Post graft contact lenses

[jayuk]

Andrew

Soft Lenses seem to be the way to go post graft with Sutures in...either Kerasoft or Soflex. However, if possible its best to avoid them until well over 15 months I would say...or when the sutures are out...whichever comes sooner...

Once sutures are out, then Sclerals, Intra Lymbals etc are all potential lenses for Post Graft Corneas........

J

[Janet Manning]

Andrew,
Thanks for your concern, but I've got usd to it after 6 years and do very well with sclerals, getting a regular 12 hours a day. Since I am fortunate enough to work from home, I don't have to struggle to get them in as soon as I get up and have no travel to work problems. As a result I no longer feel disabled, unless I'm having a bad eye day, which is relatively infrequent these days.

I was fitted with softperms about 3 months post graft with stitches still in, but only allowed 6 hours per day. Didn't get sclerals until after the stitches were out, but that was not a clinical decision, rather that sclerals were not available at the hospital where I had the grafts.

It was about 2 years of messing about post graft before I felt I was functioning properly again.

Showed my Mum the pics posted on this site today, so that she could see what I can see unaided. She was really shocked! I've always thought she didn't believe me!!!! I think it helps to show our nearest and dearest these things sometimes. My very caring partner often expects me to be able to read stuff without my lenses and will persist even when I say I've removed them. Probably because we don't discuss it on a daily basis, I just get on with it!

So thanks to Knight and Gareth for posting the pics.

[GarethB]

Janet,

When you work from home it can be just as hazardous as it is for those who travel.

Changing underwear and getting off balance can have disasterous consequnces and ruin the whole day

[Janet Manning]

Gareth

Couldn't agree more!!!!!!!

[Ali Akay]

Jay
I've tried soft lenses on post graft corneas a few times, but usually aborted after a while due to progression of new vessels. As high astigmatism is usually the main indication for contacts rather than specs, the lenses are often rather chunky and hence have poor oxygen transmission. Sometimes contacts are indicated due to a large difference between the two eyes without large degrees of astigmatism eg one eye long and the other short sighted and soft lenses could be used then (thin, high water or silicone hydrogels rather than kerasoft type thick lenses).My personal choice is high oxygen transmission, large diameter gas perm lenses (typically 12-12.5 mm dia).If possible everyone (ophthalmologist, contact lens fitter and the patient) prefers to postpone the fitting until sutures are out but it is possible to fit over the sutures. The frustrating thing is the fitter could spend a number of appointments to get the fit sorted, then the stitches are removed and everything changes and back to square one!

[Lynn White]

Ali

I have fitted post graft with soft - particularly in Trinidad - and not had THAT many probs with new vessel growth - the trick is to keep checking the fit as the graft reshapes. Sometimes softs tighten up almost overnight!! I do find Soflex quite good as they do transmit more oxygen than other thicker lenses.

Totally with you there re stitches hehe!!

Lynn

[Janet Manning]

Hi Ali and Lynn,
I realise it must be very frustrating for you optoms to have to fit and refit lenses as sutures are removed. However think how much more frustrating it is for us folk post graft with no useful vision in my case (look at the chart, what chart??). I felt totally disabled, unable to cross roads safely or feel safe on the street. It affected my whole personality. Normally I'm a confident person, but I found that my whole body language changed and I began walking round like a frightened rabbit, stopping when a crowd of people approached in the street. I was tearful and fed up because life suddenly became such a struggle.

An interim lens fitting made the world of difference to me. Even a few hours a day gave me time to go to the shops and be able to find things, time to write/ send emails. I felt so much better and more able to cope for the rest of the day without lenses.

So next time you are feeling fed up because you know your patient will be back shortly and you'll be 'back to square one', please remember that you may have given that person a new lease of life for the few weeks or months that the lenses fitted ...... and they will be forever grateful to you for that.

Thank you

[Andrew MacLean]

Part of my problem is that the ophthalmologist has removed all the sutures that are willing to let go of their place in my eye, but there is one that stobbornly remains.

This has two effects:
1 there is an artificial astigmatism (quite steep)
2 as the suture shifts slightly, the astigmatism varies, not over a day, but suddenly every six or eight weeks. It gets costly in Zeiss lenses (for my specs).

Ah well, nobody told me it would be easy or cheap!

Andrew

[John Smith]

I think you've hit the nail on the head! Nobody does tell you that it could be expensive and difficult.

Perhaps it would be better if "they" did!

Or maybe not.

[Lynn White]

Janet...

Ahh don't think we mean it that way! We know how much it means to people to get things right, thats all. It's as frustrating to us as to you to find the goal posts change just as we get a fit right!

In the past, this used to be a regular occurence with older people who had cataract ops. The incision were quite long and required about 5 stitches which were generally left in.

You'd just get the specs right (or before implants, the contact lens) and then "ping" - one would break and everything would change!

And then of course, we know its going to be expensive for the patient!!

So don't worry, we do know what it means to have those days where you can see!!

Lynn