Help! Corneal Intacs Rings?

[jamesleicester]

Hi everyone.

First of all I’d like to say what a fantastic site this is. It’s a good and reliable point of reference for KC and it’s nice to know there is a place where everyone can relate to concerning KC.

I’d like to ask for your opinions in order to help me make up my mind on an offer of a new procedure that my consultant is prepared to carry out in order to improve my vision in my left eye (no KC onset in my right eye yet). I’ll give you the background on the attempts to try and treat my KC first. I’ve gone on a bit so please bear with me!

I am 26 years old. I use a computer all day at work and am getting very tired and have regular mild headaches due to the problem with my left eye. I have been attending the eye clinic at the Queens Medical Centre in Nottingham for the past 2 years. I have been fitted with 6 to 7 different types of RGPs made out of all sorts of materials. After 1 to 2 hours of wear time every lens I have tried resulted a in dry, sore, and very red eye. I was very careful and thorough with disinfecting and always followed the solution instructions and medical advise.

Each time a new lens was ordered I would get very excited at the prospect of better comfort/sight and the ability to wear an RGP for more than just 1 or 2 hours. Alas, when each new lens arrived and was inserted the same scenario occurred; redness, soreness, dryness etc. As you can imagine this became very frustrating and my consultant and I have admitted defeat with RGPs.

Upon visiting the clinic for a check up on my last lens before calling it a day on RGPs the optometrist mentioned a procedure involving Corneal Intacs Rings. If you have not heard of this the procedure corneal rings are tiny semi-circular c shaped bits of plastic made from similar materials that RGPs are made out. They are inserted into c shaped channels cut into the inside your cornea. There is a large amount of information on the net if you would like to read more about corneal rings.

The optometrist that informed me of the rings referred me to a corneal specialist. I saw him yesterday and will comment on my consultation with him later.

So, after hearing about the rings I returned home and got on the Internet to read all about these rings. I was very interested and excited because the rings are inserted beneath the nerve endings so you can’t feel them. They are designed to reshape corneas into their intended undamaged natural shape because they are rigid (however I expect there is a degree of flexibility). Research and test results are promising and encouraging. In 58 Keratoconus eyes implanted with Intacs almost half achieved 20/40 uncorrected vision. It is reported that some receive 20/20. There is a 95% success rate (eye sight improved). If there are problems with the rings they can be removed and the cornea heals and vision returns to how it was before surgery. However, as with all surgery there are risks. One of the most obvious is infection.

Anyway, my appointment with the consultant corneal specialist arrived and although the clinic didn’t yet do the procedure, after examining the thickness and condition of my cornea he said he was prepared to do it. The only snag was he had never done it before, but did assure me he fully understood the procedure and had been trained. He has 10 years of corneal surgery experience but I was still very wary and if I think if I decide to go ahead with the operation this will most likely prompt me to seek another hospital that is already practicing!

Near the end of the procedure I was told something that killed all hope and excitement that had built up inside me between my previous visit and the corneal rings consultation that was taking place. The consultant said, even if I had rings inserted I would still need to wear an RGP. This was very disheartening because of the fun and games I have had over the past 2 years with trying to successfully fit a RGP! When asking why an RGP would be required in addition to the rings he told me that all the rings do is put the cornea into a better shape to receive an RGP, hence making wearing an RGP more comfortable. In theory I can see where he was coming from but in practice if the many optometrists and consultants could not diagnose why I was getting a red, sore and dry eye without the rings when wearing an RGP why did he think the bad reaction to an RGP would be less with the presence of the rings? This makes no sense to me. Surely to cure you need to diagnose!!! I thought that was basic medicine???

So, what I’d really appreciate from anyone reading this is for you to tell me if you agree with me…would having rings inserted mean I also need to use an RGP to gain better sight? Or, taking into consideration the purpose of rings, which is to reshape the cornea, would you say there is no need for an RGP? I suppose I could have the procedure done and see how I get on without an RGP. I could always add an RGP at a later date if required. If all fails I simply (I perhaps shouldn’t use that word) have the rings removed.

I know I should trust what the consultant told me more than I currently do but this is my eye sight we are talking about here and if something goes (although I’m told it is a fully reversible procedure) there may be no going back!

I look forward to hearing your thoughts and will discuss all thoughts with the consultant before making any final decisions.

Thank you all very much!
James.

[GarethB]

Hi James,

Welcome to the forum.

It is clear you have several problems, the first being the computer and what you describe is spending too much time at the pc.

HSE guide lines recomend regular short breaks. Secondly a VDU assesment may be in order so that you can get a larger monitor so that you can see clearly with or without lenses.

Hunidifier in the immediate area are useful as your lens issue sounds like what I had 12 months ago. Lubricating eye drops help here along with a diet change. For me it was giving up a lot of caffeine and juice drinks and substituting them with water and I now have at least 2 lires of water per day.

This took my lens wear from 1 - 2 hours to 12 plus, for the past 14 consecutive days it has been 16 hours plus!

You say you have followed the solution instructions, for me I can only tolerate one solution manufacturer so a change in solutions may help. I know many people with KC who are allergic to the preservatives so they use the solutions to clean their lenses and store the lenses dry. Prior to putting their lenses in, they give them a final rinse with preservative free saline and the lenses are nice and comfortable again.

I think i have been where you are at and having tried the above, I am back on the original lenses I started with and get perfect vision and these lenses are 30 months old.


Your last point about intacs and what the consultant said is very true. Any corneal surgery is aimed at reducing the cone to make the correction of vision easier which may be by glasses or contact lenses. By making the cone flatter, the points where the lens touches are spread and cause less irritation because of the better lens fit.

Have a look at Intacs Presentation

I have had two grafts 20 years ago, I did go for a while without sight correction, so surgery can produce perfect vision, I later needed glasses and now I am on RGP contact lenses. there are no guarentees as to what will be necessary to correct vision post op.

Hope this helps

[Sweet]

James,

Hello there and welcome to the forum!

I did have exactly what you have with a red sore eye after wearing a RGP for a few hours. It was so dry and a sudden change after wearing a lens for 14 years with no problems.

I now piggy back lenses so i have a soft one underneath and have gone from five hours to over fifteen comfortably. The only problem i have is the lenses being foggy after a long time of wear, but i just take them both out clean them and pop them back in.

Intacs as i understand don't really correct your vision unaided but make the cornea a better shape to put lenses on. I don't quite see how that is going to help with what sounds like a dry sore eye problem? But obviously the consultant knows much more than i do!! I would also be very worried about going for a procedure that he hadn't done before. I know that someone has to go first but when it comes to my eyesight i would rather it not be me!!

Hoping that you can work something out soon and that Gareths suggestions help. Take care

[jamesleicester]

Hi Sweet and Gareth.

Thank you so much for your quick replies. You have both given me some very usefull and thought provoking advise.

I am currently using a small (I think 15") screen at work so my employer is going to have to invest in a much larger one. Everyone will be very jealous so I can't wait!

I think for now I'll give RGPs another go and try out your suggestions. I had not realized the things one could try to aid comfort. I.e dehumidifier/lots of water/experiment with different makes of solutions etc.

Your feedback about rings has also helped me steer away from them for now. You have confirmed what the consultant said; making wearing RGPs more comfortable and that's what I mainly wanted advise on.

Thanks again for your help. I'll let you know how I get on once I've ordered another RGP (I snapped my last one...doh!) and given it a few weeks of experimenting.

Cheers.
James.

[GarethB]

James,

Take a look at the Keratoconus at Work Leaflet and show it to your employer. They will be more willing to help on the monitor front as it will be partly funded through Access to Work as Keratoconus is a disability.

You will get some jokes, but your collegues better be aware of the Dissability Discrimination Act as what you may take in good humour and wghat is intended in good humour could be in breach of the act!

Oh and dehumidifiers dry the air and make things worse, a HUMIDIFIER makes the air damper so more comfortable for the eyes and the lungs too

[jamesleicester]

Gareth,

Thanks again. Typo on the humidifier. Thanks for the correction though.

I'll present the links you provided to my boss tomorrow. She is very understanding and never has a problem with me taking as much time as I want to go for check-ups so she will be fine with providing what ever equipment makes my working conditions better.

Cheers.
James

[Andrew MacLean]

James, all the best.

I hope you don't attract too much jealousy when you get your new super duper monitor.

Andrew

[jamesleicester]

Thanks Andrew. I'll let you all know where I am in a month or 2 or...3.

[ashley wilson]

james

i had the intac procedure 2 weeks ago and was also told that some form of vision correction will be needed afterwards (and it usually is), however at the moment my vision is really good unaided (6/5 last week) and although it may still fluctuate is a massive improvement to 6/60 before! i was told that it will take 3 months for vision to settle.
were you offered the treatment on the nhs? quite expensive to go private but i am so glad i had it done.

ashley

[GarethB]

No worries James.

I am known for my typo's and had to look at my post a couple of times to see if I had messed up

Let us know how you get on.