Radial Keratotomy (RK) Problems Years Later — We Understand What Most Doctors Don't
Your RK incisions are permanent. But the problems they cause aren't untreatable. We've been managing RK patients since the 1980s.
RK was the LASIK of the 1980s and 1990s. Millions had it. And most doctors practicing today trained after RK was abandoned — they've never managed RK corneas. We have — for decades.
What RK Did to Your Cornea
Radial Keratotomy used micro-surgical cuts radiating outward from the center of the cornea — like spokes on a wheel. By weakening the peripheral cornea, the procedure caused the central cornea to flatten, reducing nearsightedness. For many patients in the 1980s, it worked remarkably well initially.
The problem is structural. Those cuts are permanent scars that never regain the tensile strength of the original cornea. Over years and decades, the incisions continue to gape — slowly, imperceptibly, but consistently. As the peripheral cornea stretches slightly outward, the central cornea flattens further than intended. The result: a prescription that began as myopia (nearsightedness) shifts progressively toward hyperopia (farsightedness). Most RK patients are now in their 50s, 60s, and 70s — and many are significantly farsighted even though they were once very nearsighted.
The changing corneal shape also creates irregular astigmatism that glasses cannot fully correct. This is not a glasses prescription problem. It is a corneal shape problem. Standard corrective lenses sit over an irregular surface and cannot compensate for the irregularity. That is why many RK patients find their glasses "almost right" but never quite sufficient.
Finally, there is a safety consideration that every RK patient must understand: the incision lines are permanently weak. Any significant blunt trauma to the eye — from a sports injury, a car airbag deployment, or a fall — can cause the cornea to rupture along the old incision lines. This is not theoretical. We have seen RK ruptures in our practice over 35 years. Eye protection in all physical activity is non-negotiable for RK patients.
Problems RK Patients Face Decades Later
Hyperopic Shift
You were nearsighted before RK. Now you're farsighted — and getting worse each year. New glasses prescriptions are needed frequently. Reading glasses appear earlier than your peers.
Diurnal Fluctuation
Vision is blurry in the morning and improves through the afternoon. It's not your glasses — it's your cornea physically changing shape as the day progresses.
Irregular Astigmatism
RK incisions don't heal symmetrically. The resulting corneal irregularity creates a type of astigmatism that glasses can never fully correct — only specialty contact lenses can.
Rupture Risk
Critical safety warning: RK incisions are permanently structurally weak. Any significant blunt eye trauma — a ball, an elbow, an airbag — can rupture the cornea along the old incisions. Always wear polycarbonate protective eyewear for sports.
Solutions That Work for RK Corneas
Glasses cannot fully correct the irregular astigmatism created by RK. These specialized lens options can.
Scleral Contact Lenses — Primary Recommendation
Scleral lenses are large-diameter gas-permeable lenses that vault entirely over the RK incisions, resting on the white of the eye (sclera) instead. They create a perfectly smooth optical dome of saline solution over your irregular cornea. The result is crisp, stable vision that doesn't change from morning to evening — because the correction doesn't depend on what your cornea is doing at that moment of the day.
This is the most significant quality-of-life improvement most RK patients experience. Many report that it feels like having their best pre-surgery vision back for the first time in decades.
Scleral Ortho-K — For Residual Myopia or Hyperopia
For RK patients with residual myopia or who want glasses-free daytime vision, reverse-geometry scleral designs can gently manage overnight correction. Worn only at night, these lenses allow some patients to go through the day without any lens wear. Candidate selection is careful — RK corneas require custom fitting that accounts for the incision pattern.
Specialty RGP / Hybrid Lenses
When scleral lenses are not the right fit for a patient's anatomy or preference, highly gas-permeable rigid lenses or hybrid lenses (rigid center, soft skirt) can provide stable correction. These are less ideal for RK corneas than sclerals because they contact the incision area, but remain a viable option for select patients.
Important: Standard soft contact lenses drape over the irregular surface and do not provide adequate optical correction for most RK patients. Glasses are similarly limited.
Doctor's Insight: Radial Keratotomy Complications
Direct Answers from Dr. Bonakdar
Why is my vision changing years after RK?
Radial Keratotomy weakens corneal structure along the incision lines. Over decades, these incisions continue to gape slightly, causing the cornea to flatten further and shift your prescription toward farsightedness. This hyperopic shift is a known long-term complication of RK that most patients are warned about today but weren't told about in the 1980s–90s.
What causes my vision to be better in the afternoon than in the morning after RK?
This is diurnal variation — a hallmark of RK. Overnight, your eye's internal pressure is slightly higher, which pushes the RK incisions open further. Morning vision is typically worse. As you're upright and eye pressure normalizes, the incisions close slightly and vision improves. Scleral lenses bypass this entirely by correcting optically rather than depending on corneal shape.
Can I get LASIK or PRK to fix my RK?
Most surgeons will not perform laser surgery on an RK cornea due to unpredictable outcomes and increased rupture risk. Scleral contact lenses achieve excellent vision without any additional surgical risk to your already-compromised corneal structure.
Is it safe to play sports with RK?
Not without eye protection. RK incisions are permanently structurally weak. A significant blunt impact — a ball, an elbow, an airbag — can rupture the cornea along the old incisions. We strongly recommend polycarbonate sports eyewear. This is the most important safety message for all RK patients.
Dr. Alexander Bonakdar, O.D.
Dr. Bonakdar has managed RK patients since the procedure was at its peak in the 1980s and 1990s — decades of experience that few optometrists today can match. Most doctors in practice today completed their training after RK was already abandoned in favor of LASIK. They have read about RK corneas in textbooks. Dr. Bonakdar has examined thousands of them in clinical practice, charted their progression over years, and developed fitting protocols specifically for the unusual geometry that RK creates. If you have had RK, your eyes deserve a doctor who has seen this before.
RK Patients Who Found Relief
“I had RK in 1991 and by 2019 I was farsighted and couldn't get a glasses prescription that felt stable. My vision was different every morning. Dr. Bonakdar explained diurnal variation and fitted me with scleral lenses. For the first time in years my vision is the same all day. I wish I'd found him ten years earlier.”
— Patient, Santa Ana, CA — RK 1991, Scleral Lenses 2019
“Every other eye doctor I saw looked confused when I mentioned RK. Dr. Bonakdar immediately said ‘I know exactly what we're dealing with — I've been seeing these corneas for 35 years.’ That confidence alone was worth coming in. The sclerals gave me 20/20 for the first time since the 1990s.”
— Patient, Newport Beach, CA — RK 1988, Scleral Lenses 2022
Schedule an RK Complication Evaluation
Tell us when you had RK and describe how your vision has changed. We'll schedule a comprehensive corneal mapping and scleral lens evaluation.
Your RK Surgery Was Decades Ago. Your Vision Care Shouldn't Stop Here.
Scleral lenses provide stable, day-long clear vision for RK patients regardless of what your cornea is doing that hour. Let's discuss whether you're a candidate.