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Keratoconus Consultation #2: Dr. Edward Holland – Corneal Specialist

I just finished my second informational meeting with Dr. Holland and must say it was excellent.  I cannot begin to describe the differences in the staff between the Corneal Surgeons’ staffs between Lexington and the Northern KY team.  They are more professional, friendlier, and more knowledgeable at every step of the way.  I am not going to call out the Lexington surgeons by name here, I’ve no intent to stir things up, but if you’re in the area and needing Corneal work, you owe it to yourself to visit more than one.

Off to Edgewood.

After “working” half of a day in Lexington, I grabbed the GPS and an audiobook and made the 1:15 drive to Edgewood, KY (essentially a suburb of Cincinnati on the Kentucky side of the river.)  After a yummy lunch at Panera and a few minutes checking email on my laptop, I went to the office.  I saved their office as a “Favorite” on the GPS because I have a feeling I’ll be coming here a few times!

Checking in was the usual – insurance card, verifying contact information, etc. at the desk went quickly and I noticed that the waiting room was full of people.  I also noticed that the average age of people there was well, well older than me – possibly by 25 years or more!   I sat down to read my RSS feeds and noticed that they had a very strong public WIFI for us.  Nice!  I barely got the first one on the screen before they called my name .  I felt mildly guilty, like you do in the “Fast Pass” line at Disney… until I realized that the other patients were there to see the cataract specialist, not the cornea doctor.

Feelings During the Visit

I realized as I walked to the back rooms that my anxiety about today had turned into a sort of strange excitement.  Still concern, but I felt like I was doing the right thing and taking steps to make life better – not only for me, but for my family who has to deal with my grumpiness when my eyes are hurting.  Dr. Holland’s reputation and the staff’s treatment bolstered this feeling.

Dialated Pupil - Kerataconus

Staff Knowledge about Keratoconus is Critical

I sat and spoke with a technician, who asked why I was there – did a basic vision test, including a pin-hole check.  .  I quickly established a great rapport with her and realized that she was not only smart about corneas, but it seemed more informed than the doctors I’d met about my condition earlier in Lexington.  She knew a ton about the transplant – having sat in on many operations, including the DALK procedures.  I was able to get a whole different perspective on the surgical process, etc. from her.   She also wanted to do a topography – and I told her my cone was too steep for the equipment, but we did it anyway.   Sure enough, the computer choked on my data as usual.  I’ve not had a successful topography since 2003… the equipment just isn’t able to help after a certain point.

My eye pressure was checked and they dilated my eye to examine the retina and optic nerve.  Doing it only in my left eye made me look kinda cyborg-like, and my daughter got a kick out of it.   All was golden – my eye is very healthy.  Except for that damn cornea.

Find a Great  Cornea Specialist… even if you have to drive or fly there!  Go to someone who does 50 or more grafts annually, preferably a mix of DALK and PK who has surrounded themselves with knowledgeable technicians and staff.  Your eyes are your window on the world – this is not the time to compromise.

I also ended up talking to a good, retina-surgeon friend on my front porch last year  – and she made quite an impression with her recommendations… “don’t compromise when it comes to cornea surgery, period.”  So I’ve learned a lot.

Bottom Line

If you have Keratoconus, and feel that the Doctor is treating you like the rest of his patients or that the technicians don’t understand the disease due to the “rarity” you owe it to yourself to find another expert, even if you have to drive or fly

 
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Posted by on February 3, 2011 in Dr. Visits, Pre Surgery, Surgery-Story

 

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Keratoconus Consultation #1: Dr. Edward Holland – Corneal Specialist

image: fromereye.com

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.

 

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