Since Sunday, I've had very little pain or discomfort in the left eye and it looks much better. Yesterday (Wednesday) the eye seemed a bit scratchier than normal but that could have been because of the eye lash stuck there, which Dr. Holland kindly removed today. Work isn't really a problem at all, and things are relatively back to normal.
Which brings me to the doctor visit today. There was an unusually long wait today for some reason. My eye appointment was at 9:10am and I didn't leave the office until about 10:45am or so. Dr. Holland is a very popular guy. The first resident I saw tested my eyes against the chart and noted marked improvement over last week. With the "pinhole" device I was able to read down a few lines on the chart. Keep in mind, this never would have been possible before. The fact that I can read anything at all is really quite a miracle. Just after wetting the eye (and if I focus hard enough) I can actually read book text at a reasonable distance from my eye. However, as the eye heals I can expect my vision to get slightly worse and then (hopefully) improve to a stable state. We also noticed my eye pressure had gone up just a bit.
Dr. Wang came in next and chastised me for not having gotten my Restasis. It had been held up in insurance approval and had just been released to me a few days ago. Honestly, my eye felt so good I just forgot about getting the Restasis. After all, the description said it was a medicine to make your ears tear up, and I already had wetting drops, but Dr. Wang assured me it was critical in against rejection. I hope I have not set myself back, but I don't think so. I have been religious about my eye drops and have been very protective of "Pablo." Anyway, Dr. Wang seemed happy with the progress.
Dr. Holland came in next and gave me a once over, also declaring his pleasure at my improved status. He (and Dr. Wang) said that the heightened eye pressure was likely a reaction to the Durezol, which is a steroid. Dr. Holland gave me a less-powerful steroid called Omnipred to see if that would help.
I go back in two weeks, and I hope to post some data on my improvement.
Here is my eye just a couple days after surgery. You can see the stitches to the graft. Looks messy, huh? I'd say my eye looks pretty pissed off right now.
Not much to report other than the pain and discomfort have decreased considerably. Friday, I stuck to my plan, foregoing any caffeine products and staying indoors. Had pizza delivered and caught up on some freelance writing work. I still could not keep my left eye open for long, but by the time I went to bed I was not bothered at all. Taking Tylenol in the evening helped a great deal.
Saturday, I woke up for a few hours in the morning and promptly took a nap :) Apparently, I had not been sleeping very well because this nap was very deep and well-needed. I actually dreamed and woke up refreshed. After a few minutes, I realized that I could keep my eye open with absolutely no problems! I have been religious with my eye drops and have tried to close the eye as much as possible just to keep it rested.
Today is much the same as yesterday, although the eye seems considerably more dry. Not as sensitive to light as previous days. I'm having coffee so that I can knock out some writing, and I'm not noticing any considerable discomfort. As coffee tends to dry me out, I expect to be using a lot of the wetting drops today. My vision has not changed. When I put in eye drops, the liquid allows me to have spots of clarity that are quite remarkable, but mostly things are still blurry.
I expect to see steady improvement over the next 6 months to a year. As long as the discomfort goes away and I can carry on with daily activities then I don't mind being patient. Thankfully, I'm very good about things like this, long-term-projects, so any problems I have with the eye will not be because of lack of attention or care on my part. I even have some safety goggles to wear for yard work and house work just to keep the eye clean of dust.
Physically, the eye looks much improved. Still a little bloodshot (from the Vigamox too) but otherwise looking pretty good.
Last night was rough. I managed to take a shower before bed, which wasn't as hard as I first thought it might be. I washed my head, ears and neck in the sink and used baby wipes on my face. While in the shower, I didn't have any problems keeping my eye closed tightly enough to keep the water out. Sleeping, though, was a different story. Even with the Tylenol, I was in a lot of pain trying to sleep. I could not adjust my plastic guard so that it wasn't hitting my eye lashes ( I have long eyelashes for a guy) and so I was constantly irritated. Under my eyelid, all sorts of things seemed to be going on. Itchy, scratchy and twitchy. There were throbs of pain now and again, and I found the only relief was when I kept absolutely still and tried some mediation techniques to take my mind off the pain. In this state, I kept having strange thoughts as if my eye was actively trying to reject my cornea while I lay there. It was quite horrible. After an hour, I did get to sleep. Woke up at 4am, put my drops in and slept for a few more hours.
Let me just say that I think there were a number of things that contributed to last night's pain. I had been out and about a couple of times that day, and so my eyes were moving all around in direct sunlight, being agitated. I also had a large cup of coffee in the middle of the day which I think made me hyper-sensitive. Not a good idea.
Today things have been much better. Both eyes are sensitive to light, but I have been taking it easy and resting between working. I actually managed to work for a full day today going at my regular pace. It most certainly helps that I work from home on my computer. I can't say how lucky I am there. I would hate to have had to take off work for several weeks for this.
By the way, for those who don't know me. I'm 40 years old, and no, I don't know who the donor of the cornea was. I simply call him Pablo (might as well have fun with this). Apparently, there is a cornea bank in the US so I did not need to wait for a donor. In fact, I think these operations are becoming quite common, and I don't think anyone has to wait. Another big advantage.
I wanted to post a picture of my eye for those who want to see, but I don't want to link it from FaceBook as some people might find it pretty disturbing. Yes, it is pretty gross but also fascinating. You can see the ring around my eye where the new cornea was placed, and the stitches. Compared to other recovering DALK patients, my eye looks about normal if not a little better that most.
I'll go over my eye drop routine. 4 times per day I take a drop of Durezol (steroid), Vigamox (anti-bacterial) and some over-the-counter wetting drops called Optive. The only one that is tough to take is the Vigoamox. Stings like hell. Hopefully I only have to take that for a month or two. Aside from dark places to hide, another thing that sometimes helps is just stretching my eyelid up and pulling down on the skin of my cheek. Not sure why that is, but it just feels good. Careful not to touch the eye though.
The milky haze has gone from having a yellowish tint to a more clear tone. Everything is still rather blurry, but I thought it was incredible walking around my house with just my left eye open. I could make out colors and shapes very easily and could even read some of the print on the television while standing in the hallway. I find that when I really strain hard I can make out a good deal more, but when I do that it is usually followed by a dull ache in my eye. So...just going to give that a rest for awhile.
All things considered, I think it's turning out pretty well. After reading other DALK patient blogs, I know I have a tough road ahead of me filled with a lot of ups and downs. But already, I see better. My new strategy ongoing is to lay off the caffeine products and start taking the Tylenol in the evening, so that when I'm ready for bed I can actually get to sleep.
More to come....
Slept really well last night. Actually, sleeping is easy compared to fighting the scratchiness in my eye. Took my eye drops, taped on my plastic guard and dozed right off. Dr. Holland said I can sleep in any position as long as wear my protective guard, which is a relief for me because I sleep primarily on my left side.
The double vision from last night is completely gone. Apparently, it was from the long block anesthetic they used. So now my eyes see everything together at the correct angles. No change in vision. I can see peripherally in my operated-on eye with no floaters, dark patches or spots. When I hold my eye wide open, I can look around and see that everything seems uniform. It is cloudy, but uniformly so. I think this is great because that means that the cornea must be positioned well.
Had my follow up visit with Dr. Holland today @ 9am. I put in some eye drops and we were on our way. I could hardly open my eyes outside. It seems like heat and light really make things worse, and both my eyes were watering profusely on the way there, especially the effected eye. I basically carry around tissues wherever I go. Once inside the air conditioning, things were much better. In the waiting room, I could read the big print on magazines (which is pretty amazing) and could even make my way around the room with my good eye shut. I can see shapes, people, colors...just all through a cloudy haze.
Inside Dr. Holland's office, several people stopped in to see me. One resident, a tall blond, looked at my eye with a light instrument, the kind that is common in optometrist offices. As she passed the light over it, all she could say was "that looks beautiful." She could see my eye still watering (seriously, like crying) so she gave me some numbing drops. OH BOY! With the numbing drops in, I was able to fully open my eye and look around. I have a really good feeling about the end results...although I still have a very long way to go.
Then Dr. Holland and Dr. Wang came in to check on me. They both passed light over my eye and commented that it looked great, and they seemed very happy with the turnout. They sent me on my way with an appointment next week.
I tried working a bit today. As a computer tech, most of my time is spent on the computer. This really isn't an issue because I can just keep my left eye shut and use my right eye to work...heck, I haven't been using my left eye for 20 years so really no difference for me. However, as my left eye moves against my eyelid, it creates constant irritation. So bad that I had to take several long breaks. After Michele went to school, I took a chance and drove to Kroger to get some Tylenol. Again, not much different than before except that it looked like I was crying the entire time. I'm sure I looked funny, squinting and tearing up at the register.
I'm positive I will not be leaving the house this week-end. I just want a nice, dark hole where I can heal. The less I look around at things the better. Watching TV is fine as is reading. I still keep my left eye shut most of the time though. I tried to rig up something to go over my eye that would hold it shut, but it just rubs up against my eye harder.
More to come soon....
I got to St. Elizabeth surgical center at noon and was called in shortly afterward. I want to say that Dr. Holland and his staff were all efficient and personable, making Michele and I feel comfortable. While we waited, various personnel came in to double-check my information; they asked me to verify the eye scheduled for surgery about 20 times, which I found reassuring. Dr. Holland even signed my left eye so there would be no mistake.
I'm not going to say I wasn't nervous, because my stomach was doing flip flops. Ultimately though, I needed to do something about my horrible left eye. I'd been seeing 20/100 from that eye for the past 15 years, which left it all but useless aside from getting some peripheral vision from it. Many of you scheduled to have DALK will be more interested in the procedure, so let me get straight to that.
They used a local anesthetic to knock me out so they could "block" the area. This means that they gave me one shot in the temple (not actually very deep) and one between the eye and cheek bone so that the entire area would be completely numb and immobile. Neither of these I felt because I was out cold. They woke me up a few minutes later and pushed me into the operating room. It was on!
I was awake during the entire procedure but extremely relaxed and sedated. At first, I did not like the idea of this but it was somewhat necessary according to their procedure. This isn't quite as bad as it sounds, but I'm not going to lie and say it was easy. During the procedure, I saw mostly an oval of bright light and some shadows in the operated-on eye. I felt pressure but no pain when the old tissue was being removed. During the suture phase (I received 16 sutures) I felt faint pricks and the pressure of the doctor pulling them through. I'm usually pretty wimpy about this kind of thing, but I think I handled it pretty well. The thing that got me though was that as they were packing up and finishing the procedure, someone said they were going to give me something for the pain, and I received (I think) another shot between the eye and cheekbone. That was a bit of a surprise and hurt like hell to be honest.
They put me into the recovery room and already I was feeling much better. They put a patch on my eye, gave me some do's and don'ts and let me go out the door. Regarding the pain factor, I can only say that the eye feels (and continues to feel) very scratchy and aches a bit. It is nothing out of the ordinary, but it is fairly annoying. I can tell this scratchiness is going to be frustrating for me over the next few days, even with the pain-reducing eye drops.
Two hours later I removed my eye patch and put in some eye drops. How's my vision? Well, sitting here watching the Reds game on a big screen TV, I feel like my vision is going to end up being great. When I watch the game through my operated-on eye, I can actually see the names on the back of the players' jerseys and can almost read the tiny score on the screen! I could NEVER do that before, not even with my glasses on. The only problem is that everything is very cloudy, and the image seems to be "low" so when I look with both eyes I have severe double-vision...this is likely because the drugs they used to immobilize my eye have not worn off yet. No floaters, no bubbles or dark patches. Now I just have to fight very watery eyes and scratchiness. I hope the eye stabilizes soon.
I have to tip my hat to Dr. Holland and his staff. If my vision improves and clears up (and I think it will) it looks like I'm going to have amazing overall vision. Stay tuned for more updates!
History
I scheduled eye surgery two months ago to replace the topmost layers of my left cornea. The procedure is called DALK. Of all the corneal procedures, this one is the least invasive and has the highest rate of success (95%) for my condition, Keratoconus. This is something I could have had done several years ago, but was a little skeptical of the results. Now, being 40, it seems I better just go ahead and do it so that I can have good vision for the next several years.
I picked up 2 of my eye drops today, Durezel and Vigamox, while the third one remains caught up in pre-certification. I'm a little nervous about the surgery, as anyone would be, but I hear Dr. Holland is one of the best at this, and so I’m confident I'll be seeing pretty well in a few months.
