cataract surgery vis a vis prior radial keratotomy
Posted , 4 users are following.
69, good health and due for cataract surgery on left eye.
Decades ago I had RK on both eyes to correct myopia. More than one series of incisions were made on the left eye (current physician said he's never seen that many). This complicates the cataract surgery considerably with a heightened possibility of an unhappy outcome.
My medicare is through a managed care and I have no doubt that doctors here are pressured to standardize procedures and cut costs. I'd appreciate some external feedback on the options: e.g., laser surgery, different techniques, the optimal lens etc.
Given the downside I need to be a fully informed participant in this ordeal.
Thanks everyone.
0 likes, 4 replies
RonAKA hhunt
Edited
No personal experience but on a quick look at the issue, it is complex. I was aware that Lasik surgery complicates cataract surgery, but it appears radial keratotomy is much worse. With Lasik I believe the main issues is that the incisions and resulting change in the shape of the eye makes it difficult to measure the power of the cornea accurately. An accurate measure of the corneal power is essential to be able to select the correct power of the replacement lens. It is also reported that in those with previous Lasik the multifocal and extended depth of focus lenses experience more side effects due to the combination of the lens and previous Lasik. With radial keratotomy and especially with numerous incisions these issues are all there plus there is the added complication of making the incision between the scar tissue of these incisions.
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While the sun has kind of set on radial keratotomy as a procedure there are apparently millions of eyes out there that have had the surgery. Now with time passing these eyes are starting to have cataracts. So while the days of the procedure have passed there should be a growing need for surgical procedures to do cataract surgery on those that have had this surgery.
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You have probably done your google research and are aware of these issues. However, one article that I thought was quite recent, detailed, and interesting you should be able to find with a search using the following terms. It raises some interesting complications for cataract surgery including that RK eyes are not stable and change over time (years) as well as they change in power during the day (hours) making it difficult to measure them. When do you do it?
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eyewiki aao cataract surgery following radial keratotomy
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My #1 suggestion for you is to do your research on surgeons and find ones that are experienced in dealing with RK patients. If possible get a consultation with at least a couple so you can evaluate how they will deal with the complications.
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As for lenses I would stick with monofocal standard lenses. Perhaps about the only other one which may be worth considering is the light adjustable lens (LAL). The power of the lens can then be adjusted with UV light after surgery to compensate for miscalculation of the required power. It does make the search for the ideal surgeon even more difficult in that you will need to find one that is experienced with pre op RK patients and as well uses the LAL lens. I think I would put RK experience first, and LAL capability second. Seems to me that you will need glasses after the surgery in any case, so having the power off some, is probably not all that compromising. And if the RK is not stable then ongoing adjustments with eyeglass power may be needed anyway.
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Hope that helps some. Perhaps others with actual experience will contribute comments...
hhunt RonAKA
Posted
That was helpful -- thanks.
Am I to take it that there is no particular benefit with laser surgery?
Much appreciated.
RonAKA hhunt
Edited
I think there may be some benefit. However, I think I would find a specialist in doing cataract surgery on RK patients first. Then discuss it with them. They should know what really works, and what does not. There may be better ways of breaking up and extracting the natural lens as well considering that the normal incision used for cataract surgery may not be as good.
kathleen07994 hhunt
Edited
Shannon Wong with Austin Eye has a 7-4-18 video on YouTube entitled "The Symfony Lens for Cataract Surgery after Radial Keratotomy (RK).." I believe his patient had 12 RK incisions. Perhaps an EDOF lens is more forgiving than a multifocal or trifocal lens. An excellent surgeon experienced with RK patients would certainly be ideal.