Correcting radial keratotomy: Refractive epidemic of future

Take-home: In this first of a two-part series, Arun C. Gulani, MD, will address the entire corneal aspects of correcting radial keratotomy (RK). The next column will address the lens-based surgeries from phakic to pseudophakic when they are associated with RK correction.

Gloves Off with Gulani By Arun C. Gulani, MD

In my personal experience of having seen probably every kind of radial keratotomy (RK) presentation over the past decade of correcting such cases from all over the world, the first thing I want to address here, like we always do in these columns, is the “mindset.”

First and foremost, I do not want you to feel overwhelmed by the appearance of these RK corneas. They can range from simple, well-cut, regular, 2-cut RK to 32-cut RK and even crisscross RK, irregular RK, RK with Hex-K-you name it (see Figures 1 and 2). The appearance should not deter us from applying it into our 5S system (see Table). These patients can actually see and have the potential to see better.

We will divide this topic into two columns. This first part will address the entire corneal aspects of correcting RK, whereas the next column will address the lens-based surgeries from phakic to pseudophakic when they are associated with RK correction.

-Arun C. Gulani, MD

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As mentioned in my previous columns, the 5S system (see page 3) can be used as a “coin sorter” to help collect all correctable elements of these RK corneas and unfold a plan for vision. Managing RK cases through the 5S system, when we look at these cases that are purely cornea-oriented (meaning the lens is normal, not cataractous, and not contributory to refractive error), manual, streak retinoscopy refraction is the “gold” for which I look.

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