Intacs update/Big pupils/CR3

[alice44]

I had my 3 month check up yesterday and wanted to report back a few things and ask for some advice.

Check up
My eyes seem much the same. I could get one more line on the eye chart than before the op, but for me the glare, as I've said before, seems no better. My eye is flatter though and I'm off to try out the Kerasoft lenses next week, so maybe my eyes will be easier to fit!

Big pupils
Apparantly my eyes find it harder to focus and the glare is worse as I have big pupils. The consultant gave me some eye drops to reduce the size of my pupils (to be used sparingly). I tried them this morning and the vision through my intacs eye was loads better (though still the glare). Has anyone else ever used these?

CR3
I also have been told that my cornea is very elastic and would benefit from CR3. Has anyone else had CR3 after intacs? I would be interested to hear both negative/positive results. I'm slightly reluctant to undergo anything else after the intacs weren't that successful, but then I'm thinking that maybe if my cornea hardens around them it might give me some improved results. I'm aware that it can stop progression, but I'm not sure if this is too relevant for me at 29.

Any thoughts/advice will be gratefully received.
Alice

[Andrew MacLean]

Alice

Difficult decisions! If it helps, I continued to see a deterioration in my condition up until I was registered blind at the age of 52! While KC very often does stabilize, it is not always so; sorry!

I think that CXL is not more commonly offered along with INTACS. But, the decision has to be yours. CXL may slow the progression of KC, but it may be that your KC was slowing anyway; I think that if you trust your ophthalmologist then you need to talk a load of issues over, come away and think about them and then make your decision.

I know that this decision will weigh heavily with you, and hope that you come to a resolution with which you will be happy, or at least content, in the years that follow.

All the best

Andrew

[timmytim7]

hi,

at what age does KC progress to normally?

i had cxl done last year and i'm 26.

i notice that there is a study that shows cxl and intacts together work better than seperate. some clinics seem to offer both treatments at the same time.

anyway if i were you i would find out if you're KC is likely to progress much first, and if the answer is yes, then i'd get cxl. it's expensive but it's a quick operation and doesn't hurt (until afterwards for about 5 hrs that is! in my case anyway!)

good luck,


tim

[Andrew MacLean]

I am not sure that I can answer the first question with any confidence, but the literature does suggest that KC tends to be self-limiting; it arrives at a point and then does not progress further.

The problem here is that there are exceptions to every rule and that there seems to be no way of predicting who will fall into the group whose KC continues to deteriorate. There is a further complication in that it is now possible, with modern laser topographies, to diagnose KC at a sub-clinical stage. The people whose condition is picked up in this way may, in fact, have continued blissfully unaware of their KC throughout their lives.

Andrew

[Karl R]

Alice

Seems like the reduction in pupil size is helping your vision after Intacs, even if it is not to the extent you had hoped for which is a shame. KC progression is exponential, usually developing rapidly through the teen years before slowing down and almost stopping in the thirties. If your cornea is still elastic, and the intacs are not performing as well as could be expected on their own, it may well be worth considering having the c3r treatment. This however is a decision that only you can make, and I can understand your hesitancy.

Karl

[Lynn White]

Alice

Looking at this as a professional, what I can say is that as a whole, there is a general thought process going on that a good way to reduce the progression of KC and obtain better vision, is to combine intacs with CXL. Each on their own have advantages and disadvantages.

Intacs

Advantages
The rings reduce the amount of distortion in your cornea. This can sometimes have spectacular effects on vision - other times it doesn't help much but does reduce ghosting and glare associated with distortion and aberrations.

Disadvantages
Doesn't slow down progression of KC

CXL

Advantages
The process "thermosets" the cornea if you like, slowing down progression markedly. It also strengthens the cornea by increasing teh cross linking of collagen fibres

Disadvantages
Although the cornea is now stronger, you are still mostly stuck with the visual affects you had before due to aberrations and distortion - depending at what stage you had the CXL. This is why if you are going to do it, you may be better doing before your condition deteriorates much further.

Logic would therefore imply that if you combine the two procedures, you gain the best of both worlds - Improved vision and a slowing of progression. Results seem positive so far but like any new procedures, it is too early to say hand on heart with complete certainty that this is the best course of action. Only time will tell.

What I will say though, is that either procedure on their own or together will not necessarily do away with the need for contact lenses or glasses afterwards. What they will do is give you a really good chance of attaining better vision for longer compared to if you did nothing.

I will also say that if the professionals are saying that your cornea is very thin and elastic, this will not get better left alone. Did you ask them how long they estimate your KC may progress?

As for the drops to constrict your pupils - this is actually the same sort of thing as looking through a pinhole. It cuts out light traveling through the periphery of your cornea so reduces distortions.

Hope some of this helps!