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TOPIC: Airline Pilot's PRK and Crosslinking Experience


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Date: Sat Apr 3 4:04 AM, 2010
Airline Pilot's PRK and Crosslinking Experience
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Good day to all....
It is with my profound pleasure that I first of all thank all members for their continue effort in keeping this endeavor true to its very important purpose. As this troubling disease has laid residence with me for the past 13 years, I've found myself riddled with frustration, sorrow, unease to name a few. Non the less, it's very apparent that 1 out of every 1000 persons on the face of the earth that has this disease, mirror this very same sentiment.
Just around mid year of 2009 I decided to refocus my approach on treating my disease. I've always been urged that contact lens- namely RGPs- were the best and most conservative approach in not only attaining the best vision possible but to also possibly abate the progression of the disease.  Being a Airline pilot, I assume that my optometrist's approach appeared to be the most viable and at an obvious glance, posed little or no risk. Non the less, my eyes, as most of ours do, began to deteriorate very rapidly. What was once a blurred image surely came to be a smudged image of color. It was apparent that the future not only held the loss of my Pilots Medical License but it was sure to be followed by a more probable end result of a corneal transplant.

On my first step towards and more emphatic approach to solving this dilemma, I was pointed in the direction of a very well revered and reputable Ophthalmologist by the name of Dr. William Trattler of Baptist Medical Hospital. In a very succinct and direct manner, I made it clear that I was willing to try just about anything in order to at least preserve my vision and at best, BETTER IT ! His response was immediate.
"Two things ! Topo Graph Guided PRK and Cross Linking."
I was bewildered beyond description. At just the sound of it, it screamed INVASIVE and for that my previous Optometrist must have at that moment done a back flip.  Non the less, this bewilderment was sudden but ever more so, brief !
My response was, " When do we start!" 
After a thorough description of all the benefits and underlying risks, he informed me that he would be the one to conduct the Cross linking on a trial basis and as for the Topoguided PRK, it would be conducted by another Ophthalmologist by the name of Dr. David TC Lin of Pacific Eye Care Centre in Vancouver BC.  As doctor Trattler is very capable of performing both procedures, he opted to have the Procedure conducted by Dr. Lin. Apparently the Laser (Allegretto Eximer Laser 400) in Canada is much more advance which would allow for a more precise ablation of the irregular surface area of the Cornea and as a result of which, the healing time would be significantly reduced.

Pre and post of Results Op Cross Linking

Refraction before surgery, ---------10/05/09  OD -7.75 +1.25 X 80 20/40   OS -5-.75 +1.50 X 100 20/30+2
Corneal thickness,--------------------10/05/09 OD 391  OS 412 by pentacam
02/03/10 OD 385   OS 420Corneal Curvature, --------------------10/05/09 OD 50.50@180  //50.25@090 OS 48.12@154  //46.12@64
02/03/10 OD 49.7@124 // 49.5@034 OS 45.2@110 //  46.9@020
BSCVA, -----------------------------------02/03/10   OD -8.00+0.50 x100  20/30    OS -6.00 +0.75 x105  20/25

UCVA,--------------------------------------11/02/09  OD 20/200   OS 20/200
02/03/10  OD 20/400  OS 20/100
Intraocular Pressure-------------------11/02/09  OD 10 OS 11
02/03/10  OD 13 OS 12

As this may appear to be a little bit in the gibberish, just prior to my Prk Operations with Dr. Lin. I had another optical assessment conducted in Vancouver. Of which the result in summary were,
2 Diapoter in reduction of my cones in both eyes.
My vision pre-operatively to X Linking was 20/200 Left and 20/400 Right 
Post op 20/40 Left and 20/100 Right

Not bad at all....!!!

In march, it was time to have the Topograph Guided Prk done and I cant deny the fact that I was nervous at best amid the foliage of risk. Needless to say, I was as determined more than ever to have it done. It felt as if my journey to good vision was underway and at this moment, I was not getting off of the ride. Talk about being Gullible.

The procedure was very simple. Just look at the light, don't move, ignore the smell of burning skin and in the space of 10 minutes per eye, the escapade was over.
Bandage contacts were placed in my eyes and my Vision was immediately better to a point. Don't get me wrong, I didn't think that I was 20/40 in my left but i was certainly better than 20/100 in my Right. My eyes felt more balanced. and the quality of vision had certainly improved.



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zk


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Posts: 53
Date: Sat Apr 3 7:50 AM, 2010
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Thanks a lot for sharing
I did cxl around 7 months ago
Would be nice if I can do prk as well.
Good luck with healing and keep us updated.


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Date: Sat Apr 3 7:11 PM, 2010
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Thanks Zk for your kind wishes. I hope that this blog will shed some light on any issue that you may have....

Proceeding on......


After Leaving the Dr. Lin's office, I was expecting the worst. In my many readings, especially of one of the bloggers - Dominic's experience- I was sure that I was going to be in for a very difficult night.
Surprisingly, aside from the fact that I was a bit groggy, everything appeared to be fine. I was very well taken care of by my wife. It is EXTREMELY important to have someone follow you along to assist in various respects. You ll come to soon realize that walking and doing everything on your own becomes extremely challenging.
Upon reaching back to the hotel room, it was quick to bed as this was urged by Dr. Lin. This period is extremely important in the healing process. The lack of care for the upcoming week is a very important stage in the intial development in the eyes healing. I made it a very special point not to do anything. Other than traveling back to Toronto and then to Florida, everything else, I left for everybody to do. Again, having a great support team is essential.
I often read about people going for long walks, heading back to work and so forth. Please keep in mind that this is again an extremely crucial time. The susceptibility of getting your eyes infected and so forth is exponentially greater at this time. Remember, if your eyes become infected, the rules of the game change completely.

Anyhow, the following morning was basically just as normal as any another. There was some obvious discomfort in my eye, but nothing to really write home about.
We shortly then after ended went to have the post op work done. At which time, Dr. Lin would advise me if it was okay to fly home that day or stay on til the following day. This was all dependent on state of the eye of course.

Dr. Lin's Evaluation:

My eye's had very little Tissue in which to mold. You have to remember that the more tissue your Cornea has, the more of which there is a chance to have an unimaginable good end result. (being 20/20 or better without glasses)

As for me, I was 420 Um in my Left with 20/40 with 6 Diopters of Astigmatism BSCVA 20/30. However, I was 20/25 or a little better with RGPs (BCVA)
Right 407 Um with UCVA 20/100 and 8 Diopters of Astigmatism BSCVA 20/25.BCVA 20/20 with RGPs

Please remember that there is a difference between what is attainable with a contact lens vs. Spectacle (Glasses)

Dr. Lin's prediction, barring no complication of infection or any complications of any sort that my end result will be
70% chance that my Left eye will be 20/20 UCVA with 0 or + 0.25 Diopters of Astigmatism.
50% chance of a attaining 20/20 BSCVA
He was however certain that 20/20 can be achieved with soft toric lenses.

Now, that might not be very good results for the common person but I'm very sure that most KC patients would love the fact that they can finally wear soft contacts at worst and at best be within visual range of capability to wear Glasses.

I have sorted through a barrage of treatments and as much as I've tried to evade the invasiveness of what this procedure may present, I sure that this is the right decision.

I've looked into, Intacts, CK, Custom PRK, Topo Guided PRK, and one of the most promising, the VISIAN ICL. Non the less, Topo Guided Prk was the most suited for what my state and Stage of Keratoconus.
As all cases are different, I strongly encourage that each patient find the best clinician there is that specializes in KC. There are copious amounts of good Optometrist/Ophthalmologist but bear in mind, they may not be the best when it comes to Keratoconus.
To name a few, Dr. William Trattler=Miami Florida, Dr. K- Greece, Dr. David TC Lin and not to mention, the one that is most popular, Dr. Brian Boxer Wachler. All of which (EXcept for Dr. K)  I have had personal experience with.
The most Important however, it is incumbent on all patients, irrespective of the having the most suited doctor, that they conduct a vast research of all area of the disease and the methods in which to treat it.
Taking a break..... Listed below is a link for your perusal. It was a Topo Guided Study  that Doctor Lin had conducted a few years ago.

file:///Users/GINAG/Desktop/CRST0507_11.pdf






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Date: Sun Apr 4 4:01 PM, 2010
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I'm sure that you've heard this along the path of life, " Nobody's cares more than what bothers or pleases you than YOU."
Not to say that this mantra of some sort bears absolute truth to it, but I'm sure you can appreciate its suggestion.
In a situation such as this, being an avid and impassioned researcher of this issue, allowed me to widen the ambit of knowledge of just the basics of Keratoconus. Being armed with the knowledge and the questions in which to ask are important beyond words. Remember, if it wasn't for my assiduous approach in research, I would have still be playing with RGPs until my vision would have possibly completely deteriorated. It only serves as an advantage to know what treatments are available. I'm very confident that it's common practice of a lot of Optometirst/Ophthalmologists to withhold a lot of what may be on the forefront of treatments simply because of the apprehensions and reservations on what it is that those treatments can deliver. It is my belief that this offers itself as a dis service to who we are as patients. It is important to be presented with all of these availed treatments-along with the risks and benefits of course- so as to allow us to make the most viable and informed decision. Again, without reading anything, how would we know that there are a plethora of treatments out there that might better serve us? Anyhow, that was just food for thought. Please forgive my rambling....


IMPORTANT FOR THE FIRST-TWO WEEKS OF TREATMENT.

1. No rubbing of eyes. Rubbing may disrupt and further distort the fragile surface of the Cornea. Believe it or not, you are encouraged to wear Goggles or any eye wear that you are confident to remain in place while you sleep. This is to prevent inadvertent/unconscious eye rubbing during sleep.
2. No washing of your Face-( Inclusive of Swimming, Showers, Saunas, etc.) Water, believe it or not, is often enough a source of bacteria and may lead to an infection if it is allowed to enter the eye. You are encouraged to use Q-tips/Cotton Pads along with a Sterile solution (Refresh Tears for example) to clear around the eyes.
3. No touching of eye. Again, the transference of bacteria can pose a problem. Keeping your hands clean is encouraged.
4. My Personal thing- Maintain a good diet. It's amazing to know how better and more efficiently you body 'runs' once it has proper diet and not to mention, REST.


MEDICATION:

I cannot state enough as to the importance of maintaining a proper and timely medical regiment.
I was prescribed: Steroidal Drops (anti inflammatory), Antibiotics (Oral and Eye Drop), Vlatrex (Oral Anti-Viral), Anti Pressure Eye Drops and finally Preservative Free eye moisturizers. All are to be used in succession of one another at varying times of the day. He also encouraged taking Vitamin C to assist in the healing.
Some of these meds are not typically prescribed but I due to the fact of the exigent circumstance in returning to work in the upcoming few weeks, I urged Dr. Lin that shortening the healing time as best as possible, would be most important.





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zk


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Date: Sun Apr 4 6:42 PM, 2010
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Thanks a lot for sharing. I have mild-moderate keratoconus in both eyes, but I also had a myopia of -6 in both eyes prior to that. After developing the disease, glasses now give me around 20/40 – 20/50 vision in both eyes. Rigid gas permeable lenses gave me around 20/25 but I dropped wearing them after 2 weeks, they are just not for me. So I researched all about soft lenses for keratoconus as well as procedures and surgeries. PRK + CXL caught my interest the most but I haven’t consulted any doctor about it yet. I did CXL around 7 months ago in Ottawa and the ophthalmologist said wait 2 years until your cornea fully heals and then have LASEK. So Im lost whether this is a better approach, doing the cxl and then doing prk separately or doing both at the same time. Doing both sounded more reasonable because your basically removing the epithelium once and doing both procedures. My only problem is I have developed a light corneal haze after cross linking which seems pretty stable. So if I ever need to go for a procedure to remove the haze I thought since I am going through the same risk basically, removing of epithelium and healing of epithelium, I might as well see if I can do prk as well. Like you said, wearing soft torics that give you good vision is a more than satisfying result for people with keratoconus. I plan on asking about the procedure you did at my one year follow up for cxl. Since I live in Ottawa, I was considering going to the Bochner eye institute in Toronto, any experience with that hospital and doctors there?
Good luck with your recovery, glad its going well so far, keep us updated.

zk


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Date: Sun Apr 4 9:47 PM, 2010
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Hi Zk,
Very good to hear from you and I'm very appreciative that you've taken the time to include all of us on what's been going on with you. By all means, feel free at will to ask any question that you may have.

First of all, to be very honest, I have not had any experiences with doctors in Toronto. What I've come to believe is, in Canada as well as Europe, the technology when it comes to lasers in particular, tend to lead by approximately 4 years in comparison to what is available in the United States. Now, again, this is what I was told. So, if it is that you're seeking the the most precise laser/eximer in which to perform the procedure (PRK or Lasek), I'm pretty sure that you're in the right part of town. I was told that in going to see Dr. David TC Lin at Pacific Eye Care Centre in Vancouver, BC, he could perform-based on his experience and available technology-the best form treatment for me. Now, that recommendation could have be based on my particular stage or state of Keratoconus. What I suggest you should do is to have a very thorough assessment of your case by way of Topographies, Corneal Thickness, Ocular Pressure and so forth and so on. After you've gotten that, I would recommend that you shop around to various Doctors. What I've come to realize about doctors is that they ARE NOT PERFECT. Some take actions with varying contradictory approaches. Example: Dr. Trattler-my Ophthalmologist's approach in treating KC in my particular case, as may in all cases, believes that the X Linking should be done first, a 6-12 month pause, then PRK. He believes in removing the Epithelium for a more deeper soak of X Linking. Now, this contradicts Dr. Brian Boxer Wachler's approach which is to X Link the eye with the Epithelium. His belief is that there is no proof in the betterment of treatment when the Epi is removed. He furthermore believes that in removing the epithelium, the procedure poses more risk of corneal haze among other complications that what is necessary. Make note that he was the very first Doctor in which to have used X Linking as a treatment for Keratoconus.
So here you have it, both very reputable Doctors with two very contradictory approaches.
But to make the point, get an assessment, and have them scan a personal copy for you. In doing so, take those records and shop around. I know of 3 extremely reputable Doctors. Trattler, Lin and Boxer-Wachler. Call each, email your records and see what there advice would be. You will be amazed at the widening of you options and perspective that you'll have available. With those options, research thoroughly and then, make your decision. Like I said, ask me and maybe I can steer you in the right direction.
Ok Let me give you some food for thought. VICIAN TICL..... Remarkable technology for people with Astigmatism. If I'm not mistaken, there is a place there in Ottawa that is one of the very few places that offer this device as treatment for Keratoconus. It is a implantable lens that appears to be minimally invasive and at same time reverse-able. There is another one by the name of VISIAN ICL which is more prevalent as a treatment for advanced myopia. However this ICL version (Implantable Contact Lens) does not provide correction for an Astigmatism. Google/YOUTUBE the VISIAN ICL as there are many short clips and documentation for it. The TICL has not been main stream as yet due to the fact that it is not FDA approved. They are expecting it to be approved by the end of the year, but who really knows.
Beware of irreversible procedures especially if the inherent risks are HIGH. Try to focus on procedures or forms of treatment that offer minimal risk vs Benefit.

I hope this helps my friend.......

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Date: Sun Apr 4 10:40 PM, 2010
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RECOVERY


Day One-Three:

Vision :
Blurry at Best. However, not impossible to move around. If I'm not mistaking, my vision was 20/80 in both eyes. Remember also that with the implant of the bandage contact lens, your vision is slightly better than what it normally is (post Operative). There maybe a change in your medication when the bandages are removed 4 days later-providing on your eyes condition of course.

Condition:
Burning, Itching, "dirty' feeling..... DO NOT RUB OR WASH.... Best thing to do is to adhere to the regiment and also use your lubricating drops. Celluvisc- NO PRESERVATIVES by Refresh was what was recommended.

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Date: Mon Apr 5 8:27 PM, 2010
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Day 4:


Vision:
Still blurry. Not sure of Visual Acuity. Good time to Download Eye Chart. Nothings best than checking up on you own eye's visual progress as the ensuing weeks/months approach. For all you IPHONE users, there is an Eye Chart App in which to down load.

Condition:
Still burning, itching and "dirty" feeling are still present but a lot less. I think Ive become an addicted to using the No preservative re-wetting drops. I think I may be using One - Two Viles per 2 hours. Not sure if the frequency presents itself as being counter productive. Never the less, it does provide a lot of comfort.



Day 5: Bandage Removal (W/ Dr. Trattler- Miami,FL)

Assessment: Eye condition and healing appears to be on par. Surface area (of course) still irritated from the PRK. Vision drops once contact bandages were removed. Not sure of of how much but I would equate it to the paces of people being removed. Most detail at a relative distance had now become a bit more blur. The Infamous GHOSTING was now realized.
No Topos or scans were taken as the results would not have been accurate. Also there were changes made in the medicinal arrangement of my anti biotic drops, steroidal drops, etc. Only addition was RESTASIS. Supposedly an excellent lubricating drop when treating Dry eye. Very Expensive might I add.

Next Visit scheduled for Day 13.




Day 6-13:

Vision:
Ghosting and Blurry. Its very strange. I feel as if my quality of vision has improved. My vision was a lot worse pre op to X Linking. Again, after XLing, Left eye improved dramatically 20/200 to 20/40 However the right Eye was a bit more stubborn. Pre op XL was 20/200-400. the post Op XL 20/100. However so, there s a difference in the impairment of vision. Im not sure how to describe it. Both eyes though worse than 20/40, first of all appeared to have less disparity between the two eyes. Its almost like your vision has improved but yet making out detail is poor. Not sure if this blurriness can be corrected by soft contacts of Spectacle as yet. Tomorrow I have a follow with Dr. Trattler so hopefully there will be a moderate improvement in the healing of the eyes.

Condition:
Eyes still burn every so often. I suppose that this is an indication of your eyes becoming dry since my last instillation of lubricating drops. And there I thought I was using too much. The itching has basically subsided.
Mental health: I think that anyone who appreciates there independence will become frustrated with what is generally experienced at this stage of Post Op. I think that sometimes I have to remind myself that this world is still spinning. Always remind yourself that this endeavor is in effort to achieve BETTER vision and way of life..



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