Wouldn’t it be great to wake up one morning and miraculously have perfect eyesight? No more squinting through thick eyeglasses, no more messing around with contact lens cleaner.
For the 70 million Americans with myopia, or nearsightedness, the surgical procedure of radial keratotomy offers that vision.
It’s time for a closer look.
“It’s not a perfect operation,” said Keith Thompson, an Emory University ophthalmologist involved in a comprehensive study of the procedure. “We just can’t shape your cornea as accurately as we can shape a piece of glass or plastic.” But “for appropriate candidates it really adds tremendous value to the quality of life,” he said.
Radial keratotomy, known as RK, has jumped from 30,000 operations in 1988 to 250,000 in 1993. Many ophthalmologists lure patients with the promise of excellent results such as those enjoyed by Margaret Hodges, 34, of Atlanta, who went from having 20/300 eyesight to 20/20-perfect.
“I’ve been real lucky,” Hodges said.
According to the Prospective Evaluation of Radial Keratotomy (PERK) Study headed by Emory ophthalmologist George O. Waring III, she was lucky indeed. Doctors don’t aim for perfect vision to avoid overcorrecting, which causes farsightedness. In the PERK study, 19 percent of the patients remained nearsighted; 17 percent were “overcorrected,” resulting in farsightedness. And more than one-third needed glasses or contacts for myopia or farsightedness within five years of surgery.
An article in the August issue of Consumer Reports on Health suggests that the main reason for the boom is money. Medicare has slashed payments for cataract surgery, cutting into the income of many eye doctors. RK is not covered by Medicare or most insurance companies; they consider it experimental or cosmetic. So doctors can charge whatever they want. The 10-minute operation typically costs from $800 to $1,400 an eye.
Techniques have improved since the PERK study, which analyzed operations performed from 1982 to 1988. As with any surgical procedure, though, prospective patients should consider carefully what they’re gaining-and risking.
Modern radial keratotomy has been practiced in the United States since 1978, though the procedure was conceived in Japan in the 1930s, said ophthalmologist Daniel J. Hennessy. A similar procedure, astigmatic keratotomy, treats astigmatism.
Myopia occurs when the eye focuses images in front of the retina instead of directly on it, making distant objects blurry. Generally this problem stems from excessive curvature of the lens or cornea and can be corrected by glasses or contacts.
In RK, the surgeon makes four to 16 corneal incisions that radiate outward like the spokes of a wheel, flattening the cornea while leaving its center intact. The tricky part is deciding how deep to cut.
“You cannot predict it,” Hennessy said. “You tend to undercorrect because if you overcorrect, there’s not much you can do.”
Surgeons can perform “enhancements” on undercorrected eyes, making further corneal incisions or deepening existing scars.
Technology has improved, partly because of the PERK study, Thompson said. “We’re certainly much smarter than we were. The instrumentation has matured.” Doctors use knife guides and microscopically calibrated diamond blades. A decade ago, they used razor blades.
Even so, some patients experience fluctuations in vision, sometimes becoming progressively more myopic from morning to night. They also are more likely to develop farsightedness-and need eyeglasses-past age 40. RK also involves a slight possibility of developing cataracts and chronic corneal infection, which ultimately can require a corneal transplant.
After RK, an eye is more vulnerable to serious injury because the tiny incisions in the cornea can burst open if the eye is struck during a sports activity or an auto accident. Such damage can be repaired by sutures or corneal transplants.
Less serious side effects include a “star burst effect,” in which patients see a halo or star pattern around bright lights at night. This minor problem, shared by some contact lens wearers, usually fades in months with the help of prescription eye drops.
RK surgery generally is more successful with moderately myopic eyes and with older patients, although doctors aren’t sure why.
The bottom line is, radial keratotomy is a viable alternative to visual correction, with the right patient and the right surgeon. With so many ophthalmologists advertising RK, people should be careful to choose an experienced and honest surgeon.
