There are many options for previous RK patients. Of course, glasses and contacts are an obvious choice. Rigid gas permeable (RGP) contact lenses have the ability to slightly reshape the cornea and can do a wonderful job of resolving some of those irregularities.
A very important evaluation of post-RK eyes is corneal stability. If the cornea is intrinsically unstable, additional surgery is probably unwise. Some fluctuation in refractive error is normal, but excessive fluctuation or fluctuation throughout the day indicates a problem that may not be helped by additional surgery and additional surgery may actually may make things worse.
If you have healthy and stable corneas, LASIK, PRK, and LASEK may be options for you. LASIK would only be appropriate if the RK wounds are strong. If they are weak the cornea may split into so many pieces of pizza when the LASIK flap is created.
The surface ablation techniques of PRK and LASEK do not create the LASIK flap so there is no possibility of corneal break-up. There is a longer vision recovery period and will probably be some discomfort, but these techniques can be appropriate and even preferred.
CK, IntraLASIK with the femtosecond laser created flap, and Epi-LASIK are not recommend for patients with previous RK. Each can disrupt the RK incisions.
You may want to consider Refractive Lens Exchange (RLE, http://www.usaeyes.org/faq/subjects/rle.htm) as an alternative to additional corneal surgery.
Glenn Hagele
http://www.USAEyes.org
I am not a doctor.
