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Many MDs still recommend RK to the low myope
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GRAND CAYMAN, British West Indies—"Radial keratotomy (RK) will survive, at least for a while longer, because it is better for low myopes," said Robert G. Wiley, MD, of the Cleveland Eye Clinic. "It will last at least until results with lasers are proven better."
Wiley presented results of an informal survey of ODs and MDs, as well as presenting his own opinions on the future of RK, here at the Island Ophthalmology Seminar.
Quick visual recovery with RK
"RK will survive because of the quick visual recovery," he said. "It's an inexpensive procedure with inexpensive equipment, and it has a long track record in the United States. RK has excellent results for low myopia, and it has been proven effective in a comanagement relationship."
The survey, which was administered by Wiley and his associate, Jeffrey M. Augustine, OD, posed the question: "For an appropriate candidate who wished refractive surgery (–3.00 D, –6.00 D or –9.00 D myope), what would you recommend?"
Wiley surveyed 80 ophthalmologists on the American Board of Eye Surgeons and received 36 responses. Augustine surveyed 70 members of the Optometric Refractive Surgery Society (ORSS)—of which he is president—and received 43 responses to the same question.
The ORSS is made up of optometrists who have a primary interest in comanaging refractive surgery patients.
"Most ophthalmologists agreed that RK for –3.00 D myopes is best," Wiley said. "However, most optometrists feel PRK is best in –3.00 D. In the higher myopes, laser in situ keratomileusis (LASIK) was chosen most often by both groups. Ophthalmologists who are more familiar with results in the low diopter range seem to agree that RK is better than PRK."
RK predictable for low myopes
Wiley believes this may change as results with laser procedures improve. However, "right now, the results of RK, especially with an experienced RK surgeon, may be better than laser in low diopters," he said.
"When one considers RK disadvantages, perception may not be reality in all groups of cases. RK is much more predictable and stable in the low myope group," he said.
According to Wiley, RK still has an image problem, but he feels it is probably related to the fact that RK is more unpredictable and has more visual complications when used in higher diopter patients.
"Laser surgery for myopia is a procedure designed by Wall Street," Wiley said.
"Marketing people realize that laser can be 'sold' to the public. Laser is synonymous with high-tech, and patients seem to want high-tech in refractive surgery."
Wiley went on to point out that often Wall Street is right, however, and that laser surgery may be better in the long run, even in the low myope group.
"It's a catch-22," he said. "Right now I firmly believe RK is better, but a year fromnow, I may think laser is better."
Which type of surgery would you recommend?
| PRK MDs, ODs | LASIK MDs, ODs | RK MDs, ODs | |
|---|---|---|---|
| -3.00 | 25%, 60% | 8%, 10% | 67%, 30% |
| -6.00 | 56%, 50% | 28%, 50% | 17%, 0 |
| -9.00 | 13%, 16.2% | 84%, 83.8% | 0, 0 |
Advantages of RK
- It is more accurate in low myopes.
- Fewer lines of corrected vision are lost.
- Surgery is not performed in the visual axis.
- More than 1 million procedures have been performed.
- Astigmatism correction may be more accurate than with a laser.
- Many surgeons have experienced excellent results.
- Visual recovery is quick.
Disadvantages of RK
- It is less accurate in higher myopes.
- Long-term stability is still in doubt.
- Microperforations are not un common.
- Corneal weakness is perceived as a problem.
- Morning-to-evening visual fluctuation is common.
- Hyperopic shift is perceived to be a problem.
- Regression is not uncommon.