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Three Weeks Since Graft and Second Post Assessment

September 14, 2011

Hello everyone! Today, as promised, I thought I’d write a report on how my second appointment at the eye infirmary went. I had two appointments this morning- one to see the optometrist and one to see my consultant Mr Morgan.

So first I saw the optometrist. She asked how everything had been going and I said it had all gone really well- there’s no discomfort and appearance wise the eye looks completely normal. She echoed what Mr Morgan had told me in the past, which is that the vision will take a while to settle, and the reason for this appointment was to see how the eye is focussing at the moment so they can get an idea of how well the vision might be in the future.

She asked me to read the eye chart with just my right eye, and I found that I could read the top letter ‘A’, and just about make out the letters on the second line which were ‘O’ and ‘X’. She then put a pair of those infamous plastic glasses on me which allow different lenses to be placed in them. You all know the ones I mean:

Very attractive(!) So once those were on and a lens was in them she asked me to look at the ‘O’ which was on the second line, and did a series of ‘one, two’ tests, where she basically holds a double sided lens in front of my eye and asks if the ‘O’ is clearer with ‘one’ (the first side of the lens) or ‘two’ (the second side of the lens). I’m sure this is familiar to anyone who has been fitted for contact lenses in the past. After trying three or four different lenses the ‘O’ wasn’t really much clearer. She then tried the ‘pinhole test’, which again most of you are probably aware of, in which a lens is placed on the eye which is completely blacked out apart from a tiny pinhole in the centre. With this I could immediately manage the fifth line of the chart easily and the optometrist said this was how she would have expected it to be.

I later learned from Mr Morgan that this was all to do with Refraction, which involves measuring the eye’s need for corrective lenses. Refraction is all about light rays and how they enter the eye- in an eye with a normal, perfectly curved cornea the light rays entering the eye will be focussed perfectly on the retina at the back of the eye (which contains the nerve layer which sends information to the brain), so that a crisp, clear image will be produced.

Obviously in KC patients the distorted shape of the cornea causes light to be refracted differently on the retina, which is why vision becomes blurry and distorted. It’s also why vision becomes blurrier as KC progresses, because the more ‘cone shaped’ the cornea becomes, the more distorted the light waves entering the eye become and the less likely it is that light rays will be focussed successfully on the retina. People who have had a corneal graft do have a cornea which is more normal in shape, but there is still usually a degree of astigmatism, which is why most corneal graft patients still need to use contact lenses or glasses. As with most things KC related, each patient is different and some grafts will have more astigmatism than others. I suppose it all depends on how good the fit is between the donor cornea and your own and also the skill of the surgeon in making the graft as clean cut as possible.

Mr Morgan said that the reason it takes such a long time for vision to settle after a graft is that the cornea is a bit like an un-ironed T shirt. There are tiny little creases or folds in the cornea, which cause light to be distorted as it enters the eye. These creases tend to iron themselves out naturally over a period of months, but this is why people who have had a corneal graft need to be patient- the cornea takes time to settle into a shape which is smooth and at a stage where the light can be refracted successfully onto the retina. The reason I’m only able to manage the top line on the chart at the moment is because there are a couple of tiny creases right in the centre of my cornea, which is the most important area for refracting light. Mr Morgan said that these should iron out over the next few months and that’s when I’ll start to notice an improvement in the vision.

Again he did a quick examination of the eye and said it looked excellent. He seems really pleased with how the operation went. He also said that I can now go down to three steroid drops a day instead of two, and I can also start exercising again. So it’s pretty much business as usual from now on! I’m due to see Mr Morgan and the optometrist again in a month, which I assume will be quite similar to how today’s appointments went, and we’ll see how the vision is then.

Because everything seems to be going fine and there’s probably going to be less and less to write about, from now on I’ll just write a quick weekly update every Monday on how things are going. I’ll continue to write full reports on how my appointments go, but unless anything major changes I’ll just write a quick weekly post to keep people up to date. Part of the reason I’m writing this blog is to make people feel less scared about having a graft, and even though a short ‘business as usual’ post is probably quite dull, it’s probably also quite reassuring to see that things are going ok!

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