16 months later and bad news

I'm just back from the doctor and this time the advice I got was very different to last time. Last visit I was told my vision would 'definitely' end up very good - 6/7.5 was mentioned as a minimum.

I found that very encouraging around the end of the year I was beginning to think the operation was a failure and I might have to get it done again or have further treatment such as collagen cross linking.

This time it was Dr Anthony Maloof who said he was really disappointed with the performance of the cornea which is a different shape everytime I see him. He said the options for treatment were:

Collagen cross linking to toughen up the cornea. However while this seems very good for stopping the gradual change in a cornea associated with keratoconus there was no guarantee it would be able to stop the greater variations that my eye was going through. He also said that it could take up to 12 months before I got the full benefit of that and already a lot of time had been spend stuffing around with my eye. I had noticed that too!

The other option would be for him to perform a new partial thickness stromal transplant on the eye. This was the option he recommended. He admitted it may not work better. If the issue was with the donor cornea (which apparently cannot really be tested while it is in my eye) then it would fix the problem. If it was because somehow the donor tissue and my tissue did not join properly there was a good chance it would not happen again. If the issue was with my tissue around the donar cornea changing shape...well lit would probably continue to the same after the operation. I imagine there are other possibilities as well but they are the only ones discussed.

bleh so I'm not very happy about this. I have bunch of questions to ask him. I've started some allergy desensitisation which will probably take several months - should I finish this before the operation. I noticed this year my eye (probably because of allergy) was much worse around january - should the operation by then NOT done in december like the last two? Last time I found wearing a soft contact lens greatly reduced pain - given it turns out inflammation can lead to issues with healing should I preventively wear the contact lens?

I'm going to have to ask my optomitrist if he thinks there is a trend for the changes to my eye decreasing and what he thinks about having the operation again. I'm wondering about getting a second opinion though I am not sure from who given Dr Maloof is supposed to be a leader in this type of operation.

I do remember on my first checkup maybe two weeks after the operation talking to another pateint who was doing much better then me...is that cause operations disagree with me or just this one.

He says he would be happy to do the operation under a local anaesthetic if I thought I would be ok with that. hmmm.

Dr Maloof said I am the first patient of where he thought he had to try to take the stitches out early to stabilise the eye. I am also the first where after this amount of time he has offered to do the procedure again in order to get a stable eye. SO much for a normative blog for others to read! He said that this time he would not charge more then medicare and my health fund would cover.

The next bit will probably bore the causual reader but I'm going to put some readings up....if nothing else it may make it easier for me to refer to them again!

25th Jan 2010. 48@82 41.2@172 +1.75/-5.00@150 vision with this prescription 6/9

After operation to correct curvature:

9th Feb 46.8@72 42.5@162 +125/-5/50@150 6/21

2nd March 46.0@66 43.0@156 +125/-500@135 6/15

6th April 2010 45.7@65 42.8@155 +1.75/-600@135 6/12

as you can see the vision is constantly improving since the trama of the feb operation - however each time the prescription is different which means its all pretty theoretical and I have actually had no prescription lens during this time. They take 2 weeks to order...it would be out of date by the time it arrived. Yesterday (13th April) Dr Maloof took new readings. he didn't tell me what they were only that there were quiet different from the readings on the 6th April and that the corrected vision was actually worse. It will be interesting to see what Andrew Watkins get when he measures me next - which will be as soon as he will see me next.

I've also got hardcopies of lots of pretty topographical maps taken over this period. The Topological maps show the curvature of the cornea. It should be constant. Where it is red it is too steep. This makes the eye stick out more - or be in a "cone" shape which is where keratoconus gets part of its name from. Here are comparative topolgical maps from Feb and April - you don't have to understand them to see that they are quiet different. My right eye taken over the same period shows minor difference - I don't think it has really changed so maybe there is some level of error in these measurements...even so these are quiet different. I just noticed the numbers at the bottom of the topological graphs which show more readings with different astigmatism! I'm not really sure what the diagram on the left means. (anyone care to share?)

(Click on image to view larger)