Use of reverse geometry rigid gas permeable contact lenses in the management of the postradial keratotomy patient: review and case report

What Happens 20 to 30 years After Radial Keratotomy? Case Series

ABSTRACT

Radial keratotomy (RK) was commonly performed in the 1980s and 1990s. We aimed to clarify the current status of post-RK refractive correction and treatment. We retrospectively reviewed the charts of 70 patients with a history of RK. Of the 70 patients, 44 were identified for clinical outcomes. Refractive or therapeutic intervention (rigid gas-permeable contact lens fit, spectacle prescription, corneal surgery, and use of pilocarpine hydrochloride for photophobia) was possible in 59% of patients with postoperative visual deterioration after RK; in the remaining 41%, therapeutic intervention was not possible. Rigid gas-permeable contact lens fit for corneal irregular astigmatism was the most common refractive intervention and was effective in 36% of cases in the university hospital.

TFOS Lifestyle: Impact of contact lenses on the ocular surface

Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.

Long-Term Corneal Refractive Power Changes Two Decades After Radial Keratotomy With Microperforations

ABSTRACT

We retrospectively examined corneal refractive power in three patients who had been followed up for more than 20 years after radial keratotomy (RK) with microperforations (MPs). All patients underwent RK in both eyes and were referred to our clinic because of postoperative decreased vision. MP was observed in five of the six eyes at the initial visit. The corneal refractive power of the anterior and posterior surfaces of the 6-mm-diameter cornea was examined using Fourier analysis based on corneal shape analysis using anterior segment optical coherence tomography. The spherical components decreased in all three cases. The asymmetry and higher-order irregularity components and fluctuations in corneal refractive power were markedly greater in the two cases with MP in both eyes. Fluctuations in corneal refractive power were observed at more than 20 years after RK with MP. Therefore, careful observation is necessary, even after a long-term postoperative follow-up period.

RK4 (reverse-geometry) contact lens fitting after penetrating keratoplasty

PURPOSE

We evaluated the performance of the RK4 (reverse-geometry) contact lens in patients with flat central and steep peripheral corneal topography after penetrating keratoplasty (PK).

METHODS

A retrospective study was performed of post-PK patients fitted with RK4 lenses on the Cornea Service at Wills Eye Hospital, between March 2000 and February 2002.

RESULTS

Fifteen eyes of 13 post-PK patients were fitted with RK4 lenses and monitored for more than two months (range, 2.1-23.5 months; mean, 8.1 +/- 7.0 months). The average number of lens refits per eye was 1.0 +/- 1.2 (range, 0-4). Ninety-three percent (14/15) of the eyes that were fitted achieved at least 20/30 visual acuity, and 53% (8/15) of eyes achieved 20/20 visual acuity. A comparison of prefitted and post-fitted corrected visual acuity demonstrated a statistically significant improvement (P < 0.01). RK4 lenses were successfully worn full time or part time in all cases.

CONCLUSIONS

The RK4 lens can provide well-tolerated visual correction in cases with central flat, peripheral steep corneal contour following PK.