Radial Keratotomy - Laser Eye Surgery Guide

Radial keratotomy (RK) is a more traditional type of eye surgery. The procedure has been around for quite a long time and requires the use of a blade as opposed to the more technologically advanced laser. Due to this lower level of technology, LASIK has largely replaced this procedure, however it is still available in many clinics.

RK produces the best results in those patients who had mild refractive errors. It can also be employed to treat conditions such as short-sightedness (myopia) as well as astigmatism. You should note, however, that RK often does not totally cure short-sightedness and glasses or contact lenses may still be required after the surgery.

How is RK different from procedures such as LASIK, LASEK and PRK?

The most fundamental difference when comparing RK with other eye surgery procedures is that it involves the use of a blade rather than a laser. Like the laser, the blade is used to reshape the cornea and all four of the mentioned treatments (RK, LASIK, LASEK and PRK) are used to correct refractive errors.

A point, which may be important for you to consider when comparing the procedures, is that laser eye surgeries tend to carry less risk of complications plus a higher level of preciseness compared to RK.

Am I a suitable candidate for RK?

There are a number of factors that influence how suitable you are for the RK procedure. The most general of these factors include:

• A minimum age of 21 years old
• Good overall health and suitable medical history
• Realistic expectations in regards to the results of the procedure

There are also some factors that are more specific to suitability for the RK procedure. These include:

• Mild to moderate short-sightedness (myopia)
• An eyesight prescription that has not changed over the past two years and is therefore considered 'stable'

If you have certain medical conditions, you may be refused the RK procedure for your own health and safety. These medical conditions may include insufficient wound healing; severe short-sightedness; an eyesight prescription that is still changing as well as corneal diseases.

Many surgeons also advise pregnant or breast-feeding women as well as people who play contact sports, such as rugby, that RK may not be the most suitable procedure at present.

Potential risks of the RK surgery

Risks and complications following RK surgery are rare but still possible. It is important that you consider all the risks before committing yourself to undergoing the procedure. Complications that are associated with RK include:

• Overcorrection may occur, which can result in you experiencing a level of long-sightedness.
• Your eyes may be under-corrected so that the short-sightedness remains even after the procedure.
• It is rather hard to precisely predict what the outcome of your surgery will be, both in the short and long term.
• Your night vision may be inhibited with glare, halos and/or starbursts.
• You may develop an abnormal form of astigmatism, which may lead you to experience double vision or 'ghost' vision.
• It is possible that you will develop an eye disease, such as glaucoma, which disturbs the optic nerve at the back of the eye.
• You may still require the use of glasses or contact lenses to counteract the effects of potential long- or short-sightedness.
• Within the three years after your surgery, you may suffer from cornea puncturing, rupturing or infection.
• There is potential for you needing further surgery in the future as the cornea weakens or if cataracts develop.

Benefits of RK surgery

There is one key, primary benefit that is promoted by RK surgery. This benefit is that short-sightedness may improve a significant amount, if not fully, which can improve many patient's lives.

Your RK consultation

Before undergoing the RK surgery, you will have to attend a consultation with your surgeon. During this consultation, you will be required to explain your medical history, lifestyle and other factors to prove that you are a suitable candidate for RK.

During your consultation you will also be given the time to ask any questions that are on your mind about the surgery and its outcomes. It may help if you create a written list of all the questions you have so you can tick them off once your surgeon supplies you with an answer. This will ensure that you leave the consultation with all the information you feel you personally require.

If you would like some help developing a list of questions, you may wish to visit our section entitled 'Laser Eye Surgery: General FAQs'. Here you will find a number of broad questions that you can tailor to your needs.

At the end of your consultation, your surgeon should be able to provide you with an accurate quote as to how much your RK procedure will cost. Obtaining an estimate from an indirect source is difficult as laser eye surgeries such as LASEK are now recommended instead of RK. However, if you directly contact a number of clinics, you should be able to obtain a number of price estimates.

What does the RK procedure entail?

The first step of the RK surgery involves the surgeon positioning a 'lid speculum' over the eye. This is done to prevent you from blinking throughout the surgery. The next stage involves the surgeon administering some eye drops to numb the eye so you do not experience much pain or discomfort. Some surgeons even supply a mild sedative to further relax the patient.

Once the eye has been sufficiently numbed, the surgeon will proceed to create a number of radial cuts into the cornea. These cuts are made by a knife blade, which has been specially designed to be extremely precise. Whilst the cuts are being made, you will be requested to look and focus on a light.

The corneal cuts are made to force the centre of the cornea to flatten. This allows the light to be focussed completely onto the retina. The result of this is that your vision will become clear and objects that are far away will hopefully become more visible.

How long can I expect the results of RK to last?

Like with laser eye surgeries such as PRK, LASIK and LASEK, the results of RK seem to be permanent. However, our eye change naturally overtime as we age and this becomes especially noticeable once we reach middle age (in our 40s and 50s). This is due to the eye muscles hardening so their focussing ability deteriorates.

The RK recovery period

It is possible that during your healing and recovery time after RK surgery you will experience some level of pain and/or discomfort. This may come in the form of throbbing, itching or aches. To deal with this, you can purchase over-the-counter medications and take them per their instructions. If you are at all concerned about the pain, contact your surgeon.

To try and prevent the formation of infections after the RK surgery, you will be prescribed some anti-inflammatory and antibiotic eye drops to use on a regular basis. You will also be given a protective bandage to wear over the eye for a short amount of time.

Many people experience some light sensitivity within the first day or so following their RK procedure. This is normal and should completely disappear.

In the first few months after your surgery, you may experience some 'unstable' vision, but this should ease. The actual time for you to obtain clear, working vision is just a week but you should be prepared to have the odd vision issue within the first 12 months.