I had radial keratotomy several years ago and then had LASIK last year. It was explained to me that previous RK necessitated that the flap be peeled well in advance of the application of the laser to the stroma. I've also been told that RK can result in a high degree of refraction fluctuation. It has been five months since I had LASIK in the left eye, but I have even recently experienced wild fluctuations in that eye's visual acuity and refraction. For instance, my left eye appeared to have stabilized at approximately Plano -.5, but a few days ago, the left eye measured about -1.25 -.75. Within a few hours, however, it had returned to about Plano -.5. Does anyone know about how long such wild fluctuations could persist, given that, unlike most LASIK patients, I had RK prior to LASIK?

RK is a surgery in which the cornea has 8 or more vertical incisions placed in the cornea. Some patients develop a weak cornea that will alter its curvature throughout the day, causing visual fluctuations. LASIK can be safely performed on patients with RK, but I have not seen a study specifically addressing the risks of permanent fluctuating vision after LASIK.
Your question is certainly valid, but it may be impossible to answer. Perhaps your doctor has an idea- if so please share it with us

Bill Trattler, MD
Miami, FL

RK is a surgery in which the cornea has 8 or more vertical incisions placed in the cornea. Some patients develop a weak cornea that will alter its curvature throughout the day, causing visual fluctuations. LASIK can be safely performed on patients with RK, but I have not seen a study specifically addressing the risks of permanent fluctuating vision after LASIK.
Your question is certainly valid, but it may be impossible to answer. Perhaps your doctor has an idea- if so please share it with us

Bill Trattler, MD
Miami, FL

Jason,

I also had RK prior to LASIK. My RKs were done in 1982/1983. Sixteen two depth cuts followed with 8 additional cuts. Started out ~ -11 and was able to see fairly well for a brief time; but, had significant daily variations, with each week starting with slightly more regression. Ended up with ~ -9 diopter vision with well healed cuts, fully correctable vision with glasses. Still had some daily variation - so I discussed it with my LASIK doctor. He asked me to come back a week or so after the detailed screening exam for 3 non-dilated exams to measure how much variation there was. Measurements indicated to him that the variation that I was experienced was not out of the ordinary and should not effect my decision to have LASIK or not.

I had LASIK done to both eyes on 1/6/00. I believe he made a thicker flap (180 microns), used a stronger eyedrop to fight infection for the first week, and used a soft contact lense as added precautions because of my previous RK history.

Improvement was immediate but not complete. My vision improved daily. I was able to get the restriction off my drivers license within 24 hours of surgery. (Scary to think about too many people driving around with that quality of vision.) Returned to work on Monday after Thursday surgery. It was a struggle and I limited how much reading I tried. But it got better every day.

My three week follow up was Wednesday. Measurements were slightly nearsighted with some astigmatism. Vision was 20/20- and 20/30- each eye with 20/20 using both. BUT NOT 'SHARP' 20/20. The vision does change as the eyes grow tired but it is not as noticable as before the LASIK. I believe that is because I have eliminated thick glasses with the associated glare and reflection (even with rolled and polished lens). But with LASIK my vision is getting better every day. "SHARPER" 20/20 etc. The nearsightness has gone from struggling the first week with +1.5 drugstore reading glasses, to not needing them most of the time.

The exam showed a few abnormal cells at the edge of one flap. The recommendation was to do nothing - the cells should be absorbed with no additional treatment.

The Doctor told me to epect the healing time to be extended because of the previous RK. And that the astigmatism could changes as the healing at the RK incisions may heal at slightly different rates.

Jason, I hope my history will give you some comfort. Sorry for being lengthy, but this web sight has done me good by providing personal experiences as well as informed Doctor comments.

Good Luck