Problems With Conductive Keratoplasty And Monovision By Dr. Jay B Stockman O.D. At Isnare.com Ezine Articles

Conductive Keratoplasty is a procedure whereby radio waves are introduced into the peripheral cornea in an attempt to steepen the corneal curve. This will increase the power of the cornea effectively making that eye nearsighted. In doing so, the eye will be able to read things up close more easily. This is accomplished because the radio waves emit energy that is absorbed by the surrounding tissue. The protein in the tissue then contracts pulling the surrounding areas inward. When done in a specific, calculated fashion the cornea changes shape to get the desired result.

This procedure is performed on individuals that see well in the distance, but do not want to wear reading glasses. When one eye sees near and the other distance, that is called Monovision. It used to be done a lot with contact lenses until multifocal contacts took over as a better alternative. The problem with employing mono vision is that one eye is always blurry. If looking far then the near eye is out of focus, and the opposite applies when reading up close. This new visual environment takes time to get used to, and some folks never adjust to it. The success rate depends on what your visual demand is, and what one’s personality is. For example, I am way to neurotic to get used to it. A smudge on my reading glasses upsets me. I would be a terrible candidate for this surgery. On the other hand my business partner is always happy with everything, and would therefore be a great candidate. That is how he has gotten along with me for 14 years! So the first thing one needs to determine is what the expectations are and how you as a person deals with change.

The next consideration is what the uncorrected distance vision is. The best candidate is one who has no distance prescription at all. I have found that the 2 biggest factors that determine success with this procedure is
1) realistic expectation
2) good distance uncorrected vision.

The first seems silly, but actually is the most important. If one expects to be perfect all the time with out any sacrifice then they should not have the surgery. The fact is that there will be poor binocular vision and thus bad depth perception. The will affect the tennis and golf game as well as judging distance when driving. Glare will also result when driving at night. I have had patients that were happy as clams despite less then perfect vision and the side effects that I mentioned because they expected as much. Others saw great and had very few side effects,but complained bitterly since they wanted perfection.

Distance vision plays a big role in success. If the non operative eye is farsighted the success rate goes down significantly. That eye will see blurrier after surgery, and will try to focus which will make the distance vision even worse. This accommodation with make the near vision worse since eyes focus together and will move the focal point in closer then the person wants to read. Therefore, only those individuals that have NO distance prescription at all should have CK.

I am fortunate to work with some of the best eye surgeons in the US and all these factors are carefully evaluated prior to making a decision. As they say,” go into surgery with both eyes open.”

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