Once I felt that a transplant was my only viable, long-term option, My wife and I went to Cincinnati Eye Institute to visit Dr. Holland. I brought her along because I thought they might dilate my eyes, plus it’s nice to have a second set of ears. I’d been to a few other surgeons in Lexington – some highly regarded – but for some reason I felt less comfortable with them and their answers.
Dr. Holland impressed me from the handshake forward. He was well versed and spoke with confidence about the situation. He seemed quite comfortable with new techniques, such as DALK, where my other surgeons had said that PK was the way to go.
As we began, Dr. Holland pulled out the eye chart and covered my right eye. I just sat there, looking at the blur. “That’s what I thought” he said. “Contacts are not cutting it for you anymore.”
I had formulated a lot of questions for him…
Q: Is the Femtosecond laser promising for me – should I postpone my surgery until this is more available in the USA?
A: It is promising for making the cut more precise, but few have it right now. The jury’s still out on how much it helps over an experienced surgeon.
Q: I’ve heard good things about Deep Anterior Lamellar Keratoplasty (Is a DALK surgery possible for me – or will Penetrating Keratoplasty be the only option?
A: I think you have an 80% chance of a successful DALK. That will be our goal, but we can convert to PK if needed.
Q: Other corneal surgeons I spoke with seem to avoid the DALK option, saying it’s inferior visually. Why?
A: Sometimes it’s a matter of practice. You get comfortable with a way of doing things. PK is very good, and done well the outcomes are great. DALK takes a lot of practice.
Q: Does my eye look generally healthy?
A: Yes. I don’t see any other underlying issues.
Q: Why do I feel pressure/aching occasionally?
A: With the poor vision, your eye is probably in a constant strain to focus. That can cause aching.
Q: What is the reason for the constant “sunburn” feeling I have?
A: The epithelial layer of your eye has a lot of nerve endings. When it’s stretched or rubbed, it can feel like stinging or burning.
Q: Are “intacs” an option for me?
A: No, because you have too much scarring. They can flatten the cornea, but the scars would still be there and you’d be unhappy.
Q: What is the success rate with eyes like mine?
A: Excellent. Kerataconus patients are usually the happiest with a transplant.
Q: Should I wait?
A: It’s up to you, but if you want to go forward, we need a month’s notice. There are complications if you let advanced KC progress also. Unfortunately, it doesn’t really get better.
Q: What’s the healing time?
A: Around a year.
Q: Is there a chance of acute hydrops? Ruptures of other types?
A: Probably not – and that is treatable.
Q: What’s my potential visual outcome… will night driving be better?
A: Our goal is 20/20 without correction. After healing, you should be far, far better than you are now.
Q: Is it possible that there are better scleral or semi-scleral lenses that would help me avoid surgery?
A: There are options, such as Boston’s $5000 lenses… but your scarring is going to always get in the way of good vision.
Q: What about rejection?
A: DALK reduces the risk of rejection – but it happens. Almost all the time it’s treatable if you take care of it pretty quickly.