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Can Scleral Lenses Help Patients with RK Scarring?

One of most successful scleral lens patients arrived to the office for her annual contact lens evaluation.

She is an 80 year old female who had radial keratotomy (RK) surgery years ago. She did quite well for many years, but then her vision started to decline. She ended up having some corneal epithelial splitting issues due to the RK incisions, and Dr. Wellish had to fix those areas and then stitch them (you can see the stitches in the photos).

She also has 3+ nuclear sclerotic cataracts. When I saw her a year ago, I thought the vision potential was meek, due to her scar tissue from the RK surgery, the irregular corneal shape, the stitches on the cornea and the dense cataracts.

cataract OD cataract OS

If you asked me to guess what the patient’s best corrected vision would be, I would have said, maybe 20/50-20/80 if I had to bet money on it.

For cases like this, I always put a diagnostic scleral lens on and perform a simple over-refraction to see what the vision potential is. To our surprise, she was able to achieve 20/30 in office with a diagnostic scleral lens. She had a very large amount of against the rule astigmatism, which is to be expected in a patient who has dense cataracts.

We decided to proceed with a custom scleral lens called the Latitude. To design this lens, we needed to take 3D images of her eyes using the sMap 3D instrument. Then, the lab uses special software to design custom scleral lenses for each eye.

When we dispensed the Latitude scleral lenses, she was seeing 20/25 and 20/20 in each eye! This was shocking to everyone, and we were so happy for her. The lenses fit her eyes perfectly and she’s done well for the past year.

She arrived today for an annual evaluation of the contact lenses with no complaints. Her vision was 20/25 on the right eye and 20/20 on the left eye. The lens fit remained excellent for each eye, and the surface of the contact lenses were unremarkable. She will follow up with Dr. Wellish as directed, and we are so happy her vision and lens fit have remained stable!

medmont od os medmont

OCT – OD

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oct od nasal

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OCT – OS

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Can Radial Keratotomy patients wear contact lenses?

In our practice, we see MANY radial keratotomy (RK) patients.

This case is a true representation of why we do what we do. It’s cases like these that inspired me to create a clinic that is solely dedicated to specialty contact lenses. Helping people achieve vision who thought there was no hope gives me a true purpose in life!

A 46 year old black male with a history of RK (radial keratotomy) in both eyes was referred for scleral lens consultation. He started wearing a scleral lens 5 years ago on the left eye due to deteriorating vision. However, he felt uncomfortable with his habitual lenses and could not tolerate his lenses for more than 30 minutes. He said the vision was good with the scleral lens, but because of how uncomfortable it was, he could not wear it.

The slit lamp examination showed 8 RK cuts on his cornea in the right eye and 8 RK + 2 AK cuts superior and inferior in the left eye. Radial keratotomy was a surgical procedure performed in the 1990’s as a form of refractive surgery. It has now been replaced by a much safer technique called LASIK. RK surgery works very well for many patients for about 10-20 years. After that, the cornea can fluctuate and change shape and cause distorted vision. Many RK patients have multiple pairs of glasses that they change throughout the day, depending on what their vision is during that specific time of day!

The right eye was 20/50 and the left eye was 20/200 uncorrected. Due to the irregularity of his cornea, we recommended a custom scleral lens either Latitude or EyePrint Prosthetics. The patient opted for EyePrint Prosthetic lens and was able to achieve 20/40 acuity with the diagnostic lens in his left eye. We took a mold of his left eye in office, using the EyePrint impression system. Then, we inserted a diagnostic scleral lens. This helps us determine the prescription that will be added to the custom scleral lens. With the diagnostic lens, he was able to go from 20/200 to 20/40, which is a huge improvement in his vision.

We sent the EyePrint impressions of his left eye to the laboratory in Colorado and submitted his order. The EyePrint team worked hard to design a perfect, custom scleral lens for this patient.

About 1 week later, he arrived for his dispense appointment. During a scleral lens dispense, we insert the lens, and we check the fit and vision of the lens to see if any adjustments need to be made. If a patient has not worn a scleral lens, we will then review insertion and removal, as well as proper scleral lens care.

We dispensed his new custom lens and to our surprise he was able to comfortably read to 20/20 acuity! This was no expected due to the fact that he could only achieve 20/40 with the in-office diagnostic lens. What an exciting outcome! He was thrilled with the vision and exclaimed “the comfort is fantastic!” We are looking forward to seeing how he continues to do.

It’s success stories like these that motivate us to continue to innovate and deliver superior results to our patients. We are so grateful to help be a part of this patient’s journey to better vision!

Next, find out how to insert a scleral lens.

radial keratotomy patients 1

Corneal topography of his left eye showing irregularities.

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Photo of patient’s left eye showing RK cuts and scars

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Photo of the EyePrint Prosthetic on patient’s eye

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The mold of his left eye, which we sent to the laboratory

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.

Radial keratotomy patient has drastic vision improvement with scleral lenses

We had the pleasure of seeing one of our patients back for a scleral lens fitting today!

We had previously seen this patient in July of this year. He was kindly referred by Dr. Stafeeva for a specialty contact lens consultation. He had radial keratotomy surgery (RK surgery) many years ago, which has distorted his vision over time. Radial keratotomy surgery was a procedure done in the 1980’s and 1990’s to help patients eliminate their need for glasses. It was a type of refractive surgery performed where a small scalpel was used to make tiny incisions onto the front part of the eye, called the cornea. The small incisions re-shape the eye, which corrects your vision and eliminates the need for glasses. RK was replaced by safer procedures such as LASIK and PRK. RK is not performed in the United States anymore.

Many patients who’ve undergone the RK procedure notice problems with their vision. Some of these problems include problems with glare, ghosting, double vision, fluctuating vision, and an overall decrease with vision.

With glasses, this patient can see 20/50 in the right eye and 20/100 in the left eye, and also reports ghosting and double vision in each eye.

We fit this patient into the Ampleye scleral lens to see what kind of vision we could achieve. With the scleral lenses, he was able to achieve 20/25 vision in the right eye and 20/40-2 vision in the left eye. Scleral lenses are filled with a preservative free saline solution, which reshapes the way light enters into the eye, providing much better vision. He also noticed that his double vision and ghosting was much improved with the scleral lenses.

There was a bit of excessive clearance in each eye, which will be adjusted when we order his lenses. He does also have excessive compression on the left eye, which will also be adjusted when we design and order the lenses.

Looking forward to seeing how this patient does at his dispense! Thanks again Dr. Stafeeva for trusting us with this special patient!

Radial keratotomy and scleraL lenses

Update on our 79 year old patient!

▪️If you recall, our RK patient (with moderate cataracts OU and sutures OD) returned for her 2 week follow up after her dispense.

▪️With her Latitude custom scleral lenses, she was able to achieve 20/25- in the right eye and 20/20- in the left eye (despite the air bubble in the lens).

▪️She had adequate central clearance in each eye and the edges were still perfectly aligned.

▪️She had a few issues in the beginning with insertion but after the first 4 days she became proficient.

▪️We reviewed her lens care system and she was following the prescribed protocol perfectly.

▪️She is incredibly happy with her vision with the lenses, and she has recently started to make jewelry again.

▪️She saw Dr. Wellish the day prior, and he was pleased with the state of her eyes too!

▪️Grateful to be a part of this patient’s vision rehabilitation journey!

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