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Post Info TOPIC: Epi-on or Epi-off? Need Advice! (Dr. Tayfour in Windsor)


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Date: Wed Apr 1 2:36 AM, 2015
Epi-on or Epi-off? Need Advice! (Dr. Tayfour in Windsor)
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Hello All,

 New member here. Recently diagnosed with keratoconus. Left eye is much more progressed than the right eye. I live in the Detroit MI area and the only physician around who performs CXL is Dr. Tayfour in Windsor Canada (see: http://www.wlei.com). This doctor performs both Epi-On and Epi-Off. 

I just had a consultation with him and he recommended for me Epi-Off because my corneas are a sufficient thickness. He said he traditionally only recommends Epi-On for patients whose cornea is too thin to risk removing the epithelium, but ultimately it is up to me. 

I understand Epi-off has substantially more data and literature published with positive results but also comes with more risks (long recovery and pain, hazing, infection, etc). On the other hand, Epi-on does not pose any of these risks but there is not as much data supporting its effectiveness. 

So basically I'm torn. What are your experiences and advice? Thanks!!



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Date: Wed Apr 1 7:01 AM, 2015
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Its a good question and you have got the details right.

You could opt for what your Dr recommends and leve it at that, or you could go for epi on...and if it does not work to treat progression, then go for epi off.

The risk of progression is vastly higher than any of the risks, if your KC has been deemed as the progressive type through topographical and thickness testing done over a duration of time (using the same testing equipment and Dr).



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Date: Wed Apr 1 2:58 PM, 2015
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Hi Wayne,

 

Thank you for the response. Since I was just diagnosed in January I'm positive if or how fast it's progressing since I do not have test results taken over a long period of time. I can tell you that my left eye is substantially worse than my right eye, though.

I agree that the risk of it progressing is definitely worse than the risks associated with Epi-Off. I guess what this comes down to is the efficacy of Epi-on type. It seems you get a different answer depending on who you ask or what article you read. 

My main concern with Epi-Off is enduring a long, painful recovery that will put me out of work for a while. Not to mention risk of corneal hazing (has anyone had to deal with this??) 

Thanks,

Aaron



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Date: Wed Apr 1 9:51 PM, 2015
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Aaron,

Pain does occur on and off for 24 hours (at the most 48 hours), where its at its most at that time, and it gets better after that where the eye just feels uncomfortable but not painful.

Directly after treatment you will feel tired and most of the time you will want to sleep. When you awake you will be well on your way to less pain felt.

The pain occurs when the eye lid touches the area where the epi was removed. In two days most of the Epi should have grown back.

Keep well away from water until your Dr has given you the go ahead to wash your face.

If the eye lid is kept bandaged shut with the use of an eye shield then it will be difficult for the eye lid to move and so cause pain.

You will be given eye drops to reduce pain and given tablets to take.

Epi removal in CXL is not very different to PRK laser which many people have who have normal corneas. Then also there is limited topography guided PRK for KC that some centers also do.

Haze occurs in most people, but some people do not notice it. At one month it should clear sufficiently, however the last remains of haze will slowly fad away over the coming months. This should not affect vision too much.

If you do one eye at a time and do the worst eye first, you should still be able to get around while your treated eye is recovering.

Good luck, Remo



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Date: Thu Apr 2 3:40 PM, 2015
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Aaron, we are facing a similar situation. We are consulting with another doctor for my 17 year old son tomorrow.

This is just my opinion, but I think that is what you're asking. I've spoken to several people who have had epi-on CXL, and plus I have read the posts on this board and on others who have had epi-on CXL. All of the people I had spoken to or read posts about, who had epi-on CXL, were happy with the results. One person I spoke to, whose son had it done 4 years ago, had good results, as the progression was halted. Of course, the problem is that everyone responds differently.

Anyway, I am leaning towards epi-on for my 17 year old.

-Dorrie-

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Date: Fri Apr 3 12:15 AM, 2015
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Hi Remo and Dorrie,

Thank you for the response. I got an email from the doctor's office this morning and the surgical coordinator told me that if the doctor recommended Epi-Off then that is what they'll do. They also said my cornea is too thick to have good results from Epi-On (haven't looked into this much yet, but that's what they told me). So looks like Epi-Off is what I'll have done (only other option is to travel to a clinic that will do Epi-on). 

I think right now the biggest issue with Epi-On is that there isn't an industry standard protocol established like there is for Epi-Off since there isn't as much research data. Depending on what physician you have performing it you may get different results because there are still so many ongoing studies. (This is just what I've gathered from reading articles/talking with physicians). 

You may find this article of interest. It compares the two procedures and the pros and cons: http://www.keratoconus.com/resources/cross+linking+epi+off.pdf 

Has anyone had any serious complications from Epi-Off? It seems that any issues generally resolve in a few weeks.

Thanks,

Aaron



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