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Radial Keratotomy Patient With Scleral Lenses

We recently had our first follow up with our 53 yo M with a history of RK in both eyes (right eye had 8 cuts and left eye had 16 cuts) since we dispensed his Ampleye Lenses. Radial Keratotomy (RK) is a type of eye surgery that was performed in the 1980’s and 1990’s. The purpose was to correct patient’s vision so that they did not have to wear glasses or contacts. Small cuts were made on the cornea which altered the corneal shape, resulting in clear vision without the need for glasses or contacts. Many patients who had RK surgery now suffer from vision issues such as blurred vision, distorted vision, double vision, ghosting, and other visual anomalies. This is due to the fact that the cornea now has an irregular shape (from the RK surgery) and now has irregular astigmatism. This results in the vision problems mentioned above.

Luckily, there are specialty contact lenses called scleral lenses or scleral contact lenses which can drastically improve the vision of RK patients. Scleral lenses are special contact lenses which are custom fit to the patient’s eye. The bowl of the scleral lens is filled with liquid, and then placed onto the eye. The gas permeable lens material creates a smooth surface, which results in much better visual quality. Often times, when RK patients are fit into scleral lenses, they state that their vision is much less distorted. Another benefit is that the vision fluctuates much less during the day. Many RK patients suffer from fluctuating vision, due to the constant change in their corneal shape during the day. Think of their eye like an accordion. Sometimes the shape is in one position and other times it is in a different position. Many RK patients have multiple pairs of glasses scattered all over their house! This is because as their prescription changes throughout the day, they have different prescriptions that help to improve their vision.

Scleral lenses have been an amazing technology that helps RK patients see much better. Whenever we see RK patients in the office, we always ask them if they have any issues like the ones mentioned above. If they do, it is worth it to attempt a scleral lens fitting. The scleral lenses are fit by one of the doctors in the clinic, and the fitting process usually takes about an hour. Several lenses are used from a fitting set until a proper shape is determined. Then, we check the prescription to see what prescription needs to be added to the lens. After, we consult with the laboratory, and we design the lenses together.

When the lenses arrive, we then schedule the patient for a dispense. At this visit, the doctor will insert the scleral lens to the patient’s eye and then perform a series of tests. This is to ensure the lens is fitting properly and also that the vision is satisfactory. If everything looks good, then the patient proceeds to a contact lens training, where they are shown insertion, removal and lens care. After a successful training, the patient goes home and then tries the lenses for about 2 weeks. After that, they return to the office for a follow up to check everything again.

This patient had poor vision, ghosting, and double vision before we fit him into scleral lenses.

He was interested in trying scleral lenses due to symptoms of fluctuating vision and dry eyes that have been worsening since he moved to Las Vegas.

For follow up visits, we typically like to see our patients after wearing their lenses for several hours to assess how their lenses settle on their eyes. At insertion, his lenses were looking pretty good. However, at his follow up visit, we saw some mid-peripheral touch in his right eye. Although he felt comfortable in the lenses, we definitely want to make some adjustments to allow vaulting over the entire cornea.

Scleral lenses are a great option for RK patients, and should be considered when patients have visual issues.