I had RK in both eyes 10 years ago along with enhancements in each with 16 cuts in each.
I am now experiencing what seems to be the known side effects such as day to night vision flux, halos and starburst at night and huge loss of depth perception. The side effects are getting worse and I wonder if another surgery would be helpful, ie. get rid of the side effects which are most troubling. My vision is supposedly good when checked 20/30-40 depending what time of day it is checked and 20/30 left...but nothing I see is sharp. All of the side effects are causing me to feel terribly upset and I wonder how I will be able to manage them for the rest of my life if there are no solutions available. I am 38 now. So I will stop rambling and ask a question...
-How do I find out if or what questions should I ask my doc to determine if I am a candidate for Lasik
-Have you ever heard of the usual post RK side effects to be treated successfully, (I hope someone says yes :)
-any suggestions on what I might do personally to alleviate the side effects?
Thank you
Doria

You are not crazy nor are you alone, and you have several options to help resolve your problem.

What you describe are known late-term complications of RK. They tend to be more common with early RK patients or patents with more than 8 incisions. Also, a gradual change toward hyperopia (farsighted) vision is a known long-term complication. If you are over age 40, the combination of hyperopia and presbyopia (when you need reading glasses to see things close) can provide poor vision at all distances.

The fluctuation in vision acuity throughout the day is most likely cause by the cornea becoming unstable. Loss of depth perception is common if one eye has a significantly different refractive error. As your two eyes fluctuate independently, there may come a time during the day when the refractive error between the two eyes is significantly different, and loss of depth perception occurs.

You may also experience momentary dizziness and headaches, although these symptoms do not occur in every case.

What would probably be the best and least invasive response would be to get fitted with rigid gas permeable (RGP) contact lenses. If you do your homework you will probably find an optometrist who is knowledgeable in the unique needs of a post RK contact lens fitting for RGPs. If you need some help finding such a doctor, just let me know where you live.

Because the RGPs are rigid, they may help reduce the fluctuation. Because they can mildly reshape the cornea, they can help provide better vision quality than soft contact lenses or glasses.

Another issue that can exacerbate or even cause your symptoms is dry eye. Your optometrist can check both the quality and quantity of your tears.

A new technique for stabilizing the cornea called Corneal Collagen Crosslinking with Riboflavin (C3-R) may be helpful, but this is a new technique that is not very well proven. See http://www.usaeyes.org/faq/subjects/c3-r.htm

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Thanks very much...I will research that...so I am guessing perhaps that surgical correction is not an option?

>You are not crazy nor are you
>alone, and you have several options
>to help resolve your problem.

>What you describe are known late-term complications
>of RK. They tend to be
>more common with early RK patients
>or patents with more than 8
>incisions. Also, a gradual change toward
>hyperopia (farsighted) vision is a known
>long-term complication. If you are over
>age 40, the combination of hyperopia
>and presbyopia (when you need reading
>glasses to see things close) can
>provide poor vision at all distances.
>

>The fluctuation in vision acuity throughout the
>day is most likely cause by
>the cornea becoming unstable. Loss of
>depth perception is common if one
>eye has a significantly different refractive
>error. As your two eyes fluctuate
>independently, there may come a time
>during the day when the refractive
>error between the two eyes is
>significantly different, and loss of depth
>perception occurs.

>You may also experience momentary dizziness and
>headaches, although these symptoms do not
>occur in every case.

>What would probably be the best and
>least invasive response would be to
>get fitted with rigid gas permeable
>(RGP) contact lenses. If you do
>your homework you will probably find
>an optometrist who is knowledgeable in
>the unique needs of a post
>RK contact lens fitting for RGPs.
>If you need some help finding
>such a doctor, just let me
>know where you live.

>Because the RGPs are rigid, they may
>help reduce the fluctuation. Because they
>can mildly reshape the cornea, they
>can help provide better vision quality
>than soft contact lenses or glasses.
>

>Another issue that can exacerbate or even
>cause your symptoms is dry eye.
>Your optometrist can check both the
>quality and quantity of your tears.
>

>A new technique for stabilizing the cornea
>called Corneal Collagen Crosslinking with Riboflavin
>(C3-R) may be helpful, but this
>is a new technique that is
>not very well proven. See http://www.usaeyes.org/faq/subjects/c3-r.htm
>

>Glenn Hagelehttp://www.USAEyes.org

>I am not a doctor.

If the cornea is not stable, surgery for purely refractive purposes is probably not wise. You will continue to fluctuate but just in a different range, and the surgery may weaken the cornea more. Surgery for stabilizing the cornea, such as Intacs or C3-R, may be appropriate.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.