Lasik Over RK Articles

Lasik over Three Radial Keratotomy Procedures. Now 20/20 with GVR Scleral Lens

This is a photo of me with our 2 student externs, Jenna Adelsberger on the left and Amanda Golchin on the right. Standing to my left is our patient Alejandro who visited us earlier this week from San Juan, Argentina. 28 years ago, Alejandro underwent 3 separate Radial Keratotomy (RK) procedures in each eye. This was followed by LASIK surgery in each eye 15 years ago. For over 20 years, Alejandro has suffered from poor vision that was not correctable with eyeglasses or contact lenses. Alejandro's visual symptoms included halos around lights, glare, double vision and reduced vision in low light environments. In addition, both of his eyes are extremely dry which has caused him to have significant ocular pain over all these years. 2 years ago, we fit both of Alejandro's eyes with GVR Scleral lenses which have provided him with clear (20/20) stable, comfortable vision with no distortions and with all day lens wear. Last year, Alejandro returned for his annual examination. Both of Alejandro's eyes were stable and his vision remained the same. When I examined Alejandro this past week, he was still doing well with his scleral lenses and his vision and eyes had not changed. Because the scleral lenses vault over his dry, distorted corneas, Alejandro does not suffer any ocular pain from dry eyes. This is due to the liquid reservoir that exists between the back surface of the scleral lens and the front surface of his corneas. The 2nd photo is of Alejandro's right cornea. Fluorescein dye was instilled on the front surface of the eye. Where there is a break in the cornea, the dye will get into the open wound and light up. Note the numerous incisions that were made into this eye which have not healed after all these years. I expect Alejandro to continue to wear his scleral lenses comfortably and with excellent vision for many years to come.

Lasik over Radial Keratotomy Equals Severely Distorted Corneas. Now 20/25 in Each Eye with GVR Scleral Lens

This is a photo of me with our 2 student externs, Jenna Adelsberger and the extreme left and Amanda Golchin on the extreme right. Standing to my left is our patient Nick, who underwent 3 separate Radial Keratotomy (RK) surgeries in the 1980's followed by 2 separate LASIK procedures 20 and 23 years later. These surgeries left Nick with severely distorted corneas which were later diagnosed as "post refractive surgical corneal ectasia". Nick's corneas were so distorted that he was unable to wear any type of contact lens. Eyeglasses were not able to provide Nick with functional vision. Before visiting our office, Nick used pilocarpine eye drops 3 or 4 times each day in order to function. Pilocarpine drops function to constrict the pupils which help minimize the effect of the distorted corneas on his vision. 3 months ago, we fit both of Nick's eyes with the Eye Print Pro Scleral lens. Eye Print Pro technology involves making an impression of the front surface of the eye. This procedure is painless and takes just a few minutes. The impression or mold of the front ocular surface is then sent to our special laboratory where a scleral lens is made. Every "hill and valley" of the entire front surface of each of Nick's eyes is imbedded into the back surface of the Eye Print Pro scleral lens. Today, Nick told me that he has never seen as clearly and as comfortably as he is now seeing. Without these lenses, Nick's visual acuity is less than 20/800. With the Eye Print Pro scleral lens Nick is able to see clearly (20/25) in each eye without any distortions.

Lasik over Radial Keratotomy with Declining Vision now 20/20 in Each Eye with GVR Scleral Lens

The photo below shows our student extern, Jennifer Vicente, on the right and me on the left. In the center is our special patient, Frank. In the 1980's Frank underwent Radial Keratotomy eye surgery. While Frank was able to see clearly for several years following the RK surgery, his vision gradually began to fail. In 2005, Frank had LASIK surgery done on both eyes. After this procedure his vision decreased rapidly in his right eye forcing him to undergo corneal transplant surgery in this eye in 2010. Frank visited a number of doctors over the years attempting to get fit with contact lenses without success. One month ago Frank visited our office. When first seen by us the visual acuity in this right eye was 20/350 and in his left eye 20/60. We fit both of Frank's eyes with GVR Scleral lenses which are providing him with clear (20/20 in each eye) comfortable vision with all day lens wear without visual distortions. The first ocular photo shows the GVR Scleral lens over Frank's eye with the corneal transplant. The 2nd photo is of Frank's left cornea. A special dye (fluorescein) was instilled onto the ocular surface of this eye as a visual aid which is why the cornea appears green. Note the open "frowny-face" incision at the top of the photo and the open "smiley-face" incision at the bottom of the image. These incisions are still open 30+ years after the surgery was done. The purpose of these incisions was to eliminate Frank's need for eyeglasses or contact lenses. I expect Frank to be able to wear his new scleral lenses for many years with excellent vision and comfort.

Patient with Fluctuating Radial Keratotomy Vision Stable at 20/20 with GVR Scleral Lens

The first photo below is of me with my patient Doreen who visited us recently from New Jersey. Doreen underwent 2 separate Radial Keratotomy ("RK") surgeries in 1985 and 1986. For the first few years, Doreen was able to see relatively well. However, for many years her vision was unstable and would fluctuate from morning into evening. Eyeglasses were not able to provide Doreen with the vision that she needed. Recently, we fit both of Doreen's eyes with gas permeable GVR Scleral lenses. With her new lenses Doreen has clear (20/20), stable vision both at distance and near and is able to wear her lenses almost all of her waking hours. In the 2nd and 3rd photos you can see the scarred radial keratotomy incisions, many of which are still open after all these years. Today I asked Doreen when was the last time that she saw this clearly, her answer was " this is the best vision I've had since I was eleven". I feel very honored and privileged to have made such a difference in Doreen's life.

Lasik over RK with Epithelial Ingrowth

This is a close up photo of a cornea that underwent 2 separate RK (Radial Keratotomy) surgeries in the 1980's followed by 2 separate LASIK surgeries in 2001 and 2003. Look carefully and you can see the scarred RK incisions radiating onto the cornea from the white portion of the eye. At 9:00 O'Clock you can see a long horizontal blood vessel growing onto the cornea along one of the RK incisions. Know that blood vessels do not belong in or on the cornea. At the end of the blood vessel toward the center of the cornea is a "hatchet like" milky white object. This is known as "epithelial ingrowth". The cells on the outside surface of the cornea are called epithelial cells. What has happened here is that some of these epithelial cells got underneath the LASIK flap and began to grow. When this happens the usual treatment is lifting the LASIK flap and cleaning out these cells. If this does not work and the cells begin to obscure the vision, corneal transplant surgery may have to be done.

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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