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

Radial keratotomy (RK) is a well-known procedure for reducing myopia. However, the complications associated with the procedure and the development of newer technologies, such as photorefractive keratectomy and laser-assisted in situ keratomileusis, has resulted in the technique of RK falling out of favor. A number of patients who received RK during the 1980s are now experiencing a shift in their prescription and are presenting to primary care practitioners for contact lens fitting. These patients pose a significant challenge to the contact lens practitioner, and novel methods frequently are required to fit corneas that exhibit such abnormal topography. This article reviews the potential problems associated with fitting patients who have received RK and describes a case in which a novel lens design was used to achieve a successful lens fit.

Screening for Psychiatric Distress and Low Self-esteem in Patients Presenting for Excimer Laser Surgery for Myopia

BACKGROUND

Patients presenting for photorefractive keratectomy (PRK) may have unusual psychological profiles. Certain psychological variables may impact treatment outcome, making early identification crucial. We report a controlled questionnaire study of psychiatric "anxiety/distress" and self-esteem in myopic patients who presented for excimer laser treatment.

METHODS

Ninety consecutive myopic individuals (patients) who presented for excimer laser PRK and 50 consecutive myopic individuals who presented to an optometrist for contact lens fitting (controls) were assessed using two self-completion questionnaires-the GHQ30 and Hudson Index of Self-Esteem ISE. The questionnaires were distributed during assessment for treatment.

RESULTS

PRK patients had a 90% response rate for both questionnaires and control patients, 98% for GHQ30 and 100% for Hudson ISE. PRK patients were significantly older (p = 0.000003), had a greater myopic spherical equivalent refraction (p = 0.012) and had better spectacle-corrected visual acuity (p = 0.0096). No significant differences were demonstrated with regard to anxiety/distress in terms of absolute scores (p = 0.07), or the proportion of patients being positive or negative (p = 0.10). Similarly, self-esteem was not significantly different between the two groups (absolute scores p = 0.69; positive/negative p = 0.29). The high response rate shows that the GHQ30 and Hudson ISE are easy to use and well tolerated by myopes in a busy clinic setting. The fact that the patients were older, with a greater refractive error, may partly reflect the onset of contact lens intolerance.

CONCLUSION

The psychological findings suggest that PRK patients cannot be considered more distressed or anxious than other myopic individuals. There is no evidence that their decision to undergo surgery is driven by abnormally low self-esteem.

Attitudes of Successful Contact Lens Wearers Toward Refractive Surgery

BACKGROUND

Traditionally, spectacle wearers and contact lens failures have been the patient population targeted for refractive surgery. We surveyed successful contact lens wearers to determine their attitudes toward refractive surgery.

METHODS

One hundred thirty-three consecutive successful myopic contact lens wearers older than 21 years were requested to read information regarding both radial keratotomy and excimer photorefractive keratectomy and complete a questionnaire. We report on the relationship between interest in undergoing radial keratotomy or photorefractive keratectomy and various patient parameters.

RESULTS

More than 75% of those surveyed indicated that they would consider either procedure at any time in the future. The only statistically significant correlation found was that patients younger than 40 more frequently expressed an interest in undergoing radial keratotomy than patients older than 40. Nearly 70% of those surveyed would not spend more than $ 500 per eye for either procedure, and most patients grossly underestimated the costs associated with contact lens wear.

CONCLUSIONS

In addition to spectacle wearers and contact lens failures, successful contact lens wearers can also be considered potential candidates for refractive surgery, provided it can be offered at a cost acceptable to them and if concerns regarding surgical side effects are addressed to satisfaction. This group does not appear to represent "early adapters" to new refractive technologies. The greatest interest was expressed by those younger than 40 years.