I had a bi-lateral Radial Keratotomy Spring 1983 in Eugene, Oregon while a student at the University of Oregon. I have enjoyed corrective free vision for the first 20 years post-operative, however, I have been wearing bi-focals for the last 8 years for reading and distance vision. Before I had my RK, my refractive error was -3.25 in my left eye and -2.75 in my right eye with and no astigmatism. I have 12 incisions in my left eye and 8 in my right.
Over the last 8 or so years, I have noticed a huge swing in my vision from morning to night. In the morning I am very farsighted and late in the afternoon or early evening a little myopic. I also developed a significant astigmatism in my left eye (+2.25) making night driving very difficult.
Late last year I did some research on PRK after RK and decided to have the custom Wavefront PRK done on my left eye on January 28, 2011. I am 9 months post op and can squeeze out a weak 20/20 on the eye chart at 400 PM in the afternoon. My auto-refraction measurement result was -.75 X +.75. I see much better after the PRK than before but seem to have even a greater variation in my visual acuity during the day.
I had the custom Wavefront PRK done on my right eye June 24, 2011. UCVA was a week 20/20 before the surgery but I was looking to get rid of the high order aberrations. Now after the surgery I am a little farsighted +1.50 X .50 and UCVA is 20/30.
Daily diurnal fluctuations seems to be getting much worse due to the weakening of my corneas from the RK and the recent PRKs have exacerbated the problem... After doing some research there appears to be a couple of solutions out there....Corneal Crosslinking (CXL) and Intacs that may potentially help stabilize my corneas.
On September 1, 2011 I had the cross-linking (CXL) procedure done on my left eye as part of an FDA clinical trial at Dr. Schwartz's office in Scottsdale, AZ. The first 36 hours post-operative was incredibly painful. I am now 18 days post-operative and have noticed a significant improvement in the reduction of fluctuations of my vision during the day. I start the day with great vision (20/20) and over the course of the day I become a little near-sighted...feels like by 6 pm I am about a -1.00 or so (20/30 - 20/40) but won’t know for sure until I go in for my 1 month check up on October 6, 2011.
I really hope that this procedure works and have high hopes at this point. I plan to have my right eye done in December.
Steve Ramsthel
Scottsdale, AZ
Update - October 12, 2011
The fluctuation of my vision during the day has decreased significantly, however I do notice some fluctuation from morning to night and hope that this will improve with time. I have my 3 month follow-up scheduled for the first week in December. I will probably have my right eye done in January 2012.
Had a doctor's appointment for my one month follow-up (had to post pone for 2 weeks because of business travel). Now 6 weeks post-op and have amazing vision in my left eye. At 400 pm in the afternoon (time of appointment) I could easily read the 20/20 line on the eye chart (UCVA - uncorrected visual acuity) and could clearly read the 20/15 line with a little correction of +.75 X -.50 @012 degrees (BSCVA - best spectacle corrected visual acuity).
Update: Feb 7, 2012 :
Now almost 6 months post-operative and vision in my left eye with 12 RK incisions is pretty stable through the day and night. My prescirption has changed as a result of the crosslinking procedure from -.25 X -.50 to +1.50 X -.25. My doctor did tell me that my prescription would change. I plan to have an H-PRK enhancement in my left eye in April to bring me back to plano.
I don't think that I will have the crosslinking procedure in my right eye (only 8 incisions) since my vision is pretty stable and the PRK ehancement has now got me pretty close to plano. The vision in my right eye is incredible...wow this PRK really works!
I don't think that I will have the crosslinking procedure in my right eye (only 8 incisions) since my vision is pretty stable and the PRK ehancement has now got me pretty close to plano. The vision in my right eye is incredible...wow this PRK really works!
Thanks for this great article!! Hope the treatment continues to go well :) I would also like to suggest pure marine collagen supplements as i have taken them for the past year and found that it has helped my recovery after a cateract op.
ReplyDeleteSteve - Thanks for sharing your story and I hope everything is going well. I'm 20 years post op RK with visual fluctuation and considering cross linking to stabilize.
ReplyDeleteHi Charlie,
DeleteDid you ever have the CXL procedure done to help reduce the diurnal fluctuations in your vision?
Hope all is well with you! Steve in Scottsdale
Update: Feb 7, 2012 : Now almost 6 months post-operative and vision in my left eye with 12 RK incisions is pretty stable through the day and night. My prescirption has changed as a result of the crosslinking procedure from -.25 X -.50 to +1.50 X -.25. My doctor did tell me that my prescription would change. I plan to have an H-PRK enhancement in my left eye in April to bring me back to plano.
ReplyDeleteI don't think that I will have the crosslinking procedure in my right eye (only 8 incisions) since my vision is pretty stable and the PRK ehancement has now got me pretty close to plano. The vision in my right eye is incredible...wow this PRK really works!
This comment has been removed by the author.
ReplyDeleteSteve,
ReplyDeleteYou write
"My prescription has changed as a result of the cross linking procedure from -.25 X -.50 to +1.50 X -.25"
Does this mean your glasses prescription ( you have become farsighted) or does this mean your refraction ( you have become nearsighted )
Thanks, Richard
Yes this means that I am now a little farsighted since the crosslinking procedure hardens and flattens the cornea. I am having a PrK to eliminate my farsighted condition and bring me back to plano.
DeleteSteve
480.772.1814
Steve,
DeleteThanks. I had CXL ( left eye) Nov.5 2011 in Cleveland because of fluctuating RK. I had RK in 1995 and was -7 which was a lot to correct. I have noticed some improvement, but I was told it would take 6 months to a year for the final result. I haven't noticed any shift towards hyperopia and will just wait and see if the eye continues to improve in terms of stability. I hate being farsighted in the morning and it is really bad when I travel to high altitudes and spend the night. My corneas are thick ( 600 microns ) so I hope that helps with healing.
Good evening Richard,
DeleteChecking in to see how you are doing post operatively from your CXL procedure. Any improvements in your diurnal fluctuations?
I hope you are doing well!
Steve in Scottsdale
April 26, 2012 - I had my final PRK enhance on my cross-linked eye ( left eye) 3 weeks ago and I now see 20/20. Not only do I have great distance vision but I can also read the paper without any reading glasses. My diurnal fluctuations have dismissed to the point that I don't even notice it and I have great vision.
ReplyDeleteCross-linking combined with a PRK enhancement after RK is the way to go!
Steve in Scottsdale
Steve - where did you have the CXL treatment done? I'm in the same boat - RK many years ago and big diurnal changes in vision. My local eye doctor was dead set against CXL - stating that it's not proven and can lead to complications, but did not offer anything specific. I want to do more research. Thanks. Wayne (in Portland OR)
ReplyDeleteSteve - Just saw the rest of your blog which identified the treatment center. Apologize for overlooking it the first time through. Thanks for the blog.
ReplyDeleteCheers..Wayne
When and where did you have your RK?
DeleteI grew up in Portland, Oregon and had my RK in Eugene while I was a student at the University of Oregon.
DeleteHi Wayne,
DeleteDid you ever have the CXL treatment done on your eyes to stabilize your diurnal fluctuations? I hope all is well with you!
Steve in Scottsdale
Now almost 10 months post-operative CXL in left eye and have minimal diurnal fluctuations in vision, however, my eye is pretty dry and requires me to add drops at least 4-5 times a day.
ReplyDeleteGreat blog!
DeleteAre the dry eyes a result of the CXL or PRK?
Any more updates?
Dry eye was due to the CXL. I no longer have dry eye and vision is stable in left eye. Read the 20/15 line a month ago at the doctors office. Need readers +2.0 for close up vision due to presbyopia.
DeleteGoing to have CXL on my right eye in three weeks. CXL continues to improve my visual acuity in my left eye over the last 18 months.
As a post-RK patient, my vision tends to be worse in the morning and best in the evening. You may not know the answer to this, but does it matter what time of the day you have the CXL procedure? In other words, if I had the procedure at 3PM, will my cornea stabilize at my 3PM vision state? Or the morning or evening state (worse vision or best respectively)? Just trying to get a feel as to where in this vision fluctuation the cornea stabilizes.
DeleteBill,
ReplyDeleteMy personal experience was that my vision stabilized at mid-day correction plus +.75 even though I had the procedure done in the morning. CXL will harden and flatten your cornea. I had a PRK 11 months after the procedure to get me back to Plano. My vision is now pretty stable with only a slight fluctuation for the first 60 minutes in the morning.
Steve
Having my right eye done this Thursday morning in Scottsdale at Dr. Jay Schwartz's office.
ReplyDeleteFebruary 9, 2013 - Had my right eye done on the 7th. Appt was at 930 am and out of the office by 1130am. Had intense pain for about 4 hours and took some pain medication to get me through it. Woke up yesterday morning with no pain and could see very clear. F/U appt at 130pm and tested vision result of UCVA of 20/25. My near vision seems to be much better. Seems like the .75 astigmatism is gone although I am still +1.00 (cylinder - farsighted). Diurnal fluctation of vision seem to have been eliminated but only 1 day post-operative so I don't know if I am out of the woods.
ReplyDeleteThis time around I had much less pain and seem to see much better the day after than when I had my left eye done (Sept 2011). CXL seems to give me higher quality vision which is hard to quantify...kind of like going from digital to HD TV...vision is much sharper and clearer.
Steve, thanks for the continued updates. I plan on getting my left eye done this coming Thursday. I'll post my results afterwards.
ReplyDelete-Bill
Steve, if you had to do it again would you do both eyes at the same time?
ReplyDeleteThanks,
Bill
Bill, if I had to do it all over ago I would do both eyes at the same time with the Athens protocol which is a combo of CXL and a topography guided PRK. Dr. David Lin in Vancouver BC is the most experienced refractive surgeon doing this procedure in North America.
ReplyDeleteI had both eyes done a week ago, and while my results aren't as dramatic as yours, I'm still very happy with the results. My ophthalmologist, Dr. Sandy Feldman, the only one in San Diego performing CXL, takes a conservative approach with PRK after CXL. She said she would rather wait a year after CXL before performing PRK to assure that the corneas are stable.
DeleteHi Bill,
DeleteDid you get a PRK after you had your CXL done about a year ago? And if so, what are your results?
I hope all is well with you!
Steve in Scottsdale
I entered a reply this morning but now I don't see it. Guess it got lost? Anyway, I never got the PRK done. I may eventually. The CXL didn't work as well as I had hoped. Maybe because of my age (I'm 61) and my eyes take a long time to change, I don't know.
DeleteHello, I also am experiencing the same visual fluctuations, now 20 yrs post RK. Steve I live in Scottsdale have met with Dr Schwartz and I am a candidate for the CXR. I admit I am apprehensive…how is your vision now? Still happy?
DeleteSteve,
ReplyDeleteEarlier in this post you said "is really bad when I travel to high altitudes and spend the night." Has CXL helped in this regard?
Thanks,
Bill
That wasn't my post....someone else that had an RK and was Looking at cross linking.
DeleteSteve
You're right, sorry. But did you notice any changes in your vision at different altitudes? If so, did CXL help? Thanks, Bill
DeleteThe only fluctuation in vision that I have experienced is due to a hydration issue. To combat this I have used the Genteal eye gel at night and it has worked wonders in solving my dry eye problem.
DeleteWaiting one year for a PRK enhancement is the right thing to do
Hi Steve has your doctor indicated when the FDA might approve this procedure
ReplyDeleteAlso I had 8 incisions each eye in 1993 and PRK in right eye after in 2008. So far I don't have as many problems just a little farsighted +2 in right and +3 in left. I am very interested in following your progress long term. I am still somewhat younger.
ReplyDeleteMaybe things will be worse later. I'm hoping having had 8 incisions might make things a little better for me than having had more like 16 incisions. How are you doing to date 8.15.2013? Still doing ok with left eye.? How about the right eye. It looked like you had CXL in right eye as well. Is the right eye doing well so far?
Hi Eric,
ReplyDeleteChecking in on your progress...
I hope all is well with you!
I had RK 20 years ago, I am 49. My near vision is going, wearing readers 2.0 now. My far vision is fading to about 20/50. I tried wearing RGP lenses and those not comfortable, I am considering having crosslinking done myself in Scottsdale AZ. I live in Nebraska and would have to travel, but it would be well worth the trouble if I have a good outcome. There is a CXL study going on in Minneapolis, but they are not seeing RK folks, just keratonconus patients. My question to everyone out there is if you have gone through this, please post your results comments, concerns regarding the procedure. Looking to go through with this, this spring/summer. The other thought i have and i keep going back to it is if I should have topography based prk at the same time as CXL. I would have to go elswherer for that, like Boxer Wachler in Los Angeles or somewhere else. I really want to hear from anyone with this type of experience.
ReplyDeleteI had RK 30 years ago, and I’m 62. I started needing readers about 10 years ago. I had 8 incisions in my left eye, 4 in my right. My left eye started getting a lot more far-sighted, so I had PRK in the that eye. That lasted about 5 years, and it started getting far-sighted again. About 2 years ago I had CXL done where I live, in San Diego, by Dr. Sandy Feldman. I consulted with Dr Boxer Wachler in 2005, but at that time Dr Feldman advised against it. However, about 5 years later she started performing CXL at her office.
DeleteHas the CXL helped me? That’s hard for me to say. My eyes continue to become more far-sighted, but it’s possible the degree to which they’ve become far-sighted has decreased from the CXL. I still have the morning and evening vision fluctuation. Overall I’m glad I had it done, just in case it has helped. In retrospect I probably should have done it sooner at Boxer Wachler, but since my ophthalmologist Dr Feldman advised against it, and I truly hate LA, especially Beverly Hills where Boxer Wachler is located, I didn’t have it done there.
My advice is, if you have the money and time, get it done at Boxer Wachler. Dr Boxer-Wachler has the most experience, and the procedure can only help. The one side-effect I had was cornea scaring, which resulted in some haze at night time. Lotemax drops have helped a lot though. The other side-effect is the time and money involved, but it’s probably better to have it done sooner than later if you can.
I hope that helps.
-Bill
Hello Bill, I too had RK down 30 yrs ago and am the same age as you. I have been approved fot the CXL study here in Scottsdale. I was hoping to hear that you have stopped the visual fluctuation..is it less? Can you limit it to just two pair of glasses..I must have 20 pair now!! I NEVER know where I will be, that is so frustrating!! Are you able to drive at night? Thanks…this is such a difficult decision to make, I will need cataract surgery in the next few years, so was hoping to have a more stable cornea first. Thanks…Any regrets?
DeleteCarla, Did you get the cross linking procedure,? If so, what can you tell me about your experience and how are you doing now? Very curious, I am going to get PRK, or PRK XTRA done, which is crosslinking during the PRK procedure. I am going to treat my right eye first, as it is the most affected by RK , cant see distance or near very good with that eye. At least my left eye the distance vision is still somewhat decent, but since I am 50 now, presbyopia has set in and I cant read anything without reading glasses.
DeleteHi Bill. You information does help me a great deal and I really appreciate it. I have been mulling over all the possibilities of what I could do. I could do CXL and possibly intacs to take care of my prescription or I could do CXL and PRK combo. I probably would choose boxler Wachler for either procedure. Do you have dry eye? Also do you think that if you were 10 years younger when you had cxl if it would have made a difference? Or was the procedure different than what they use in scottsdaIe? I presume yours was epi off due to scarring you mentioned. I want to make my next decision very carefully.
ReplyDeleteHi Joyce,
ReplyDeleteMy eyes may be a bit drier than normal, but I don't notice it.
Yes, if I were 10 years younger I would have had CXL on the chance it would help. I think the sooner it's done the better. I know I said I'm not convinced it works for me, but I also wish I had it done earlier, just in case it is helping but I'm not aware of it. I'm not sure of the procedure in Scottsdale, but I assume all CXL procedures are similar. My CXL procedure was epi semi-off because that's what the ophthalmologist thought was best at the time.
It's good you're doing your research. Hopefully others will chime in here as well.
Good luck!
Bill
I hope for others input as well. So is your right eye still better than the left, the one you had prk on? Or is it declining at the same rate? Have you had any topography scans since cxl to see where things are at. I will try to post a pic of mine later. Would be nice to compare images. If anyone else has gone through cxl please post your experience here.
ReplyDeleteBoth eyes now have about equal vision and both seem to be declining at about the same rate. I believe I had a topography awhile back, and no problems.
DeleteLooking back, are you glad you had the PRK on your one eye? Did it make it more spherically correct, or easy to get a glasses prescription for that eye? In other words, less astigmatism, less aberrations, etc. Or did it regress to pre prk condition?
DeleteWhile I'm glad I had PRK on one eye, it did in fact regress to almost pre-PRK conditions over time. But if I hadn't had the PRK my eyesight in that eye would be a lot worse. So overall I'm glad I had it done.
DeleteWhat was the cxl recovery like? Also how did the prk go?
ReplyDeleteCXL recovery was normal I guess. The first few days were a bit painful. PRK same.
DeleteI had a weird thought and hope I might get a response from someone who knows more than I do about all of this. An RK persons cornea continues to flatten out over time, so would it be prudent during a CXL procedure to leave the riboflavin off that part of the cornea and just stiffen the outer portion. Doesn't the continued flattening lead to progressive hyperopia ?. perhaps if just the outer area were stiffened it might actually prevent further flattening??? Just thoughts that I wanted to address, they may sound crazy but just wondering. Sort of a custom CXL procedure
ReplyDeleteBill you mentioned you had corneal scarring. Was it from the CXL procedure?
ReplyDeleteI think so, but I'm not sure. My ophthalmologist told me it was there, and while discussing it I failed to ask what caused it. I'll see him in a few months again and if I remember I'll ask. But it's almost all gone now and I can probably stop using the Lotemax eye drops soon.
ReplyDeleteReplying to: "Hello Bill, I too had RK down 30 yrs ago and am the same age as you. I have been approved fot the CXL study here in Scottsdale. I was hoping to hear that you have stopped the visual fluctuation..is it less? Can you limit it to just two pair of glasses..I must have 20 pair now!! I NEVER know where I will be, that is so frustrating!! Are you able to drive at night? Thanks…this is such a difficult decision to make, I will need cataract surgery in the next few years, so was hoping to have a more stable cornea first. Thanks…Any regrets? "
ReplyDeleteFor me, maybe because of my age, I still have daily visual fluctuations, but maybe not as much, it's hard to tell. More importantly, I believe my eyes have slowed or stopped becoming more farsighted, but that's also hard to quantify. I only wear one pair of glasses throughout the day, but I do have a bit of trouble reading first thing in the morning. Yes, I can drive at night. No regrets on CXL, only wish I had it sooner.
You mentioned cataracts. I'm looking into Refractive Lens Exchange, essentially the same as cataract surgery. Getting a consultation in a few weeks. I have minor cataracts, not enough for surgery now, but may opt for RLE for better vision.
I noticed CXL is now in the Wikipedia:
ReplyDeletehttps://en.wikipedia.org/wiki/Corneal_collagen_cross-linking
Hey! I have keratoconus and had CXL in my left eye (OS) only-- done by Dr Mark Speaker (NYC) in March of 2015. I was 30 at the time. A full year after the procedure and I still notice some side-effects. My night vision now has milk-ness to it. This is reported to happen to about 10% of people that have it done. I only notice when I cover/close my right eye but it's made me hesitate to do the right eye as well. HOWEVER-- my vision is so much better in my left eye than my right now and easier to correct. I see best with mini-sclera contact lenses and passable with glasses but not for night driving, I appreciated reading the comments so just wanted to add my experience (even tho I'm not post-RK). I live in Portland, OR and will look into CXL here. I paid $2500 for one eye so this next time I may try and see if they'll accept me in a clinical trial... found clinical trial info here;
ReplyDeleteMilky-ness I meant to say
Deletehttp://www.aecosurgery.org/aecos-sponsored-clinical-trials.htm
Deletehttp://www.aecosurgery.org/aecos-sponsored-clinical-trials.htm
DeleteMilky-ness I meant to say
DeleteThanks for sharing Kata!
Delete