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Would like to know more about 'AK'incisions to lower astigmatism before
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MedHelp Member's Question

Would like to know more about 'AK'incisions to lower astigmatism before

by Mintha, Oct 29, 2006 12:00AM
Would like to know more about "AK"incisions to lower astigmatism

before Lasik and after Cataract surgery. Does anyone have experience with these?



Earlier in the year had cataract removal and limbal relaxing incisions, which lowered prescription from -7.75 with 4 diopters astigmatism down to aproximately -1.75 with 2.75 astigmatism.My

surgeon had told me I would need Lasik afterwards to get closer

to perfect vision. Since surgery I have experienced Iritis,painful soft contact wear,and of course the not great vision. Have recently found I need YAG laser treatment as it has clouded up behind new lens.

Went for second opinion about the Lasik and second doc suggested a better result using AK incisions to get the astigmatism, then Lasik after healing. I am concerned with more cutting on this eye. Does anyone know what AK is and have opinions?
Doctor's Answer

by Forum-OD-MP, Oct 29, 2006 12:00AM
http://www.dohenylaser.com/index.php?id=20



its a form of keratotomy.  surgeons used to do this all the time...it was called "RK" or readial keratotomy and made patients less nearsighted.  no one does that in the US anymore (RK, that is).



but AK is still around for cases like yours.  its a little unpredictable as to how much astigmatism it does/does not correct.  its kind of an "art"...not nearly as scientific as say LASIK, but AK is one of the only things available for refractive procedures in certain high-astigmatism Rx's....
Member Comments (7)

by JodieJ, Oct 29, 2006 12:00AM
To: Mintha
I researched methods of astigmatism reduction before I had cataract surgery.  I read that AK can produce severe night aberrations, including halos and starbursts.  LRI's are reported to involve less risk of a bad outcome, and they are used more frequently today than AK.  (But LRI's are unreliable and reduce astigmatism by only about 50% on average.)  Laser vision correction (LASIK, PRK) is supposed to be the most reliable method to correct astigmatism.



I'm curious--is there a specific reason why you need "perfect" distance vision?  (You'll still need glasses or contacts for clear near/intermediate vision.)  And why even consider having two procedures (AK and then LASIK) when just LASIK would do the job?  The more procedures you have, the higher the risk (and the cost).  Why not give your eyes time to completely heal and then reevaluate your goals?

by JodieJ, Oct 30, 2006 12:00AM
To: Mintha
I'm not sure I understand your situation.  Are you saying that you had catarct surgery on one eye, which eliminated much of your myopia and astigmatism...and now you want to get an accomodating lens for your second eye?  Will you be doing LASIK then on both eyes?   Have you considered monovision or modified monovision instead of the Crystalens?



I had to smile at your reference to "perfect" vision.  I'm also a former high myope with astigmatism.  Recebt cataract surgery and LRI's gave me 20/20 vision for distance, but it's sure not what I'd call perfect vision.  My near and intermediate vision are now so blurry that I'm very uncomfortable without glasses/contacts in most situations.

by Mintha, Oct 30, 2006 12:00AM
To: Jodie
Thanks for your reply and to the reply from O.D. about "AK" incisions.  In answer to your question,my goal is to try to come

as close to not having to wear contacts or glasses as possible. I have been severely nearsighted since around 9 years of age and have worn contacts successfully for almost 50 years. However with increasing dry eyes and glasses being uncomfortable, I would like to see if I could get as close to plano as possible.I do a lot of work that requires intermediate vision.  I am ok with having to wear reading glasses. So after much research and reading this column for months I felt my best option

to achieve this was an accomodating lens. Yes, I know there are those who don't like this lens, but I wanted to try it. My surgeon made it very clear to me that I would need LASIK afterward to get me further to my goal. I probably will forget

about the AK as it sounds unreliable....it had just been brought up by another surgeon as HE felt it had a few advantages using it to further zap the astigmatism before LASIK.  I do like my original surgeon but went to get another opinion as the second surgeon does a lot more LASIK than the first. I will make sure my eye is healed properly from everything before proceeding with the LASIK.

by Mintha, Oct 31, 2006 12:00AM
To: JodieJ
In answer to your questions...I have already had cataract surgery with limbal relaxing incisions in one eye. I had chosen a Crystalens hoping I would get some intermediate and possible a little near vision with it (if it worked). I knew I would mourn the loss of my close up vision (which I really have) Since the surgery my distance vision in the operated eye is good, I think I may have some intermediate vision, which seems to come and go, but don't think I have any close up vision left. My other eye has a cataract in it which will eventually need surgery, but for now am enjoying my bifocal contact in it and the ability to see up very close with it when the contact is off. I think until I have the LASIK (in the eye that had surgery) (to correct the left over astigmatism and nearsightedness) I will not know for sure if the Crystalens was a bad or good decision. The jury is still out. If I am not happy with it may not opt for it in the second eye. I don't know what my choices will be.I really appreciate being able to "talk" with you.

by JodieJ, Oct 31, 2006 12:00AM
To: Mintha
A doctor recently posted that the Crystalens provides the best intermediate vision of the three premium lenses.  You don't have much of a correction in that eye--are you currently wearing a toric contact?



When I was looking into methods of astigmatism reduction (before deciding on LRI's) my surgeon recommended PRK over LASIK.  He told me that PRK takes longer to heal but is much less likely to cause dry eyes (a concern of mine because I intended to wear bifocal contacts post-cataract surgery.)  He told me that either procedure would yield good results, and tho cost of both was the same.  Have you considered PRK?

by Mintha, Nov 01, 2006 12:00AM
To: JodieJ
Hi Jodie,

The correction I quoted is POST cataract surgery. Before surgery my correction was -7.7with about 3.75 of astigmatism.  So you can see I am much better.  But because I still have over 2 of astigmatism and -2 of nearsightedness things are still blurry.

I will check out the PRK.  I have pretty thin corneas and originally was told I could not have it so think that is probably still the case.  Am curious.....what is your correction now and are you able to wear the bifocal contacts?  I wore them for years and liked them.  Mintha

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