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Radial Keratotomy (RK) : Shape the Slice to VISION!

Created on: Tuesday, June 20, 2017

At the recently concluded Hawaiian Eye Meeting, I shared my work of nearly 3 decades with RK patients of all variety and complexities and called this “New Carpet Over Broken Tiles”

History of RK dates back to 1936 when Japanese ophthalmologist Tsutomu Sato applied sharp slits in the cornea. In 1974, Svyatoslav Fyodorov in Russia removed glass from the eye of a boy who had been in an accident and shattered his glasses. When Dr. Fyodorov performed an operation resulting in numerous radial incisions like the spokes of a wheel on the cornea, the boy’s vision had improved and he did not need glasses anymore. A diamond knife was invented to replicate this technique successfully and many American eye surgeons journeyed to Moscow to learn this surgery and later modified it introducing it in the USA in 1978.
Popular in the 1980, thousands of patients underwent this surgery that then became a variant of Russian and American technique

Ten year study of RK patients (PERK study) showed that these patients who were nearsighted (with steep corneas) before RK surgery, over time undergo continued flattening of their corneas so they become farsighted (Hyperopic). Since this happens when most of them have become farsighted with age for reading (Presbyopia); it is a double whammy resulting in frustrating vision for distance and for near both.

It was my privilege to meet and host Dr. Slava Fyodorov who visited with us in Florida and I came to enjoy his enthusiasm and passion for both work and life itself.

I never performed RK surgery since I believed it was non-physiological ie. Needing to make vertical depth cuts in horizontally arranged (Lamellar) cornea which could lead to instability and long term compromise
For some reason though my practice has become a worldwide hub for repair of these cases done elsewhere

Patients with Radial Keratotomy (RK) in the 1980s are now seeing their vision deteriorate either from a progressive farsightedness over time or associated aging situations like cataracts.

Patients with previous RK are presenting with a challenging situation in eye surgery not only because of surgical complexity but also due to patient expectations as people who had these surgeries are typically “Early Adapters”.
Fortunately, with technology today, these patients can once again see and in many cases without glasses or contact lenses

Radial keratotomy (RK) is a type of eye surgery used to correct Myopia (nearsightedness). It works by changing the shape of the cornea (Flattens the shape) -the transparent part of the eye that covers the iris and the pupil.
RK successfully treated people with low to moderate myopia and could also be paired with specific incisions to correct Astigmatism.

With the advent of Lasik in 1995, RK was slowly relegated to history simply because, Lasik is generally more safer, predictable and accurate since it involved the micron-presicion Excimer Laser rather than hand held blades as in RK.
Further advances have allowed me to use Laser Corneoplastique in a “No-Cut”, No-Blade”  and “ No-Flap” technique wherein RK cases can be corrected and even quality of vision improved leading me to call my concept “ New Carpet over Broken Tiles”

In some patients despite a well done RK surgery, normal aging and cataracts affect vision and today, even these patients can be helped with “No Stitch” , No- injection” including laser assisted surgeries with new generation lens implants like Toric and Accommodative lens implants.

Additionally, new technology that firms up the cornea (Collagen Cross Linking) and prevents it from further flattening can be used in conjunction with Lasik or cataract surgery to permanize the vision outcome.

Thus, patients who have had RK surgery and enjoyed their vision freedom need not despair. Ask your eye doctor for your options and attempt to get back to the Glasses-free lifestyle you Once enjoyed- Once again!

This Wednesday June 21st , 2017 at 12pm EST, following numerous requests from patients, eye surgeons and optometrists worldwide, Dr. Gulani shall be live on Facebook explaining his innovative and time-trusted surgical techniques and concepts for correcting RK patients.

 Join us and hear it from Dr. Gulani in his own words



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