Lasik Over RK Articles

RK 30 years ago, then Lasik, Incisions STILL open

This is a photo of the front surface of an eye that underwent Radial Keratotomy surgery 30 years ago followed by LASIK surgery years later. A special dye was used to highlight the defects (cuts) in this cornea. The straight lines that you see at 12:00, 3:00, 6:00 and 9:00 O'Clock are the open RK incisions. The bright green circular line going around the periphery of the cornea is the outline of the LASIK flap. Needless to say, the vision that this patient has with this eye is very poor. In addition the eye is very dry and presents this patient with significant comfort issues. This eye was recently fit with a scleral lens which has greatly improved the vision and comfort in this eye for our patient. The cuts that you see in this eye are permanent. There is no way to undo the damage to the eye created by these needless elective surgeries. The only thing that we can do is to manage the patient's comfort and vision as best we can with specialty lenses. Corneal transplant surgery is really not a viable option.

Lasik over RK Equals Disaster

The images below are of the left eye of the same patient. This eye underwent 2 separate RK surgeries over 30 years ago followed by 4 separate LASIK surgeries. As you might expect the results of these surgeries was nothing less than disastrous. The first photo (taken 4 years ago) shows the RK cuts with blood vessels growing along the inside track of the cuts. The white "hatchet-like image is epithelial ingrowth. 4 years ago I referred this patient to a world renown eye institution where corneal transplant surgery was recommended. This patient declined to accept this advice. The 2nd image was taken today. 12 months ago the corneal specialists at this institution diagnosed the crystalline appearance in this cornea as "Crystalline Keratopathy" (extremely rare complication) and was placed on fortified antibiotics for the last 12 months. The 2nd photo looks exactly like a photo that I took of this eye last year. The 3rd image was taken with a technology known as "optical coherence tomography". This images shows a cross section of this cornea with a scleral lens over it. In this image you can see the crystalline deposits deep inside the cornea. Over the last year this patient visited 8 corneal specialists from around the U.S. Many of them blamed the scleral lens as the cause of her corneal condition. In addition, a variety of therapies and treatments were recommended to her. With the scleral lens the visual acuity in this eye is clear (20/30). In addition, the cornea is clear with the exception of the crystalline deposits and the patient has no comfort issues while wearing her scleral lens. Since this eye has been stable for the last 12 months I recommended that no action should be taken and that this patient return periodically for evaluations including ocular photography and imaging.

RK about 15 years ago, then Lasik, Open Incisions

The images below are of the same eye. This eye underwent Radial Keratotomy (RK) 30 years ago. 15 years later this same eye underwent LASIK surgery. A special dye was used to highlight the corneal defects created by these surgeries. In the first photo, note the lite up radial lines. These are the still open RK cuts or incisions. Note the circular yellow green line going around the periphery of the cornea. This is the border of the LASIK flap. The bright green horizontal line going across the lower portion of the cornea is known as a "cross cut incision" intended to eliminate any astigmatic error. The fact that these defects "lite up" tell you that these incisions are still open and subject to infection from opportunistic organisms entering these defects. The 2nd image was taken with a computerized corneal topographer. This technology involves casting lit concentric rings at the cornea. These rings reflect back into the computer-camera so that a photo can be taken. If the cornea had a smooth undistorted surface, the rings would appear to be perfectly round. Note how distorted these rings are. It is for this reason that eyeglasses and regular contact lenses cannot correct the vision in this eye. A scleral lens, however, will replace this cornea as an optical surface and allow the patient to see clearly once again.

2 separate RKs, then 4 separate Lasiks

The 2 photos below are of the right eye of a patient who underwent 2 separate Radial Keratotomy (RK) surgeries in the 1980's followed by 4 separate LASIK surgeries years later. The 2nd photo was taken 3 years after the 1st photo was taken. In the first photo you can see blood vessels growing along the still open RK incisions. The white "hatchet" structure is epithelial ingrowth. These are cells from the corneal surface that got under the LASIK flap (where they do not belong) and began growing. In the 2nd photo, taken 12 months ago, note that the epithelial ingrowth has dissipated. Now the central cornea has a scratched ground glass appearance. 12 months ago, we referred this patient to a world renown eye institution where she was seen by several corneal specialists. A diagnosis of "crystalline keratopathy" was made and this patient was promptly placed on fortified antibiotics. The crystal formations seen here are deep within the cornea and not on the surface. This patient left our geographic area for a 10 month period and recently returned to see the corneal specialists at this institution. Yesterday I was informed that this patient's cornea has the same appearance as it did last year and that she is still on antibiotic therapy. I was also told that collectively, these corneal specialists have never seen anything like this before. I will be seeing her next week for the first time in a year and am anxious to have a look at her eyes as I have sequential photos of her eyes that I have taken over a 9 year period. What puzzles me is why would a doctor or doctors do so many destructive operations on a single eye and why would this patient allow such outrageous behavior be inflicted on herself?

RK, ALK, and Lasik Equals Dry, Painful, Irregular Cornea

This eye underwent 2 separate RK surgeries, 2 separate LASIK surgeries and 1 ALK procedure. This eye is extremely dry and distorted. In addition, for the last 6 months this patient has been experiencing extreme unrelenting pain in this eye which a variety of medications have not been able to address. In this photo the green-yellow radial lines represent the deep open RK incisions. Several curves green-yellow circular lines going around the periphery of the cornea are the open LASIK flaps. This patient and I are struggling to improve this situation to avoid corneal transplant surgery. Today this patient told me that she does not care about her vision any longer. She just wants the pain to go away. A number of highly trained eye specialists have been unable to help this patient. Sometimes I feel so helpless when faced with such an extremely damaged eye.

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

Have Twitter?

Follow @Boshnick or check

Have Instagram?

Dr. Boshnick on Instagram

Check out


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

Watch Video at YouTube