When should I have a graft?

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Posts: 4921
Joined: Sat 21 Aug 2004 3:31 pm
Keratoconus: Yes, I have KC
Vision: Graft(s) and contact lenses
Location: Warwickshire

When should I have a graft?

Postby GarethB » Tue 28 Mar 2006 6:32 pm

When should I have a graft?

Firstly, it is a fact that relatively few people diagnosed with KC will ever need a graft and fewer still will require a graft in both eyes.

Medical opinion is that this should be done as a last resort once all lens options have been exhausted. Generally we start off with glasses or corneal RGP lenses of which there are many designs. If comfort is an issue either due to fitting or tolerance (can be a combination of the two), piggy back lenses are used; soft lens on the cornea to be a cushion with an RGP corneal on top or a soft perm which is an RGP corneal lens with a soft material round the edges. Then there are the Scleral lenses, full size or mini.

To acclimatise to lenses can take weeks or months and can be complicated by our tolerance to lens solutions and the conditions in which we live and/or work.

This is obviously difficult for those immediately round us, parents, brothers/sister, colleagues at work. It can appear that we are suffering, but we are remarkably adaptable and that is sometimes very hard to communicate. We are often prepared to put up with some inconvenience if it means we lead a near normal life.

I think as teenagers when most of us are diagnosed we are very poor at communicating this to parents. Schools and other educational establishments are very good regarding support as are the RNIB. So education wise, we can do as much as everyone else.

The work place is slowly adapting with Access to Work scheme and Action for the blind. I am aware that some organisations are very good and by the same token some are extremely bad.

The only way we can make someone fully appreciate how we adapt is to give him or her KC and this is something we would never wish on anyone.

From a loved ones perspective it may seem that many months or years are wasted trying to find a lens management system that works and that a graft is the 'cure' and perhaps the whole lens issue can and possibly should be bypassed.

The time to graft can be recommended to us, but the correct time is when we feel we are ready for it. As has been proven on this board it is possible to live life partially sighted and has a guide dog.

A graft is far from being a cure; it is a more extreme management strategy. Anyone familiar with needle craft will know how hard it is to sew a round patch on a piece of clothing without any minor creases. The eye is very sensitive instrument when it comes to focusing light, which the cornea does the vast amount of. The lens is just the fine-tuning; this is why many grafts require further correction with glasses or contact lenses. This is because a degree of astigmatism usually remains post graft as a result of the surgery.

Therefore, a graft can be considered as a way of making lens fitting easier; be it glasses or contact lenses.

Some manage a period of time without sight correction.

The skills required to carryout a graft is much an art as it is a science.

Grafts also take a long time to settle in some cases. Results can vary from the 'miraculous' instant improvement to a long drawn out slog of a couple of years.

Is there then truly a saving to be had by going for a graft straight away?

Sorry but I am unable to answer this. Many of us set a list of criteria that needs to be achieved before deciding on a graft. If we feel the time is right then the graft is done. If the criteria are changed, then we are not ready yet.

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