Surgery questions

[timtim]

I have been considering looking into surgery more and more recently. I tried RGP's a few months ago unsuccessfully. My vision is not terrible, but my left eye has a lot of the KC smudging/blurring, and my right eye has only a little of it. I have a really hard time with the focus between my eyes. It has really affected me mentally on a daily basis for a while now. I have a tough time concentrating, and feel out of it a lot. I really haven't felt like myself mentally for the past few years because of my eye problems. I don't think i can keep dealing with it for much longer.

Is there a particular surgery method that seems to be the most successful for people? Also, I kind of wondering if it is better to wait (although I dont know how much longer I can). Say I have Intacs put in, and then in a couple years, they come out with a much better surgery. Would having the Intacts (or another surgery) prevent me from having the better and newer operation? Is this a reasonable concern.

Another issue for me is money since I live pretty much month to month. I don't know how much I can afford, but i would be willing to go into debt or do whatever I can to get some relief.

Any input on this would be great to hear, thanks

[Andrew MacLean]

Timtim

I know that this is not the answer you wanted to read first, but I am afraid that the appropriate intervention for people with KC will vary from case to case, even from eye to eye.

For my part, I postponed any sort of surgery until I was registered blind. I did not want to risk what I had.

I do not commend my approach to anyone; all I can say is that it worked for me. Your own situation is obviously different. Whereas I had one PK graft and then a DALK graft (with a cataract in between), you have to seek the advice of your eye care professionals and then decide whether you can afford the approach they advocate.

Here there is a problem for those of us who are posting from within the Socialized Medical environment of the United Kingdom; we do not really pay for treatments most of which are free at the point of delivery. The commercial medical environment of other jurisdictions would introduce a degree of complication that we'd find hard to contemplate.

What I can say is that we all know how hard it is, day by day, to be struggling with poor sight, or even sight that is inconsistent between your two eyes. I learned early on how to switch off one eye and look through the other, and while this approach still works pretty well for me, it does make some judgments hard to make: how deep is this step, or how low is that table ... .

Whatever you eventually decide, we know how it feels to be in the position in which you find yourself. You have nothing but our good wishes as you wrestle with these hard decisions.

All the best

Andrew

[Lynn White]

TimTim

As Andrew says, it is hard to recommend any kind of surgery on a personal basis as KC indeed varies markedly from one person to the next. However, I can give you some general information.

First, based on what you said, it sounds like the KC is not too advanced. You said you tried RGP's unsuccessfully and I am wondering what that meant? Was your vision better but the lenses uncomfortable? If this was the case, then your contact lens fitter could try piggy backing the RGP's on soft lenses or indeed you could try a KC soft lens. There is one called Hydrocone in the US.

Surgery for KC now includes intacs and C3R (crosslinking) which can be quite successful. I have heard of some cases who can see really well with spectacles after these operations but many others still need to wear contact lenses.

C3R (or CXL, which will be its new name, I understand) is aimed at slowing the progression of KC and has been proved quite successful so far in that respect.

Intacs is aimed at making the shape of the eye more regular. Again, this does help vision but does not necessarily mean you can throw away glasses or contacts.

Corneal grafting is a surgical procedure which is done more for medical reasons (the central cornea becomes extremely thin or there is central scarring which reduces vision) and is not to be done lightly because of the possibility of rejection etc.

These surgical procedures are mainly aimed at treating the condition. They are not a miracle cure for your distorted vision. In all of these procedures, good vision post op may well only be possible with contact lenses, so please do not think of surgery as a "cure" in that respect. KC is much more complicated than that.

To answer your other question, this is a bit difficult as one has to try and guess what future operations may entail!! Intacs do have the advantage in that they are reversible as they can be removed. In that respect, they are the best bet if you want to keep your options open for future surgery. However, if your KC appears to be progressing, then cross-linking may well be a better option as the likelihood will be that the KC will stabilise. If your KC is stable, then trying to get a better contact lens option and waiting to see how research goes may be the way.

As always, no-one can advise you about your specific case on a message board!!! To get a proper viewpoint, you need to go and get the opinion of an ophthalmologist (or two!), let them give you advice based on what they actually see when they look at your eyes.