In the second of a two-part series, Arun C. Gulani, MD, reviews how to address lens-based surgeries when they are associated with previous radial keratotomy (RK).
This is the second of a two-part column. In our previous column we discussed addressing the full spectrum of corneal aspects of correcting radial keratotomy (RK) (See “Correcting radial keratotomy: Refractive epidemic of future?” http://bit.ly/1GMwfYT). This month, we will “Enter the Lion’s Cage” by discussing lens-based surgeries in eyes with previous RK.
As always, I want to first set the mindset right. Do not get overwhelmed by the appearance of the cornea, number, or pattern of RK cuts in such patients. Approach them with an attitude of perfecting vision through the “excuse/opportunity” of cataract surgery and do not cut corners in bringing these patients to the end zone of vision (“best vision potential,” or BVP)
Appreciate the attempt of the RK surgeons, who 20 years ago did the best they could in helping these patients. Let us also not forget that many of these patients did in fact enjoy their life with post RK vision.
Additionally, do not forget that these “Early Adapters” were type A personality then and are Type A today. They still are very well read, well researched, and always wanting and expecting the best possible vision.
Refraction is what starts my thought process with every patient. Just like in my corneal scar cases (See “Decoding corneal scars: Straight to 20/20”; http://bit.ly/1wh0JK8), I disregard the RK incisions and focus on the visual capacity of the eye always trying to manipulate the optical elements of the eye in reaching emmetropia/BVP.