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Post Info TOPIC: Keratoconus and Cataracts


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Date: Sun Aug 10 3:37 AM, 2014
Keratoconus and Cataracts
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Hi,

 

I was wondering if there is anyone else here who suffers from Keratoconus + Cataracts? I've been diagnosed with both and my Ophthalmologist wants to do surgery to replace my lenses. He also mentioned installing INTACS.

 

If you are dealing with both conditions, what has been your experience? Any response would be helpful, thanks.

 

Michelle

 



-- Edited by MichelleKT on Sunday 10th of August 2014 03:37:36 AM

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Deb


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Date: Sun Aug 10 6:23 AM, 2014
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Michelle,

I do not have experience of this however everyone will get cataracts if they live long enough, and therefore we all will be in your shoes at some point!

These days there are so many cataract implant lenses around that there is lots to chose from to correct various types of astigmatism, long and short sight as well.

There is even now the "light adjustable lens" which can be fine tuned after it has been implanted.

Having cataracts may well mean your KC vision could be made better as well, so be hopeful and do your research on the treatment providers and the options.

Having implantable lenses of any kind is only really an option if your kc has been deemed to have pretty much stopped progressing. This might be through age or with the use of the crosslinking (CXL) treatment.

Sometimes it might be thought that your cornea will need more flattening/become more regular with the use of Intacs, but be sure to ask about Crosslinking as well.

Debby

 

 



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Anonymous

Date: Fri Feb 6 10:32 PM, 2015
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I am 66. I was diagnosed with KC at about age 20. For a long time it was thought to be monocular, left eye only. However, with better corneal topographers and an opthamologist specializing in KC, it was identified that the right eye also had mild KC when I was about 45. While I tried contact lenses for about 5 years circa 1978-1983 I was never very happy with them. I have been wearing only glasses since then.

About 2 years ago I started to notice an increase in vision problems of the type associated with KC. However, the optometrist was unable to achieve a good correction with glasses. I went back to the opthamologist specializing in KC, whom I hadn't seen for about 10 years. He informed me that it was cataracts that were causing the vision problems, not my KC which was actually slightly improved since he last saw me.

I had the cataract surgery in my left eye a week and a half ago. They implanted a toric lens, which is against the manufacturer's recommendations for KC patients because it precludes the use of contact lenses to treat the irregular astigmatism in the future. In my case, the KC is centered off the optical axis and fairly "tight" so my doctor felt the toric lens would work with the topology of my cornea. Since I have managed without contact lenses for 30 years, I didn't see much chance I'd want to try them in the future. 

So far the vision in my left eye is about 20/100 uncorrected and 20/40 corrected with glasses. Uncorrected vision in my left eye is now much better than my right eye, which hasn't been the case for a long, long time. I have also gone from near sighted to far sighted (by choice).

They will do my right eye at the end of this month. Since the KC is less advanced, the hope is to be able to do an even better job of improving vision.

They did not do limbal relaxing incisions (LRI) because they didn't want to disturb the stability of the cornea beyond what was necessary for the cataract extraction.

The selection of the interocular lens (IOL) is a bit of guesswork because the KC throws off the measurements used to select the IOL. Operating on the KC compromised cornea also makes this a more complicated cataract surgery. For these reasons, I'd recommend trying to find a corneal specialist who works with KC on a regular basis and has experience doing cataract surgery on compromised corneas.

Just as with other things like contact lens fittings or prescribing glasses, most doctors and optometrists will profess that they understand how to work with the KC patient but, as I am sure most of us know, there are only a few who have really worked with KC enough to be good at it. 

As for the question of Intacs, my feeling is that you want a stable cornea before you do the cataract surgery. I'd be reluctant to do Intacs followed too quickly by cataract surgery, It might be tempting to do both together so all the surgeries can heal together. But I think that would make the selection of an IOL very hard. Do you have a good record of corneal topography so that the stability of your cornea can be assessed? How much experience does your opthamologist have in dealing with KC and cataracts together? You do have to put a lot of trust in your opthamologist because doing cataract surgery in the presence of KC is as much art as science. If you don't have access to someone with much (any) experience doing cataract surgery on a KC patient, then I'd opt for a simpler procedure, e.g. conventional IOL, rather than trying to push the envelope. If I could only pick one attribute for my surgeon it would be someone with a lot of experience who had a very deft hand with the surgery to minimize the trauma to the cornea.

I think you will be pleased with the improvement in your vision when the cataract is removed. You'll still have KC but you probably don't realize how much additional visual impairment the cataracts have added.



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Anonymous

Date: Mon Apr 20 8:40 PM, 2015
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I have now had the cataract removed from my right eye and I am about 1 1/2 months post surgery in the right eye. As promised, the cataract surgery gives you the vision you had when you were 40 years younger. Unfortunately that was right around the time when my KC really became evident and I started the years long process of trying to find a visual correction that I could live with.

The result in my right eye, where the KC is more mild, is quite good. The clarity of my distance vision is very good. I feel comfortable driving without any corrective lenses although the motor vehicle department would probably want something done for my left eye.

Before plunging into the details, I stand by my original summary: Removing the cataracts will dramatically improve your vision but you will still have KC. I will add that after your cataract surgery you will likely have to rethink how your KC will be managed. That might mean going back to square one with KC depending on what you are doing now. You might be in a better or worse place with regard to managing your KC and there probably isn't a way to predict which situation you will face. 

My left eye now has poor vision in comparison to the right eye, which is what it was before the cataracts. Because of the difficulty in determining the necessary IOL power, I was left a bit hyperopic (far-sighted) in both eyes, more so in the left. Most people with KC, myself included, are myopic (near-sighted), some quite drastically. My myopia was moderate. An overnight change from myopia to hyperopia is jarring. Hyperopia is miserable because nothing is in focus at any distance. It is an undesirable result for any cataract surgery. For this reason, the goal of cataract surgery is to leave you slightly myopic. In my case, the difference in refractive error between the eyes is borderline for correction with glasses because the image in the left eye is enough larger than the right eye to make fusion of the images difficult (anisometropia).

At this point my main options for the left eye seem to be a contact lens, an implanted second lens, or IOL replacement with a more plus lens. We've been experimenting with conventional soft contact lenses. Yes I know, completely against the conventional wisdom. 

My initial recognized symptom of KC was monocular diplopia (two images with one eye). My shifty refractions before that were an unrecognized clue. As my KC progressed, the diplopic images became sufficiently defocused that my brain could pretty well suppress one of them and I elected to just use glasses. In my case, there really are just two images in each eye. In the right eye, one of the images is secondary, faint, and not too far displaced. It is easily suppressed and doesn't cause too much degradation of my vision. In the left eye the two images are about equal in strength and separated enough that I can read either if conditions are right. They focus at different distances so it is almost like built-in bifocals. I suspect the toric IOL has corrected my left eye to the point where both diplopic images are pretty clear with a spherical correction. The question now is whether a conventional soft lens can be used on my left eye to reduce the anisometropia sufficiently that I can wear reading glasses for critical close work where my right eye would be dominant, use my left eye for non-critical close work as a sort of monovision, and have driving vision either with or without the contact lens. 

A side effect of the hyperopia is that it seems like I will need about +3D in the left eye and that makes the contact lens thicker in the middle than if I needed a negative lens for myopia. Silicon hydrogel soft contact lenses are stiffer than the older, regular hydrogel lenses. I am now doing a trial with an Air Optix Night & Day Aqua lens, which is the stiffest conventional silicon hydrogel lens commercially available. The question is whether the stiffness and thickness will be enough to start to approach what could be done with a specialty soft contact lens for keratoconus. It seems like the specialty lenses provide more extreme backside geometries to vault the KC cornea and increase the thickness to increase rigidity. If I can get by with the conventional lens the advantages will be easy supply, lower cost, and the possibility of extended wear of up to 30 days without having to take the lens out.



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Date: Wed May 20 7:53 PM, 2015
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Hi, this is Anonymous, only now slightly less so.

The Air Optix Night & Day Aqua lens was not enough to do anything for the ghost image. The cataract surgeon provided a copy of my topographies to help with the CL fitting. I have a low cone that is about 56D at the peak of the cone. I think that is rated a moderate cone, although toward the upper end of that range. We did a fitting of a Kerasoft IC on the left eye and, surprisingly to me, that did seem to eliminate the ghost image. Visual acuity was 20/25-. An interesting benefit of the Kerasoft IC in my case is that it drapes over the eye and thus picks up most of the corneal shape rather than masking it the way an RGP would. Therefore, the corneal astigmatism is still present and corrected by the toric IOL. If an RGP was fitted, it would need a toric correction to neutralize the toric correction of the IOL because my eye is no longer "set up" for the spherical front corneal surface that an RGP would typically provide.

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