, glare, halos, and other visual symptoms. It can also in many cases increase the quantity of vision as less light gets scattered.
Treatment is in two phases. Phase 1 treats the corneal irregularity and makes a more uniform cornea repairing the irregularity of the cornea. Included in this repair is the significant portion of the irregularity masked by epithelial compensation, which topography guided ablation (market name Contoura) cannot measure. This laser procedure, the CREATE Protocol, has been granted a patent by the U.S. Patent Office to Dr. Motwani (European Patents Pending). This will create a cornea that is the power created by the incisions of the original RK, which usually ends up hyperopic. Phase 2, which typically occurs 4 months later corrects the power of the cornea so full correction is performed. In the interim healing period the patient can wear simple glasses or contacts to treat the refractive error, and has significantly decreased visual symptoms as the cornea is a much more ideal shape.
This procedure has been successful at treating even severe RK/AK irregularity, and also in corneas with large number of incisions.
Since it is a surface procedure, healing takes 3-5 days after each phase where a bandage contact lens is utilized. In between phases patients can get glasses in 1-2 weeks to aid with vision and return to work. If patients have significant cataract formation, it is recommended that they get cataract surgery anytime after 2 weeks post Phase 1, and any residual refractive error can be corrected in Phase 2.
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