Sunday, September 18, 2011


September , 18, 2011 
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 this PRK really works!