Lasik Over RK Articles

Lasik over RK with Ectasia, Shown with Scleral Lens

This eye underwent 2 separate Radial Keratotomy (RK) surgeries followed by 2 separate LASIK surgeries many years later. A special camera and dye was used to obtain the first image you are seeing. The RK cuts are open which is why they "light up". The straight lines are the open RK incisions. The green circular line going around the cornea is the open LASIK flap seam. These 4 corneal surgeries created a condition known as "corneal ectasia". The 2nd image below is a computer enhanced diagram showing the elevations and depressions of this cornea. If this was a "normal" unoperated cornea what you would see here would be a continuous smooth curved surface. The dark red area in this image is the "ectatic" cornea. This patient is wearing a scleral lens over this cornea which is allowing this patient to see clearly and comfortably.

3 RKs followed by 3 Lasiks

These 3 images are of the same eye. This eye underwent 3 separate RK surgeries in the 1980's followed by 3 separate LASIK procedures between 25 and 30 years later. The first photo was taken 5 years ago. Note the open RK incisions and the blood vessel growth along the RK incisions. The milky-white hatchet shaped structure close to the pupil is epithelial ingrowth which are epithelial cells found in the outer layer of the cornea which got under the LASIK flap. 5 years ago this patient was referred to a corneal surgeon at major eye institution to see if he could life the LASIK flap and clean out the debris that got under the flap. This doctor was fearful of doing this because he felt that there was an unacceptable risk that the patient would need a corneal transplant on this eye. 6 months ago I took another photo of the same eye. Note the white "flecks" in the center of the cornea. Again, the patient was referred to the corneal specialists at this same major teaching eye institution who diagnosed this eye with a very rare condition known as "infectious crystalline keratopathy." The last image was taken with a technology known as "optical coherence tomography." Here you see a cross sectional image of the same eye with a scleral lens over it. Note that these crystalline deposits reside in the center of the cornea. Infectious crystalline keratopathy is one of the risk factors for refractive eye surgeries such as RK and LASIK which may appear many years later.

RK followed by Lasik

This eye underwent RK surgery in the 1980's followed by LASIK surgery about 12 years later. This eye now has post-LASIK corneal ectasia which developed a few years after the LASIK surgery. This eye also has epithelial ingrowth. Note the thick grey white discoloration at 10:00 in this photo. This is a cluster of epithelial cells (the cells lining the outer surface of the cornea) that have gotten underneath the LASIK flap where they do not belong. In the center of the cornea opposite the pupil note the "glitter" or brightly colored debris. These are epithelial cells that have migrated (under the LASIK flap) to the center of the cornea and have deposited along the visual axis or line of vision. The green radial lines seen in this photo are the open RK incisions, still open after all these years. I saw this patient today and also one year ago. This eye appears the same as it did last year. However, yearly examinations are necessary to make sure that the cornea and eye remain stable. I have been taking care of this patient for the past 10 years. Both of her eyes were fit with scleral lenses which are allowing her to see clearly and comfortably.

Lasik over RK Equals Ectasia

Below are photos of the right and left eye of a patient that underwent both Radial Keratotomy(RK) in the 1980"s followed by LASIK surgery in each eye about 15 years later. Shortly after undergoing LASIK, both of this patient's eyes developed post-LASIK corneal ectasia. This patient has no functional vision with eyeglasses or conventional contact lenses. In order to obtain meaningful images, we instilled a special dye (fluorescein) onto each eye. In this way all of the defects on the ocular surface are readily visible. In these images note the dark green radial lines. These are the open RK incisions that are still open after all of these years. The green tinted circular line going around each cornea is the edge of the LASIK flap. The fact that you can see the dye within the flap tells you that the "seam" is open. The first 2 photos are of the left eye. Note the small green tinted round dot at 1:00. This is an inflamed area caused by loose suture. The suturing was done after cataract surgery to prevent any complications from the previous refractive surgeries. The 2nd image shows a more detailed view of this part of the left cornea. We removed the loose suture today and treated the inflammation. This patient was successfully fit with scleral lenses about 8 years ago and has had clear, comfortable vision with these lenses since then.

Two Lasiks over Two RKs. From 20/800 to 20/20 with GVR Scleral Lens

The images below are of the same eye that underwent 2 separate Radial Keratotomy surgeries in the 1980's followed by 2 separate LASIK surgeries about 15 years ago. The first is a photo showing the open RK incisions which look like the spokes of a bicycle wheel. The circular line going around the edge of the cornea is the LASIK flap border. A special dye and filter were used to highlight the corneal defects and make them more visible. These open wounds are permanent and will never close. The 2nd image was taken with a technology known as Optical Coherence Tomography (OCT). This image shows a cross section of the cornea with a scleral lens over it. The 2 curved lines at the top of this image represent the front and back surfaces of the scleral lens. The thick grey irregular structure is the cornea. Look carefully to the right side of this image and you can see the deep, wide open RK incision just below the scleral lens. The last image is a 3-D computer generated image that shows the irregularity of the corneal surface. The red colors represent steep elevations along the corneal surface while the green and blue areas represent corneal depressions. The scleral lens replaces the irregular cornea as an optical surface. In other words, the scleral lens makes the elevations and depressions along the corneal surface irrelevant. This patient is able to see clearly (20/20) and without distortions with the scleral lens in place. Without the scleral lens this patient's visual acuity is less than 20/800 and cannot be corrected with eyeglasses or conventional contact lenses.

The Wavefront Scleral Lens

The corneal irregularities created by refractive surgeries, such as LASIK and RK, are responsible for ghosting, halos, starbursting, and loss of contrast sensitivity. These "higher order aberrations" may exist on both the anterior and posterior. With aberrometry, the defects of the entire optical system can now be corrected by a scleral lens.

The Wavefront Scleral Lens

Autologous Serum for Dry Eyes

Dry eye conditions are among the most challenging conditions faced by refractive surgery patients. With autologous serum, blood is spun down to plasma, forming an eye drop that helps rehabilitate the cornea.

Learn More about Autologous Serum

Dr. Boshnick on CBS This Morning

See Dr. Boshnick and Dr. Morris Waxler (former FDA chief research scientist on refractive surgery) talk about bad LASIK

Optimum Infinite Gas Permeable Material

I am happy to announce that our Global Vision Rehabilitation Center will be designing and fitting all of our “high need” patients with the Optimum Infinite gas permeable contact lens material. The Optimum Infinite material is the most oxygen permeable material ever to be approved by the FDA. In addition, this newly FDA approved material includes a UV lens blocker. Now for the first time, with certain patients, wearing a scleral lens made with the Infinite material under extended wear conditions can be considered.

SMAP 3D Scleral Lens Design

NEW: Powerpoint presentation on SMAP 3D

Last year we introduced an exciting piece of technology that has allowed us to custom design a scleral lens much more accurately. It is the SMAP 3D, which is a computer attached to a dedicated camera that allows us to obtain a 3 dimensional image of the entire front surface of the eye, including the cornea and the surrounding white portion of the eye (the sclera). Up until now there has not been any technology that would allow us to measure the ocular curvatures outside the cornea. The SMAP allows us to do this. Read More

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Blurred Vision, Burning Eyes: This Is a Lasik Success?

EyePrint Pro

EyePrintPro technology creates a scleral lens based on a mold of the cornea. The molding is accurate to 1 or 2 microns and fits perfectly because it exactly mirrors the irregularities of the individual corneal surface. The technology is well suited for post-Lasik, Keratoconus, RK, eye injury, and corneal transplant patients. Read More in this PDF about EyePrintPro Scleral Lens Technology

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