Radial Keratotomy​—What Is It?

Awake! here presents information about the surgical procedure known as radial keratotomy, what it may do for a person, and the risks that may be involved. Awake! makes no recommendations for its use. It is the responsibility of each one, after his personal investigation, to decide whether it is for him or not.

RADIAL KERATOTOMY (RK) has recently been publicized in some countries on an expanded scale through television, magazines, newspaper articles, and radio. It has been a principal topic of discussion at international ophthalmology conferences over the past two years. Although this procedure has been performed for over 20 years and has been described by medical researchers for some years before that, it is just now becoming popular. Increasing numbers of eye surgeons are attending seminars and learning to perform the procedure.

Millions of people are either born nearsighted or become so. What does “nearsighted” mean? It means unable to see distant objects clearly without the aid of spectacles or contact lenses. Usually, nearsighted people can read without glasses but often hold the material close to find the proper focus.

Radial keratotomy is a surgical procedure that attempts to reduce or eliminate the need for glasses for distant vision when performed on nearsighted people. The surgery reshapes the cornea so that the focused image falls on the retina instead of in front of it, as in nearsightedness. The incisions are performed by making radial cuts on the outer layers of the cornea toward the edge of the visual area to make the center of the vision clear. The incisions vary in depth, length, and number.

Not a New Surgery

The ancient Chinese tried to solve the problem of nearsightedness by sleeping with sandbags on their eyes. Results were only temporary. As early as 1894, medical journals reported surgical approaches to correct or modify the cornea. Since that time, surgeons in South America, and later in Japan, described techniques to surgically change the shape of the cornea to produce clear vision. The Japanese experience stimulated a Russian surgeon to modify the approach and make it more successful.

As the results proved reliable, several surgeons from other countries observed the surgery. They returned on several occasions to observe the results and then introduced the surgery into their countries. By 1979, papers were being written to describe the technique, the results, and the modifications needed for increased successful results. So even though this procedure may be new to you, it is not new to the surgical profession.

To protect the public, a study was done in the United States at several research centers to prove or disprove the effectiveness of this method of surgery, and the results were published in the 1980’s in what was called the PERK study. The American Academy of Ophthalmology then acknowledged this technique as an effective approach to reducing myopia (nearsightedness).

Is RK for You?

Now that we know something of its development, how can you know whether RK is a technique you might consider? A complete eye examination is the first step. After a determination by a physician that your eyes are suitable for the procedure, the likelihood of success can be indicated for your level of myopia. There is a decreasing success rate for more severe myopia.

If you have been cleared for RK by the eye examination, you will want to find a refractive surgeon or RK surgeon with considerable experience. In most large cities, there is at least one expert who has some years of experience. By attending seminars, reviewing experience records, talking to previous patients and to other ophthalmologists, you can probably find an ophthalmologist who has a consistent record of good results.

Between 1991 and 1992, in the United States, the number of ophthalmologists performing the surgery increased from 13 percent to 25 percent. This means that some are new to the field, but it also shows the increasing acceptance of the procedure. Pleas are now going out from experts in the field for new surgeons to get training so that they can avoid the frequent complications that the early surgeons experienced.

Before you decide to have the surgery, it is a good idea to have educated yourself about the procedure so that you can ask the questions you need to know. Successful surgeons can analyze each patient and adjust the surgery to control the outcome. They approach each case on an individual basis, adapting the surgery to the individual. Research has verified that the number of incisions, their depth, and their length determine the result. The patient’s age, sex, eye pressure, and eye shape are other considerations. Your surgeon may consider other variables to effectively fine-​tune and adjust the result.

Knowing how many years the surgeon has been performing this surgery and how many cases he or she has performed gives you an indication of his or her experience. Recent articles in medical journals have suggested that the standard for care is for a refractive surgeon to have available a computerized video imager called a Topographer. The better the equipment, the more likely it is that your surgery will have good results.

The Procedure

If you decide that you wish to have this procedure performed on you, what can you expect? There is a preoperative workup that includes an eye examination, ultrasound measurements of the eye and its thickness, curvature measurements, eye-​pressure measurements, and possibly video computer-​generated topography. With all this data, your surgery is planned. After understanding and signing a consent form, you are usually given a sedative.

Speaking of the consent form, let’s consider some of the risks mentioned on the form. This surgery is done on the outer layers of the eye. The usual side effects are problems with glare, star bursts from lights, fluctuating vision, a foreign body sensation, dry eyes, and general awareness of the eye, which can last for hours, days, weeks, or months. The eye is weakened by the incisions. The length of time that the eye is weakened varies with each person. Many complications can be eliminated by the use of postoperative eye drops and by following instructions as to restrictions on activities. A compliant patient increases the percentage of success.

Now that you are ready for the surgery, what is next? Within 30 minutes of taking a slight sedative, you walk to the RK surgery suite. Your eyelids are cleaned, and a drape is placed over your face. Final measurements might be taken at this time, and the surgical instruments are inspected under a microscope for accuracy. Your eye receives topical drops of anesthetic. Once the eye is anesthetized, a lid speculum is positioned to prevent blinking. You focus on a light, and the center of your vision is marked for the surgeon as a point to work from. A template is then placed on the eye to mark out the surgery pattern, and then the surgery begins.

In less than 20 minutes, surgery is completed. The eye is usually covered for a period of time, but within 24 hours you can begin to see improvement in your nearsightedness. The major changes in vision take place in the next 7 to 30 days. Only minor changes take place after three months, and by one year there is relative stability. For the next 20 years, about 1 in 4 patients will notice further changes to the vision.

It’s Not for Everyone

We have talked a little about complications. Now let’s talk some more about side effects​—expected and unexpected. RK doesn’t correct all levels of myopia. In almost every case, it helps, but it is not for some myopes. Some experience fluctuating vision. This means that in the morning the vision is different than in the evening. This is especially noted in people who sit in front of a computer screen all day. The great majority of RK patients do not experience this permanently, but a small percentage do. Night glare is a complaint of many after RK surgery, but again, the majority do not complain of this as a permanent condition. Those who were dry-​eyed and maybe gave up contact lenses because of it will experience further drying for up to six months. Some have an overcorrection, which robs the near vision and can also make the distance vision poor without contacts or glasses. This is not very common but does happen to some RK patients.

In the first three months after surgery, the vision can be affected by general health problems, emotional distress, pregnancy, medications, job changes, exercise patterns, dietary changes, and especially lack of rest. One RK surgeon has noted that people who lift weights on a regular basis usually require repeat surgeries to attain their expected vision goal. There are many things that affect the day-​to-​day vision, especially in the first three months. The patient must be ready for changes in vision while healing.

RK is not so precise that it can always replace glasses or contact lenses, since these can be adjusted to your specific needs. RK surgery is a general approach, and rarely do RK patients choose glasses after surgery. It is also possible to have only one eye corrected so that you have one eye for distant vision and one for near. Enhancements can be done after RK surgery if the vision goal is not obtained and if there is more that can be accomplished. This requires a surgeon with much experience to know just how much more surgery to do.

Investigate, Then Decide

The best advice if you are contemplating this operation is to get as much information as you can on the subject, since you need to ask the right questions to get straight answers. Then go to several RK surgeons before deciding on the approach you wish to take. (Proverbs 15:22) You might find out that you are a good candidate for the procedure and may substantially improve your vision.

Recently at a meeting in Salt Lake City, Utah, U.S.A., a report was presented on a study of RK patients who were also ophthalmologists. These patients almost unanimously responded that they were happy with the surgical results​—only 2 percent were indifferent, but 98 percent of them were happy.

To awaken to clear vision every morning and not to have to reach for glasses is quite an experience! In the near future, this will happen, not by surgery, but by divine power. God’s new system will bring clear vision to all there who once wore glasses, but new vision will be especially exciting to those who have never experienced sight before! “At that time the eyes of the blind ones will be opened.”​—Isaiah 35:5.

[Diagrams/​Pictures on page 25]

(For fully formatted text, see publication)

The Typical Effects of RK Surgery

A normal eye focuses images clearly on the retina

Retina

Clear vision

The nearsighted eye is too long for images to reach the retina

Retina

Blurred vision

A pattern of eight radial cuts slightly flattens the cornea

The eye, after RK, allows the focus to reach the retina, giving clear vision

Retina

Clear vision

[Picture Credit Line on page 22]

The Complete Encyclopedia of Illustration/​J. G. Heck