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Post Info TOPIC: My TPRK - CXL experiance at Bochner


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Date: Wed Feb 26 8:55 PM, 2014
My TPRK - CXL experiance at Bochner
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I will start off by giving a little bit of history about myself, and my eyes, then the experience itself.

 

I am a 29yr old male, living in Kitchener Ontario Canada.   I was diagnosed with Keratoconus in 2003 shortly after starting university.  Truthfully, i had not even noticed any vision loss until i went for my drivers exam and my left eye could no longer read the charts (my right eye was still 20/20). 

At first, I did not believe that I actually had Keratoconus (not even knowing what it was then) because a month prior to the vision loss, I got the chemical from a glow stick in my left eye.  I did flush it as soon as i noticed the burning sensation, which went away after 10-20m of flushing the eye.  When i told the optometrist this, he did not believe that the glowstick was the cause of my eye problems, but it was possible.  

After a few months of testing, exams, eye scans etc he fit me with a hard contact in my left eye (which i only wore for a few months).  I then tried soft contacts, but did not get the vision i had hoped so I had a pair of glasses made (BSCVA of roughly 20/70) and left it at that.  I wore the glasses for a bit but again, was not seeing any real gain so i stopped wearing them.

 

For the next 9 years, I would go without any form of vision correction as my right eye was essentially perfect.

Last summer (2013) i started doing research on treatment options and learned about intacts, TPRK, and CXL.  As soon as I read about the TPRK+CXL option I knew that was the option for me.  I booked an appointment with my optometrist to discuss the option with him (and check my eyes since i had not been in to see him in about 7 years).  Unfortunately my optometrist had no clue what TPRK + CXL was, and sent me to TLC in Waterloo.  I had told him they did not offer the treatment, but regardless, went to get the scans and saw the specialist he suggested.  I figured the more opinion I got the better.

From TLC I was sent to a specialist in Toronto who offered to enroll me into a clinical study for CXL (but not combined with TPRK).  I declined, and booked consultations at Bochner in Toronto and Lasik MD in Kitchener.  My appointment at Lasik came first.  They put me though lots of tests, confirming what i already knew, and walked though the entire process of the surgery with me.  However, when they discussed which surgeon would be preforming the surgery I learned that their most experienced CXL surgeon had moved to the US, and that the one now preforming the cxl + prk had only done about 30 of the surgeries.  I was quoted $2,000 for the procedure (one eye only).

I then had my consultation with Bochner.  They used all of the same machines for eye mapping etc, but oddly enough i never had an actual eye exam.  I was then taken up stairs to discuss the surgery (nothing new as I knew essentially everything about it already from my research).  I was quoted $2,700 for the surgery at Bochner.


Ultimately, I decided that experience trumped price / convenience and booked my surgery for Feb 20, 2014 at Bochner (this was in Nov 2013).

 

Surgery Day 0

My appointment was for 2pm, but i was told to arrive at 1pm.  After arriving, I was brought into the back where they used the auto refractor, then the pentacam on my eyes.  Apparently they needed 8 scans of my left eye, (which was not cooperating).  I think we had to do the scan 20 times because my left eye could not maintain focus on the black dot.  (left eye had significant ghosting, so it was trying to focus on two objects). At this time they also went over post op care, and asked if i wanted Valium which i Declined.

I then was then sent to another room where I had assumed to see the Dr/Optometrist.  I saw Dr Stien for maybe 2 minutes.  He looked into both eyes quickly, said "no signs of scars".  "thats good", "we can help you" and then left.  

Next I was taken to pay for the procedure, and asked a second time if I wanted Valium which i declined again. (I told the lady i had been waiting for this for 8 years, i will be ok)

I then was taken down stairs to the laser room and told to lay down on the bed.  Freezing drops were put in my eye, and then the tech started calibrating the machine (this took 5-10 minutes).  Dr Stien finally came down to the room and started talking to the tech (not about my surgery about something else).  The laser gaurd was moved, I was told to stare at the red light, and then we started.  Dr Stien held my head, brushed my eye, ect and in what couldnt be more than 2m i was all done.  Worse part of the procedure was the bloody thing in my eye holding it open the whole time.

Next we went up stairs where a tech preformed the CXL.  20 minutes of drops in the eye every 1m, then 6 minutes staring at the UV blinking light.  I tried to talk to the tech BC i felt bad, but ended up just zoning out for most of the process.  One thing I did notice, was every time a drop went into my eye, it could see almost perfectly for a second or two, but then quickly went back to terrible.  Again the worst part was the object holding my eye open, (and of course the boredom)

After the CXL was done, they put the bandage lens in my eye and i was taken back down to see Dr Stien (again for 5m) where he checked the eye, said all was good, gave me a box of chocolates and said im free to go after i book the follow up appointment.

It was now about 4:00PM and we were in the car ready to go home.  Unfortunately due to traffic, weather and bad drivers, our 1h10m drive home took roughly 3 hours. The tech had told me the freezing drops would wear off about 1h after i left Bochner, so i was starting to worry about pain setting in.  At around 5:30 I still wasn't in any noticeable pain so i decided not to take the Tylenol 3 until we got home (7:30).  My eye was dripping tears and my nose running the entire ride home.  Luckily however, there really was no pain, just irritation (contact lens in eye?)

When i finally did get home, I decided against the T3 meds, and avoided bright lights.  I was not in any pain (again just irritated by what i thought was the contact) so i covered the left eye and watched some TV etc.

Day 1

Woke up with my eye stuck shut (dried tears).  After my wife left for work, I was a bit bored as my appointment was not until 1:30.  So I sat around the house being lazy surfing the internet and watching TV.  Again, at this point I was in no pain at all, and just irritated by the contact in my eye. (on a scale of 0-10 i would rate the pain between 0 and 1 and the irritation a 7).

My ride picked me up and off to Bochner we went.  This time I was sent upstairs to a different department and had an optometrist check the contact and my vision, which was still horrible.  I could hardly read the big E (20/200 i think).  

My next appointment was booked for the 25th (bandage lens removal) and off I went. 

No vision improvement that i can see.

 

Day 2, 3 & 4

There really isnt much to say about these days.  Other than extreme light sensitivity (my eyes have always been sensitive) I stayed in side most of the day, watched some tv in the basement and for the most part had an uneventful weekend.

Monday I went back to work as I was essentially fully functional other than post op care instructions i had been given (shower with eye shut etc).

No real vision improvements in these days.  Everything is still fuzzy (and worse than pre op)

 

Day 5

Bandage lens removal day had finally come.  I was starting to get sick of the contact in my eye.  Arrived at Bochner at 11am, and was gone by 11:15.  They took out the lens and preformed an eye test and a "pinhold eye test?? where you look though a pinhole and read the chart"

I could read one line below the E, and multiple lines below with the pinehole.

Vision still seems worse than pre Op, and with the lens out, i "think" vision is worse than with the lens in.

 

Day 6 (day of this post)

Vision is still bad in the eye.  Probably worse than yesterday but again it is hard to tell.  At least the bandage lens is no longer causing discomfort.  I have been using artificial tears frequently to reduce itching sensation.

 

 

 

 

 



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Date: Wed Feb 26 9:06 PM, 2014
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In case anyone is interested, I am posting all of my scans that i have.  (from 2003 and 2013).  The only one I don't have is the one from the day of surgery.

A couple interesting things to note is that the my eyes were not really showing much sign of progression (when you consider this is over a 10 year time frame AND taken on different machines which means some variance is expected.

 

Another interesting point was that when the optometrist sat me down and tested me for my prescription, it was almost identical to what my old glasses were. (they said migh tbe a 0.25 difference in the lens). 

 

When Bochner does another scan I will ask them for copies.

 

One thing that truly surprised me about Bochner was how fast they get you in and out and how little time you actually spend with a Dr.  I was warned by a few people that LasikMD would use pressure sales and feel like a fast food restaurant, however at the end of the day I feel i got the same treatment at Bochner.  Dont get me wrong, I have nothing against the no hassle, quick process I just thought they would be more personal.  At the end of the day it really doesnt matter as long as the results are good, and unfortunately it is far to early to even guess what they will be.



-- Edited by Smilloy on Wednesday 26th of February 2014 09:07:50 PM

Attachments
12.02.2003.OD.pdf (196.9 kb)
10.20.2003.OD2.pdf (198.6 kb)
10.28.2003.OS.pdf (203.3 kb)
12.02.2003.OS.pdf (186.0 kb)
10.20.2003.OD.pdf (198.4 kb)
10.28.2003.OS2.pdf (200.3 kb)
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Date: Wed Feb 26 10:21 PM, 2014
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Smilloy, Thanks for posting your story, its very interesting to read. The chemical that went in to your eye, do you know what its called ? it maybe that its caused a kc-like condition...or it may mean kc could be caused by chemicals such as that which went into your eye.

I hope healing is speedy for you. Please do read through the other story's on this treatment from others, you will see that the settling down of the cornea is slow but it is steady. I hope you get some comfort from reading through their patient story's.

Megan



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Date: Thu Feb 27 12:28 AM, 2014
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Hi Megan,

No I do not know specifically what the chemical was.  Only that it came out of a glowstick, and burnt when it got in my eye.  (I had it on my hands unknowingly, and wiped my face).

Every specialist that i have seen, said that the glowstick, is a "red herring" and did not cause the problem because there is no scarring on the eye.  I guess their thoughts are that if the chemical caused damage, there would be evidence.

With that said, I still find it hard to believe, because of a few facts.

1. I had an eye test 1 year prior to the eye exam that noticed the problem in my eye. Went from 20/20 to 20/100-200 (not sure exactly, only that it was above the driving minimum. Everything I have read says KC typically starts out with one requiring glasses, then constantly changing prescriptions until finally the Dr figures out what it is.  I know there are special cases, but I went from essentially 20/20 to BSCA 20/70 in 1 year time.

2. Was noticed 3 weeks after glowstick issue.

3. No significant progression in the 10 years following diagnosis. (again not typically of KC).  Same prescription 8 years later thats almost impossible.

4. Only one eye is bad.  Yes my right eye has KC, but its been stable for 10 years at 20/20 or better (very minor starbursts).

I know there are exceptions but typically KC onsets, progresses and effects both eyes.  

 

Personally I wonder if I had very minor KC (non progressing) and the chemical incident somehow "aged" or sped up progression while it was in the eye, then stopped.  It sounds crazy, but if CXL (Riboflaven) can lock a cornea in place, perhaps a different chemical can "unlock in"

Of course this is my theory, and goes against my Optometrist, 3 cornea specialists, Bochner and Lasik MD's professional opinions.  But with that said, not one of them had ever heard of someone getting a glow stick liquid in their eye (one of the surgeons though I said Goal Stick haha).

 

Regardless of all that, the symptoms, vision quality and cornea maps show KC, so the CXL / PRK was the only options.

 

 

I did read almost every other story on this board before I scheduled my appointment.  I would have booked it regardless of what I read, but I wanted to be ready for all outcomes.  I know the results are long term and was expecting it. I guess you just hope you will wake up and see clear one day haha.

I went into the surgery saying, IF they ONLY reduce the halos / multi images i get at night, i would be totally happy any vision improvement is a bonus.  



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Date: Thu Feb 27 5:20 AM, 2014
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There maybe a weakened cornea involved or sub-clinical kc or even what i call "20/20 KC" and a trigger that causes the advancing of the "cone".

This seems to be "trauma" of various kinds. Usually eye rubbing is suggested and contact lenses rubbing on the eye...however this could well be a chemical/irritant.



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Date: Fri Feb 28 3:06 PM, 2014
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Day 7 (1 week)

No real vision improvements yet.  Ghosting is still bad, and vision is blurry.  I cant tell if its gotten better, or worse.

 

One thing that I did notice at night, was that if i held something with text close to my left eye, it would become perfectly clear at about 3-4" from the eye.  Doing the same test with my right eye anything close than 8" started to become blurry.

Not sure if means anything, but i did find it odd that each eye had a different distance for best focus.  Perhaps it is because the left eye has not healed fully.

 

Day 8

It is possible my vision is slightly better this morning.  It is so hard to tell, but it feels like today, it is back to where it was last week before the surgery.

Still lots of ghosting around objects.

 

Another thing to note, which I hope is a good sign, is that the ghosting i see now, more regular.  It is hard to explain, but when i see multiple images now, they are almost in a uniform circle around the focus object. (IE LED Light in dark room).  Before surgery they were fairly irregular.  IE 3-4 top left, 5 bottom right and a few to the sides, and ALL different distances away from the primary object.  I think this would be a good sign as the Dr said as the eye heals, that ghosting should slowly get closer and closer to the main object.    I suspect even if i do keep some ghosting having a uniform pattern is better for correction with glasses than the irregular one. 



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Date: Mon Mar 10 2:08 PM, 2014
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Day 18

Up until this point there has been little if any noticeable improvement in my uncorrected vision.

Two weekends ago (day 9/10) I was outside and could basically read a stop sign (with significant ghosting) which did seem like a small improvement.

 

 

This morning however, there seems to have been some change.  I can now make out letters / numbers that i could never see before.  There is still lots of ghosting, and i see multiple of the same image, but one of the ghosts is getting clear enough to make out letters.  IE i could see the numbers on my car speedomedter this morning on the way into work with my right eye closed.  Of course this isnt very useful as it is still very blurry.

 

Hopefully this is a good sign that the image is starting to get crisper and the Ghosting will go away.

My biggest hope going into the surgery was that the ghosting would be minimized, (which so far hasn't happened).  Right now it is worse than pre op, but from what everyone says this should slowly be reduced.



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Date: Tue Mar 11 1:01 PM, 2014
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Yeah, I'm at almost 8 weeks now and still have a lot of ghosting. It has gone down from what it was - the ghosted images are a lot closer to the "main" image now, but it is still enough to be frustrating.

Reading online, it seems the ghosting for most people is still around to some extent until at least 4 months post-op. So, still a ways to go.

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