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PentaVision

Contact Lens Spectrum

Article

ONLINE PHOTO DIAGNOSIS

By: DANIEL DELIGIO, OD
Contact Lens Spectrum May 1, 2023 Vol 38, Issue May 2023 Page(s): 6

A 64-year-old Caucasian male presented for a multifocal contact lens fit due to fluctuating vision throughout the day. He had a history of radial keratotomy (RK) in both eyes and was currently wearing soft multifocal contact lenses with unsatisfactory vision at distance and near OU.

Exam Findings

All entrance testing appeared normal. Visual acuities were slightly reduced OD/OS at distance and near. The presence of RK scars can be seen in Figure 1 and 2. Corneal topography/tomography was obtained (Figures 3 and 4), showing the central flattening shape of both corneas with OS being slightly decentered temporally.

Figure 1
Figure 1

Figure 2

Figure 1
Figure 3

Figure 4
Figure 4

Discussion

RK is a refractive surgery for myopia that is not performed much today due to more modern refractive procedures.1 A series of partial thickness, radial corneal incisions are made to steepen the periphery of the cornea, thereby making the central cornea flatter. Corneal incisions are avoided in the central axis due to obvious stromal scarring that would occur reducing vision.1

Even though new RK patients are seldom, there still exists many out there who incur the complications of this procedure such as diurnal fluctuation of vision and irregular astigmatism. For more advanced cases, a reverse geometry GP lens may be most beneficial. Reverse geometry is usually indicated over traditional GP designs due to the flatter central cornea of RK patients.2

Conclusion

This patient desired more clarity from his contact lenses and, therefore, was fit into reverse geometry, translating, segmented, trifocal GP contact lenses with satisfactory vision and comfort. As the number of these patients will start to dwindle over the years, the knowledge of fitting these types of patients will be less useful. However, it is still relevant today, and proper handling of these cases will ensure maximal visual outcomes.

References

  1. Robin JB. Radial keratotomy: procedures. Indian J Ophthalmol. 1990 Jul-Sep;38:103-106.
  2. Mathur A, Jones L, Sorbara L. Use of reverse geometry rigid gas permeable contact lenses in the management of the postradial keratotomy patient: review and case report. Int Contact Lens Clin. 2001 Sep;26:121-127.

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