Been told by hospital I need a graft

[rosemary johnson]

I wonder if the theory about grafts being better in non-contact lens wearing eyes is about vein incursion?
People who have worn lenses for a long time can get blood vessels growing about the surface of the eye and getting ever closer to the central area of the cornea. if these get far enough, they can even grow across the pupil and interfere with the vision.
If these veins get into the area that is cut out/replaced in a graft, that makes the graft much more difficult and risky.
The veins grow if there is not enough ocygen getting to the sruface of the cornea from the atmosphere and an extra blood supply is required to supply more oxygen.

I *thought* that problems of vein incursion were much reduced with the new gas permeable materials, and the 2hard/soft comination" lenses.
But mybe that's what Karl's person was thinking of??

As for six months wear - haven't seen Karl's eyes, so don't know. Maybe he is changing very fast and feting very thin already (like my waistline and fat bum aren't, alas).
But in general ..... I must have had the lens I'm using in my left eye for at least 10 years and it's still going strong, thanks.
rosemary

[jayuk]

Rosemary

Generally Corneal Vascularisation is rare, however as you said its more around the lens type and material which cause it. I remember when SoftPerms came out in the USA, they contributed to a number of cases as there initial material used was not allowing enough oxygen transmission to the cornea....

But it is kinda intriguing as to why the consultant in this case said what he/she said to the patient...as I have not seen any research to indicate that wearing lenses gives a better outcome for corneal transplantation....or is best performed on eyes that havent worn a lens

[GarethB]

Having a graft in itself can cause corneal vascularisation and as with wearing contact lenses is rare. Where this is observed and caught early enough laser treatment is sometimes used to quarterise the blood vesels. If the blood vesel gets too close to a graft then rejection becomes more likely.

The information I have read regarding corneal vascularisation can is also caused by the overwearing of lenses. This sometimes goes with corneal scaring due to the lens trying to move around on an eye that has no tears.

If I am really concentrating on something I can block out all extrenal stimuli including pain! During my racing career, I was concentrating on the race so much and getting to the front after being pushed off of the track, it took a few hours before the pain to filter through that I had broken htree ribs and dislocated my wrist as a result of the impact. The accident happend at the start of the race, about 15 minutes into a 60 minute race!!!!! Rally cross is very bumpy and requires a lot of gear changes and it ws my left wrist (the gear change one) that got dislocated as I was changing gear at the time of impact!!!!

I can beleive that many of us do not feel lens discomfort if we are concentrating on something at work.

Karl, it would me nice if your specialist could provide a reason for their suggestion regarding grafts as I am very cureous.

[rosemary johnson]

I suspect vaxcularisation is much less of a problem now, with modern lens materials than it was back inthe old days when all lenses were sclerals made of glass.

Hey, don't laugh! We've had someone at group meetings in London who used to wear glass lenses. And I'm not *that* old!
Those aren't white hairs; it's undercoat from painting my front dorr yesterday. Honest.
Rosemary

[Karl R]

A quick update.

Good news I don't need a graft yet!

In January had my first appointment at St Paul's.

I saw one of Mr Kaye's team, which lasted all of 10 mins with the doctor, after heated debate with this doctor it was agreed that I was to see Mr Kaye himself in February.

Saw Mr Kaye last week. Mr Kaye did a thorough exam of my eyes and studied the Orbscan in detail, after this he told me that although I had only been diagnosed as KC since last year it was a mild form of KC and I probably had had it since mid teens and my cornea was healthy with no scarring. However he was concerned about my vision having deteriorated since my hospital visit in January. VA in Jan was 6/9 in both eyes, VA done on routine eye test the following day 6/10 left eye 6/9+1 right eye. Had two refractive tests done one without drops and one with to get my baseline prescription. This came back as having changed again since January VA now 6/12.5 with a much higher power lens for left eye.

As a result Mr Kaye has said that I probably would benefit from INTACS but will have to wait until they get the funding as he said it is a relatively new procedure in treatmeent of KC in the UK and not much data is available. Have agreed to have this as it may benefit me and certainly the results obtained will help others

Has anybody had this op and how succesful has it been?

[jayuk]

Hmmm I would tread carefully with Intacs.....as the possible complications with KC increasing whilst intacs are in are never discussed buy Opthams!....And whenever I have brought this up, I have got some really strange "dont ask me that cuz I dont know" looks......

[Karl R]

From what my consultant told me my KC is unlikely to progress further, but will only achieve a marginal improvement with glasses. My consultant has categorically stated that he will not fit contacts on me as apart from the KC my cornea is healthy. He seems to think that INTACS is probably the best way forward for the moment and is reversible i.e they can be removed. As said earlier I have also agreed to clinical study when the op is done.

[jayuk]

Karl

NO disrespect to you, but the advice you have been given is WRONG! There is no man, or his dog, on this planet that can say whether your KC will progress or not. In fact, I would be extremely interested in his basis of making such a claim! Does he have some method of finding out the KC Progression Scale for you?.....

This kind of advice is soo erroneous and it seems that you are being pushed for Intacs for personal and eye unit specific studies......treat carefully my freind!...I potentially see trouble ahead!

[GarethB]

Karl,

I must agree with Jayuk, KC can stabilise as quick as it starts for short or long periods. To this day it is impossible to predict the course KC will take.

The only sure fire thing is that 90% of people with KC cope very well with glasses or contact lenses and never need surgery of any kind.

There is also no literature to prove that KC is agrevated by contact lenses. I would use the same argument your doctor has used regarding the use of lenses on a healthy cornea. Why operate and put intacts on a health cornea. Any surgical technique will leave a tiny amount of scaring however small.

If lenses are managed correctly the chances of scaring and corneal damage can be kept to an absolute minimum. Been wearing lenses for two years and my cornea is just as healthy as it was 20 years ago when first diagnosed with KC. OK both my eyes are grafted, but the cornea is still healthy.

From you have posted, taking itliterally, to me it sounds like you have been given a sales pitch more than medical fact.

20 years ago grafts were the cure for KC. We now know that is not the case, it is long term management like any other treatment. Grafts still need some sort of correction in most cases.

Sorry to come over negative, but in this instance I feel honest opinion is required rather than diplomacy.

Please let us know what your next consultation yields.

Gareth

[John Smith]

I totally agree with the last two posts, especially about the use of contact lenses. Lenses are the most useful way of managing KC.

If you're worried about the possibility of scarring, then you could consider a scleral lens which does not make contact with the cornea (it's a no-contact lens if you like!).