First of all I have to say that after reading the other personal experiences posted on this site, I realize how lucky I am for having had RK only on my left eye. The vision in my left eye is now essentially useless, but fortunately I still have an undamaged cornea on my right eye. However, this doesn't mean that the surgery hasn't had a huge impact on my life. Not a day goes by where I don't spend a significant amount of time thinking about what's happened to my vision and how I allowed this doctor to ruin it. I'm also angry with myself because I knew better, and still I let the "RK sales pitch" convince me to have the surgery. I've probably let this bother me more than it should and maybe that's just part of my personality, but I also can't ignore what I'm seeing. I'm constantly fighting with the blurry double vision from my left eye and living with the stress it is causing.

After my RK, I was experiencing a tremendous amount of anxiety and began having sleeping problems. Six months later the anxiety had become unbearable and I started having panic attacks. My family doctor referred me to a psychiatrist and I've been through numerous drug trials for anxiety and depression. It's been more than ten years since my surgery and it's embarassing to admit how much this is bothering me, but I've had a hard time dealing with the combination of monovision and garbage I see with my left eye. My life is not what it was and sleeping remains a big problem. The following is a chronologic recounting of how I got here.

August 4, 1987 - Yearly Check-Up with my Optometrist
OD -4.75 -.25 x 135 correctable to 20/20 or better
OS -5.25 -.75 x 180 correctable to 20/20 or better

I was always very athletic, participating in football, wrestling and track and also enjoying hunting, water skiing and golf. Later in life I got interested in swimming and biking and became involved in triathlons. I was basically a real health and fitness nut. I didn't like wearing my glasses while participating in these types of activities, so I wore contacts. However, my eyes have always been dry and sensitive and the contacts were a real problem. My optometrist did everything possible to help me with my contact lens wearing difficulties and asked me if I had ever considered refractive surgery. I told him "I'd seen 60 Minutes!" and was not interested in RK. He said he didn't blame me and wouldn't consider RK for himself either, but that there was another refractive surgery, which was reversible, nicknamed the "living contact lens" (epikeratophakia). He said he didn't know much about it and referred me to a local doctor (the RK Doctor) for a consultation.

September 8, 1987 - First Consultation with RK Doctor
At the consultation epikeratophakia is discussed and I quickly realize that it isn't for me. RK is also discussed. I'm told RK would get rid of a majority of my myopia, but I would probably still need glasses for my best vision. I was told to think about it and come back for a second visit.

October 18, 1987 - Second Consultation with RK Doctor
Again both epikeratophakia and RK are discussed, but I'm told RK is the best way for me to go. I said thanks and that I would think about it. Actually, nothing was said that changed my mind about RK. I was definitely not interested.

September 9, 1989 - Seminar with RK Doctor
I had no further thoughts of refractive surgery until the RK Doctor started advertising for his seminars in the local paper. I was curious so I called to get invited to a seminar (I actually attended two seminars). At the seminars the RK Doctor answered questions on many topics including glare. He said problems his patients had with glare were minor, got better over time, and compared it to glare experienced while wearing a contact lens. He impressed on us that he had performed over 3000 RK's and had taught the procedure to other doctors around the world. He said none of his patients had ever had any real problems and that the only real complaint he had was from patients who were not satisfied with being slightly under corrected after the surgery. He did agree that there was some risk, but it was small and he felt that the results were worth this small risk. He also admitted that there had been people harmed by RK, but this was mainly due to the wrong doctors performing the surgery. The RK doctor stressed that the most important thing with RK is to have the "RIGHT" doctor, and HE WAS the "RIGHT" doctor. He then had a former patient get up and tell how happy they were with their surgery and how it had changed their life. I schedule another consultation.

October 13, 1989 - Third Consultation with RK Doctor
The seminar had done its intended job because for the first time I was feeling positive about RK. Now my only remaining concern was being over corrected. The RK Doctor told me that he was very conservative in his approach to RK, and with my degree of myopia that I would end up in the 20/40 to 20/80 range. He said he would do my left eye first and the second eye probably one to two weeks later. He also said he could probably get closer to 20/20 on the second eye. I had come to a point where I just couldn't wear contact lenses anymore and felt that this would at least lessen my dependency on glasses. I was finally convinced and felt I was in good hands. I said, "Let's do it!!!"

November 8, 1989 - First Surgery (day after celebrating my 30th birthday)
The RK Doctor performs the surgery using 16 incisions on my left eye. The surgery was quick and painless. I went home and immediately to bed, but woke up later with severe eye pain.

November 9, 1989 - Post Op Visit
I was told that I had a reaction to the topical anesthetic causing swelling of the cornea and a 70% epithelial defect. I was in a lot of pain and it was hard to tell what my vision was at this time.

December 5, 1989 - Follow Up Visit
Refraction -4.75 -1.00 x 176 correctable to 20/20. I was very disappointed and assumed I was done with RK. However, the RK Doctor suggests he retrace and deepen each incision. He acted as if this was no big deal, but I was cautioned that I would remain under corrected because I was an under respondent to RK. Looking back, I don't understand how I could have still been thinking RK was a good idea. I guess I already had my mind set on the expected results and couldn't turn back now.

December 15, 1989 - Second Surgery
The RK Doctor retraces and deepens the incisions. A different topical anesthetic is used with no problems.

December 16, 1989 - Post Op Visit
Refraction -2.00 -.25 x 120 correctable to 20/40? The RK Doctor calls the surgery a success and says that he is extremely happy with the results. I felt something was not right because I could not see well up close or at a distance. I was told everything was fine and to start massage and eye drops.

December 19, 1989 - Follow Up Visit
Refraction +.25 -1.00 x 135 20/40? I have severe glare, double vision, ghost images and vision fluctuation. I also noticed that objects look smaller and less bright with my left eye. I can't believe my vision is called 20/40! Under perfect conditions I could pick out a few letters on the 20/40 line, but I also saw two distinct lines (with the right eye covered) and could read both equally as well. With just the slightest squint, my vision would change dramatically and I could no longer even read the big E at the top of the chart. For this first time in my life I hear the term "irregular astigmatism".

January 4, 1990 - Follow Up Visit
The RK Doctor says the irregular astigmatism is due to the way my eye is healing and that it should get better over time. He acts as if my problems are minor and seems to be trying to convince me that I'm seeing better than I actually am. I express my concern with the way that my vision changes when I squint, but I never get a satisfactory explanation. I'm given pilocarpine to reduce the pupil size. The doctor recommends RK on my right eye using an eight incision single procedure to reduce the chance of postoperative problems. I decline, saying I need to be able to rely on my left eye before I do anything with my right eye.

Numerous Appointments February 1990 through August 1991
I'm sent to an optometrist who attempts to fit a hard contact lens on the post RK left eye with no luck. The refraction varies from visit to visit with the maximum documented over correction being +2.75 -.25 x 95. Because of my dry eyes I'm wearing glasses most of the time, which is a real problem due to the imbalance between the two eyes (my right eye is now -6.50). Just walking up and down the stairs is a challenge. I'm also wearing a patch over my left eye when driving. I really should be wearing it all the time, but I can't make myself do it.

November 16, 1990 - Follow Up Visit
The RK Doctor again tells me that my vision problems are due to irregular astigmatism, which was caused by the way the eye has healed, and should get better. He says there is no way to predict how each individual patient will heal after RK and that he has never before seen healing this severe. Eight incision RK in the right eye is again recommended to balance the eyes.

August 22, 1991 - Follow Up Visit
The RK Doctor again states that the surgery was successful in correcting my myopia but that the healing of the cornea was irregular. He says part of the problem is that I have fair skin, large pupils and that my cornea has less rigidity than normal. He again recommends eight incisions RK on my right eye.

February 17 1992 - Follow Up Visit
Again it is explained to me that my poor vision is due to the way my cornea healed. I am referred to a doctor in San Diego (a friend of the RK Doctor) for a lamellar corneal transplant - epikeratophakia. The hope is to strengthen the cornea and smooth the corneal surface. I feel I have nothing to lose.

March 13, 1992 - Third Surgery
Epikeratophakia is performed on my left eye. During the postoperative examination, I ask the doctor why I had such poor results from the RK. He was very blunt, saying that my RK was not performed correctly and that if it had done right I would not have had any problems. I'm shocked and don't know what to think!

March 18, 1992 - Post Op with RK Doctor
The eye does not look to be healing well and it's hard to tell if there is an infection or if it is just inflammation.

May 11, 1992 - Post Op with RK Doctor
Refraction -5.25 -1.75 x 40. My eye is now healing well and remaining sutures are removed. I have not mentioned the San Diego doctor's comment concerning my RK.

Numerous Appointments June through October 1992
I'm again sent to an optometrist who attempts to fit my left eye with a hard contact lens with no luck.

October 15, 1992 - Follow Up Visit
Refraction -1.25 -1.00 x 115. It is again explained to me how the irregular healing of the cornea caused my poor vision. The epi has helped some with the imbalance between the two eyes and a little with the stability, but not with the double vision, ghost images or glare. Also, now I am having problems with the eye being very dry, sore and red. The RK Doctor recommends he do a corneal transplant. I feel it's time to talk to someone I can trust.

November 1992
I decide to see a corneal specialist in Rochester, Minnesota. After examining my eye the doctor sat back and said, "No wonder you can't see!" He was very kind and spent a considerable amount of time explaining fully to me what was causing my vision problem and answering my questions. Although he couldn't do anything about my vision, it was very relieving to finally know what was really going on. The following is from his write-up.

Consultant note:
33 year old engineer with chief complaint of severe visual aberration following RK. Noted over correction and unstable vision post-op, especially when squints ... Had myopic epi … Has difficulty sleeping, can't drive comfortably. Has stopped night driving...
Exam …:
... Some incisions reach limbus and others do not. Epithelial rests at 2:30 and 6:00 … The incisions do not create a circular clear zone. It is oval, displaced superonasally and has one very long crooked incision at 6:00 as drawn which encroaches into the center of the cornea… Topography shows severe distortion within the pupil space with a flat zone located superonasal to fixation.
Dx:
Severe visual disability following RK and epikeratophakia for myopia OS. RK is obviously decentered relative to the pupil and to fixation. The clear zone is inappropriately oval and has inferior radial incisions that encroach into the very center of the cornea. Plan: Penetrating keratoplasty is his only hope for improved vision with the present level of technology, but the risks involved with that procedure are very great including refractive instability, potential for host wound gape with increased chance of bacterial keratitis, increased chance for vascularisation of the host with increased risk of graft rejection that would entail. If it were my eye, I would suffer with the chronic visual disability rather than risk the PK and hope some laser technology could help me in a few years. Discussed in full with the patient who has my full sympathy.

Legal Action?
I'm angry! Not only was my surgery botched, but I feel I was conned and lied to by the RK Doctor. My eyesight has been permanently damaged and this seems to be acceptable; "Oh well, next patient". I contact a lawyer who agrees to take the case, but a few weeks later he calls saying he has a conflict of interest and to refers me to a new attorney. He felt there was a conflict of interest because he had done a seminar for the RK Doctor on "how not to get sued!" The second attorney spends some time on the case but recommends I do not proceed with the suit. He said I had waited to long to initiate the action and also that he was having trouble finding an expert witness willing to testify against the RK Doctor. I decided to end it because I really didn't want to get involved in a lawsuit anyway. I had initiated this action because I was angry and felt I had to do something. What I really wanted to do now was to just try to get my life back to normal.

May 25, 1993 - Follow Up Visit with RK Doctor
Refraction -2.00 -2.75 x 125. The attorney contacted the RK Doctor's office to request copies of my medical records. This brought on a call from the RK Doctor's office and I was asked to come in for an appointment. I'm not sure why I went, but it's the last time I see the RK Doctor. I finally confront the RK Doctor, telling him that the other doctors have said my RK was not performed correctly. He says although they are both fine doctors, they do not know nearly as much about this surgery as he does. The RK Doctor insists that the surgery was done correctly and the cause of my poor vision was due to my unusual healing.

June 1995 - New Doctor
I start seeing a new local cornea specialist. I was considering having the epi lens removed because of the pain and redness it is causing. I was also thinking about a cornea transplant. I am referred to a specialist in Boston.

July 24 1995 - Boston Specialist
Refraction -5.50 -2.50 x 140
I see the cornea specialist in Boston and received a copy of his letter to my local doctor.

… Corneal distortion with irregular astigmatism and scar formation after 16 incision RK. History suggestive of "flail" cornea syndrome, partially stabilized by epikeratoplasty but with residual disabling glare. …As you noted, several of the inferior incisions extend virtually up to the direct visual axis… I feel that here is no alternative other than penetrating keratoplasty if any further surgery is going to be undertaken.

Currently
OD -8.00 - - correctable to 20/20
OS -5.50 -3.75 x 98
I've not had the cornea transplant because I could very easily end up with even more problems. I've also not had the epi removed. I have had my tear ducts cauterized, which has helped some with the pain and redness I've experienced since having the epi. I'm still struggling with driving and pretty much anything else requiring good vision. I'm also frustrated that my right (good) eye never seems to be seeing 20/20. Before I had the RK, my myopia had actually been improving and I was wearing a slightly weaker prescription than I had been ten years earlier. Now it seems that every time I get a stronger prescription, within a short period I'm back to being nearsighted. I've gone from -4.75 to -8.00 and I'm worried this will not end. I blame it on the constant strain of trying to see.

As far as the future, I really don't have any hope that good vision can be returned to my left eye. I will always be looking through the incisions and the cornea will always be unstable. However, I do hope that someday maybe something can be done to eliminate the double vision and provide me with eyesight that I'm at least comfortable with. If my vision could be improved to where I'm not being constantly reminded of my problem, I'm sure my metal health would also improve.

bdm1959@yahoo.com