I asked Dr. Koffler what care I needed to take related to my graft and the Shingrix shot.  They suggested that Tobradex – same as I use for Influenza vaccines – would be fine and would cover both.

I’m having more dry eyes than before now, so am keeping Systane with me at night, adding drops anytime I’m even slightly awake.

When I do have a “dry eye pinch” (usually caused by opening my eyes suddenly while they are dry) it can cause me to have blurred vision for 24 hours, which doesn’t make it easy to work!)  So I’m doing all I can to avoid this happening.

I’m reconsidering Restasis again, despite the cost…but Dr. Koffler told me about a dry eye “serum” which can be created from my own blood (really!) and turned into eye drops that lubricate as well as heal.  That sounds amazing, and I assumed it would be horribly expensive but he said it was about the same per-dose use as Systane.

I am giving it serious thought, but for now, my dry eye is fully under control and my vision is sharp.

Also:  No significant changes to my prescription, so have no plans right now to change glasses.

Update: I also have some thoughts that this blurring is also caused by medicine, including Benadryl and Zyrtec.  Apparently these impact one of the muscles that is used for close vision focus.

After a clean bill of health from Koffler Vision Group, the diagnosis was dry eye, so I’m ramping up the Restasis ($) and systane.   I had them check my eye pressure, look at the optic nerve, and check the corneal thickness.  The Dr. said my graft looked “gorgeous” and I had no worries there.  My vision checked out at 20/30 and I was out of there!

All came out great.  I know I’m hypervigilant and possibly a bit psychosomatic, but I really value my vision.

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.

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.

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!

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.”

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