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Category Archives: Dr. Visits

A Boring Two Year Checkup (Boring is Good!)

02 Apr

Well, had my two year checkup with Dr. Holland and it was a boring visit.  No changes, no sutures out.  Boring is GOOD.

He says that we will leave the sutures in until they cause issues, and eventually one will break.  I’ll just go to a local surgeon to have them removed.  Here’s a boring image of my topography.

Everything feels fine – still using Restasis for dryness and as an anti-inflammatory -  It’s almost allergy season, so I will start my daily Zyrtec soon.

Dr. Holland re-iterated that my graft is looking good and should last the rest of my life.

2-year-topography

 
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Posted by on April 2, 2013 in Dr. Visits

 

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Graft Looks Great – 2 More Sutures Out (and they were stubborn.)

16 Nov

Well, 4 months elapsed since my last visit to Dr. Holland, so I had an appointment today.  I had the usual check ups and topology.  Their office was a *zoo* … I waited 2 hours.  Thank goodness their office has Wi-Fi and I was able to do some email and watch a bit of YouTube.  Not an empty seat in the waiting rooms – and I had asked for “first appointment of the day.”

My eye pressure was 18, totally normal.  The graft was crystal clear.  No problems.  I complained about my dry eye at night and he suggested I change to a gel based lubricant and gave me some samples.  I’ve used them before and not liked their goopiness.

The topology (right) showed that it was time to remove two more sutures, so I was numbed up and Dr. Holland started the process.  It seemed to take longer than usual to cut and pull them out.  I was stone-still during this process.  Anyway, after the numbing drops wore off, it was pretty sore – yowch!  The sutures seemed to be a bit stubborn.  I think that the longer they’re in, the more they integrate into the tissue of your eye.  I took some Tylenol and started my weekend a bit early

Anyway, the usual Vigamox antibiotic dose for 3 days and go back in 4 months.

Now I will make an appointment to get fit for contacts to match my new Rx (suture removal changed my astigmatism levels.)

postscript:  Eye was completely normal the next day.  No discomfort at all. And I think my vision has improved a bit, especially with my glasses.

 
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Posted by on November 16, 2012 in Dr. Visits, Recovery

 

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DALK Transplant – Stellar Follow Up + New Soft Lens Trial

08 Jun

photo: Logan Ingalls

Well, it’s been a good week for my DALK recovery.  I went back to Dr. Holland for my graft checkup and he said it was perfect.  I also corrected to 20/20 on their refraction gear.  I had already ordered a new, special soft contact (see last post) and was not able to take it with me to Dr. Holland.  He wasn’t bothered by that and said that if the soft lens worked for me, it would be fine for my eye.

The downside to the soft lens (at least the first one I tried) is it corrected me only slightly better than 20/30.  This means there is room for improvement.  But the comfort is … amazing!   The fitter (Tamra at Dr. Koffler’s office here in Lexington) seems to think that I should wear it for a week and then we may want to correct the power to hit near 20/20.

Other questions answered:

  • Sutures:  We’ll take them out if they degrade.  Otherwise, he said, leave them in for now.
  • Graft Fragility:  I had lots of anxiety about the graft’s fragility, but Dr. Holland told me to quit worrying.  It would take a severe trauma to disturb the graft now that it’s healed up.
  • Rejection Period:  I’m exiting the prime rejection period for DALK.
  • Glasses:  Dr. Holland said to go ahead and make the lenses for glasses.
  • PRK/Lasik is still an option if we cannot make contacts work.   Insurance won’t pay for that in KY (or OH.)
  • If we run into suture issues (e.g. one breaks) we will remove them all at once.
  • He said it was right to stop wearing the RGPs if they were hurting.  He said I should be pain free and use whatever gives that to me.

Exciting!

 
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Posted by on June 8, 2012 in Dr. Visits, Recovery, Surgery-Story

 

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Contact Lens after Corneal Transplant – Trying a Mini-Scleral

12 Apr

Well, after a fair bit of anxiety and dread, I found my visit to Koffler Vision Group* for the fitting of a new mini-scleral RGP contact lens on my grafted eye to be quite uneventful.  We tried several diameters and shapes until one felt, well, like it wasn’t there.  (*My choice for contact fitting in Lexington.  I’m still Dr. Holland’s patient.  I would link to their site but it is not great and crashed my browser twice.  I will link to their Google Place page though)

Turns out the one with most comfort was a mini-scleral.

I hadn’t considered mini-scleral for my grafted eye, but it makes sense.  It forms a “helmet” over the graft and rests well outside my cornea.  It keeps the corneal hydrated and provides good vision.  I think I had put mini-sclerals out of my head after my less-than-stellar experience with them before my graft.  But that was not due to the lens, it was due to the cone and abrasiveness.

Anyway, I have my lens ordered and will post again when I get it in.  As usual, the Koffler staff were terrific.  By the way, Dr. Koffler was my second choice for my graft – but I just clicked better with Dr. Holland’s attitude about DALK options.  I feel confident either would do a great job, especially on a PK or other surgery.  I did apologize for being such a grump during my last visit to them 2 years ago (I was frustrated with trying to find a contact lens with a steep cone.)

Oh yes, they did a new topography.  Said it was “beautiful.”

 
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Posted by on April 12, 2012 in Diary Entries, Dr. Visits, Keratoconus Technology, Recovery

 

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New – DALK Transplant Chronology

12 Mar

Quick post to let you know that I just made a new page which covers the chronology from my first Dr. appt to one year after the surgery.  Same posts, but in chronological order.

http://corneanews.com/about-kerataconus/chronology/

 
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Posted by on March 12, 2012 in Diary Entries, Dr. Visits, Interesting Stuff, Keratoconus Technology, Little Things That are Better, Pre Surgery, Recovery, Surgery-Story, Tips, Vision Improvements

 

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11 Month Checkup – Graft Clear, Pressure Down – “Go” for Contact Fitting

27 Jan

Had a good appointment with Dr. Holland today.  Especially amazing was the clarity I got on the vision test.  We went through the usual blur-blur-blur series as the technician flipped lenses and asked “now?”.. “now?”…”now?”   Here we go again… but then, almost startlingly, she flipped a lens and the eye chart snapped into focus.  ”Whoa!” I said.  ”Ah, we found the sweet spot” she said.  In 15 years I’ve never seen so clearly through that eye and any correction device.  It was almost overwhelming.

Dr. Holland examined the graft and said it was completely clear and that my eye pressure was down.  I’m reducing the pressure medicines to once daily, and staying off the steroids.  I’m reminded that I am at the peak rejection period for my graft (many, including me, thought that the rejection period peaks right after surgery, but it doesn’t.)

I have bad nearsightedness, even with the astigmatism getting resolved, so vision correction will be part of this plan.  It’s time you could get fitted for a RGP lens….   that scares me.  I have this graft which I have been treating like a delicate piece of crystal.. and now I’m to put a lens on it?   I’ll have to get over this.  Will schedule my fitting in the next couple of weeks.   There is still a possbility that I’ll go with PRK if recommended.

No sutures out this time – and the ones in there now may remain a while.

Next Appt, early Spring.

 
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Posted by on January 27, 2012 in Diary Entries, Dr. Visits, Recovery, Vision Improvements

 

Corneal Transplant Surgery – 8-month Follow Up – Steroids to Stop in 6 Weeks.

17 Nov

Post Corneal Transplant Topography 8 monthsToday I went in to Cincinnati Eye Institute for my 8-month follow up with Doctor Edward Holland.   The visit followed the same routine as before – corneal surface scan, vision check, pressure check, doctor chat, and suture removal.

My vision is not changed much – and the topography showed that my astigmatism has shifted axis, and Dr. Holland adjusted his suture removal strategy.  I had two sutures out today, which was quick and painless.   My eye pressure was in the normal range and my optic nerve looked just fine.   He told me not to worry about the eye pressure as long as the optic nerve looked good.

The only big news is that in 6 weeks, I’ll be stopping my steroid drops!  This is a bit early and reflects the fact that my cornea is “crystal clear.”   I’m to watch for inflamation around the graft, but none is expected.

I hate late morning appointments.  I left Lexington at 8:30 and wasn’t back until 2:30.  My next appt is at 7:55 AM.  I’ll probably be back in Lexington by 11:00.

 
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Posted by on November 17, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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DALK Checkup – A Few New Nuggets of Info

29 Sep

Lexington Farmer's Market

Well, today was a routine checkup.  Topography, pressure check, eye test.  Pretty much the same as the last time.  Dr. Holland removed two sutures as we continue “suture roulette.”   The graft looks great, and we’re right “on track.”

I did learn a couple of things today:

  • Peak rejection time is 8 months out from surgery.   This is for PK or DALK.  I thought it would be earlier.  This means that I must be extra diligent for RSVP symptoms between now and early next year.
  • The first sign of rejection will be redness and light sensitivity, not pain.   You should never wait for the pain if redness and pain are present.
  • When Restasis is part of your post-op drops routine, you should usually use it last.   So, for me, it’s Steroids, Pressure Med, then Restasis.
  • He suggested that I might go ahead and use Restasis in my right eye if allergies get bad again.  I think I’m through the worst of Fall allergies, however.
That’s it.
Learn more:
Oh, I really do appreciate all the messages I get about how much people are enjoying the blog.  Thanks much.
 
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Posted by on September 29, 2011 in Dr. Visits, Surgery-Story

 

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5-month DALK Follow Up – 20/30 Corrected Vision – 5 sutures out!

05 Aug

Had a very good 5-month visit today where 5 sutures were removed.  We’re playing “suture roulette” now, chasing the astigmatism around my cornea.

My astigmatism went from 9 diopters to 4 diopters, which is excellent.  I’m now seeing 20/30 corrected!   The graft is also healing very well.  My steroidal dose was cut in half and my eye pressure is now stable/managed.

For the first time in 10+ years, when they adjusted the settings on the eye testing optics, I reached a 20/30 level of vision.  It used to be a pure blur.  They used to flip the lenses around and I’d say “same, same, same”…it never got better or worse.  But now, it’s like it should be.

Dr. Holland said if I was in a hurry, I could possibly get fit for contacts, but I’m going to wait and let the graft heal as long as possible.

It couldn’t have been a better visit.    Back in 8 weeks.

Roulette Wheel Photo by Photo: Heather Rai

 
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Posted by on August 5, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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Managing Intraocular Eye Pressure Issues with my Corneal Transplant (and… 2 more sutures out!)

01 Jul

Topography - to map the surface of the cornea and guide suture removal

Well, I just returned from anther follow up with Dr. Holland post-corneal transplant.  The graft and optic nerve look good, but my eye pressure is still too high – a condition known as “steroid-induced intraocular pressure.”  I’m among a small number (8%) of people who seem to have steady, ongoing eye pressure rises with use of steroids.

We’ve adjusted the type of steroids I’m using, and I’ll be taking a drop to reduce eye pressure as well (the drop is normally used for Glaucoma patients.)   I was also relieved to learn that there were no other reasons my eye pressure was rising (such as tissue or structural complications from surgery.)   Apparently that can happen with full-thickness graft, though rare.  I will be happy when the pressure is moderated – as I don’t like the sound of Glaucoma one bit!   What I think is going on is that I will be using a tiny amount of steroids – far less than most people.   This means I must be alert for any irritation symptoms.

Vision was stable, not that much better.  They claimed astigmatism was down, but I’m not seeing it.  I worked hard to see eye chart numbers.   I wish I’d brought my glasses so they could have evaluated those.  I think it will show I can see pretty damn good through them (despite the old prescription.)

But in terms of graft recovery, things looked good enough to remove a couple more sutures.   This time, the removals had a bit more of a pinch and I was slightly sore afterwards.   Tylenol and back to work.  Next time I might ask them to delay the numbing drops until right before the process itself.   There is this unpredictable delay between numbing drops and when Dr. Holland actually does the removal.   Last time, it didn’t hurt at all.    This is similar to how it went during surgery – my pain meds started wearing off before the procedure was done.  Ouch!

One Niggle… I’m consistently impressed by the Cincinnati Eye Institute Staff, but sure wish they’d dump the blaring TV’s in the waiting room.   It’s not just them, it’s everywhere.  Doesn’t anyone else like to pull out a book to read anymore?

 
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Posted by on July 1, 2011 in Dr. Visits, Recovery, Surgery-Story

 

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