ALK on Hyperopic Cornea

The 3 images below are of the same eye. This eye underwent a refractive surgical procedure known as Automated Lamellar Keratoplasty or ALK. This procedure was abandoned about 15 years ago and as far as I know is not being done any longer. This eye was about +4.00 of hyperopia before the surgery. In order the improve this patient's distance vision this surgery created a cornea that looked like a keratoconic cornea or a cornea with post-LASIK ectasia. It was thought that by doing this the light rays would focus directly onto the retina without the need for spectacles. This did not happen. This surgery is done in a similar manner to LASIK except that the treatment zone is small and in the central area of the cornea. In the first photo, note the grey rings around the periphery of the pupil. This is the edge of treatment zone. The 2nd photo was taken after a special dye was instilled onto the ocular surface. In this photo you can see the small elevated treatment zone. The last image was taken with a technology known as "optical coherence tomography" or "OCT". This is a cross sectional image of this patient's cornea. Note the cuts created by the laser. After this patient underwent this needless, harmful surgery, the best corrected visual acuity in this eye was less than 20/200. He is now wearing a scleral lens on this eye which is providing him with 20/30 corrected vision without distortions.