Today I watched a robin working her nest. My depth perception was, well, deep. With keratoconus, I would previously have been less able to pick out the nest against the leaves in the background. But this time, it was clear. The colors were distinct, and the ugly little birdlings were even more homely than I recall before. Brilliant.
Tag Archives: recovery
A very big day on this long journey. Today, I inserted the mini-scleral lenses in my grafted eye at Dr. Koffler’s office…and, for the first time in 15+ years, I had clear vision in my left eye. My brain and eye muscles are not sure what to do with the new information so the crispness came and went, but here are my unfiltered first impressions:
- Wow. I can read the doctor’s diploma across the room.
- The world is sparkly!
- Everything’s in 3D!
- Look at the birds!
- Look at the clouds!!!
- I don’t want to take this out!
I was only at a 3-hour wear limit today, so pulled them out mid-morning. I’m looking forward to inserting them again tomorrow.
The removal was touch and go because I’m out of practice, and the eye is just slighly “dry-sore” tonight. Nothing bad at all. Totally expected.
I got a ‘care package’ with new plungers and other solutions, etc from the office.
Postscript: Day 2, 3 of lens were tricky. Eye was a bit sore from lens and insertion / removal was difficult. I’m clearly out of practice on this. Still feel a lot of anxiety about damaging my graft with lens effort.
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.”
When you are in recovery from corneal transplant, your doctor will begin removing sutures – a few at a time each visit (providing everything is going well.) Each time you leave you’ll be asked to drop antibiotics for 3-4 days several times per day. A tiny amount, all in all.
The tip I have is this… ask the doctor or assistants if you can have a sample antibiotic (left by drug reps) rather than a prescription. The samples have just the right number of drops for 4×3 or 3×3 and are meant to be given away for free. This can save you the cost of the antibiotics and a trip to the drug store. Even ask them to give you several bottles to be used on the subsequent visit (they have a decent shelf life.)
The doctors can get more, trust me.
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.
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.
Roulette Wheel Photo by Photo: Heather Rai
This is a really short update to let everyone know I’m doing fine. I have another appointment Friday with Dr. Holland when I assume he’ll do another topography and remove more sutures. I’ll report back then with a usual update. My only concern is eye pressure, but I’ve been diligent at meds and hope it’s stable.
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?
During this visit I had usual vision checks, numbing drops, eye pressure check and topography taken of my grafted cornea. The eye pressure was a bit high, so I’m cutting back on steroids to a lower frequency. The topography was successful (first successful one I’ve had since around 2003, my cone was just too steep.) I tested to 20/60 with pinhole (which reduces effect of astigmatism.)
Corneal Roulette – Suture Removal to Adjust for Astigmatism, Tension
Dr. Holland identified some “tight” and “loose” areas on the sutures via the topography. He then showed me where he’d be removing sutures. I really like how Dr. Holland stops to let the patient view the diagnostic tactics. I have 24 stitches, and it’s impossible to keep them all at the same tension. Also, the cornea heals at different rates, meaning you might get tension in one area and “slack” in another.
Before the suture removal, the assistant gave me numbing drops and antibiotics. Then they gave me four more numbing drops, the comment being “you want your eye to be nicely numbed for this part.” Yikes.. Anyway, the anxiety was for nothing. I rested my chin on the rest and the assistant pulled open my eye gently with a swab. Dr. Holland viewed through the microscope and in literally 10-12 seconds, snipped two strategically placed sutures, almost before I realized it. He then used tweezers to pull out the microscopic threads and before I knew it this was over. He showed me the sutures – they are like butterfly eyelashes (as my daughter used to say) truly tiny. Then, antibiotic drops were used (and will be used for a few days) since the suture leaves behind an entry point for potential bacteria.
So, the removal of the sutures was 100% pain free.
Interestingly Dr. Holland told me that if we stabilize the astigmatism, we’d stop taking sutures out – leaving them in place for years. This would promote a very solid wound healing process. Some patients have sutures out more quickly based on astigmatism situations.
Droopy Eyelid after Corneal Transplant
After surgery, as my swelling went down, my wife and others noticed that my left eyelid was a bit droopy – a bit more closed than it should be. Dr. Holland explained that this is probably due to the spreader which was used during the operation which caused a contusion of the muscle. For most people, it will gradually recover within a year. If not, there is a simple procedure to adjust it. No matter what, he said you shouldn’t do anything until a year had passed. He said the bright side was that it provided slightly more protection to the eye.
Restasis is an Anti-Rejection Drug – News to Me
I think that I know quite a bit about corneas, DALK, etc, but today proved I have a long way to go. I thought I was taking Restasis for tear production, but actually it was to prevent rejection. Mark that down in your note book. Dr. Holland also told me that Restasis was good for combating allergies and is in FDA trials for that indication! Okay.. bottom line, use the Restasis whether or not your eyes are moist. Dr. Holland said that it was a steroid-sparing allergy drop. They’ve used it for hay fever conjunctivitis for a long time.
Eye Pressure Still a bit High
Dr. Holland told me that 8% of patients react to topical steroids, such as durasol, were prednisolone was a bit weaker and caused less pressure. It’s only a problem while I’m on steroids, which, for DALK, would taper steroids over a year or so. I was slightly concerned about what effect higher pressure might have on my eye. Dr. Holland explain that the only thing that would be a concern was the optic nerve – and mine was just fine and there was nothing to worry about. Postscript: eye pressure continues to rise, new drops started.
Astigmatism after DALK Surgery
How much astigmatism, and how it will progress during post-op recover, is highly variable. Some patients have high astigmatism until sutures are removed, while others have low astigmatism until they’re removed and suddenly have a lot. It’s all normal, and we just have to wait and see where it will go. If there is a lot of astigmatism after all sutures are removed, we will discuss PRK with a laser to fix it. For me, I’m minimally nearsighted right now, and will likely remain so for ever. My corrected vision is 20/60 at this moment. He said another patient at his office recovering from DALK was 20/25. Nice.