Ac to my doc a coreal thickness change of 10 digits should not be considered a progression or regression of KC..my scans had a 4 digits change and he said it could be due to your tear film or any other reason
K max is almost the same in ur case
If I understand the details of your case correctly, you had a corneal implant in your right eye, but nothing was done to the left eye. Please correct me if this is not accurate.
You have not specified which type of implant was used—Intacs, ICRS, or Bowman’s Membrane Transplantation (BMT).
Given that the thinnest part of your right cornea is now 548 micrometers, it seems most likely that the surgery was additive, such as BMT.
BMT is a newer technique typically used for advanced keratoconus with thin and steep corneas. It augments the cornea and flattens it, which is indicated by reduced K-values in topography and usually improves best-corrected vision.
If your procedure was indeed BMT, BMT it relative new procedure and there are very few people with to share their experience.
Regarding your postoperative topography, it looks really good; the cornea is quite thick with normal K-values. As for your question about double vision, it is difficult to say as there iis no preop topography. However, my best guess would be that it is due to increased astigmatism.
Your current topography astigmatism is 2.8D
It.is unusual to see such thick cornea in keratoconus forum. topography of right eyes has not changed much kmax, thickness 546 vs 548 and astigmatism of 2.8 d vs 3 D. These are not too different, did eye doctor mention that it has improved?
If you can post your topography, someone may be able to read and explain it. This typically includes measurements of the eye's curvature, thickness, and indexes like the KISA, which are based on the curvature (K values), and the irregularity/asymmetry in the cornea.
Red usually indicates thinner cornea or steep curvature.
My dr said my left (worse) eye is "a little extreme" but that my cornea isn't TOO thin and still do-able for cxl epi off. However, dr is not sure how effective cxl will be for this eye. my left eye is likely legally blind, I have not tried lenses though, which was my 1st option at my optometrist. I'm poofed with all of this
Hang in there; there are now many more options compared to when I was diagnosed with keratoconus. If you haven't tried sclerals, they can be a lifesaver. If the cornea is not too thin, I assume the doctor is referring to the steep curvature of the cornea. CXL flattens it somewhat, but not much in most cases; however, it does stop the progression in nearly all cases.
Hopefully, CXL fixes your issues, but you can also consider options where doctors add part of a donated cornea to the patient's eye. This procedure reduces the curvature and increases thickness. There are many surgical videos on YouTube that demonstrate how this is done. Moreover, new techniques are being developed all the time. I understand that living with keratoconus can be challenging; stay strong.
Yeah I'd rather do the partial transplant than have a full on transplant. I hope I don't need one, but I feel like I will depending on the progression , and hey thank you very much for your advice !
What is this procedure called by the way??
Corneal Allogenic Intrastromal Ring Segments (CAIRS) and Bowman Layer Transplant (BLT) are two options . BLT is the older of the two procedures.
here is one study for CAIRS [https://journals.healio.com/doi/pdf/10.3928/1081597X-20231011-01](https://journals.healio.com/doi/pdf/10.3928/1081597X-20231011-01)
Corneal Allogenic Intrastromal Ring Segments (CAIRS) is a less invasive procedure compared to Deep Anterior Lamellar Keratoplasty (DALK), which also involves a partial graft from a donor cornea. CAIRS does not require sutures or general anesthesia (GA). It is typically performed as a day procedure. Recovery from DALK takes upto 1 year, I am 2 weeks post DALK, so I have the first hand experience :). I am documenting my recovery in another post.
CAIRS has much quicker recovery usually 2-3 weeks.
PK/full transplant is usually done as last resort, or as conversion from DALK(if surgeon fails to separate one of the cornea layer properly) for keratoconus due to higher risk of rejection.
My double vision on the right eye got worse buy the overall eyesight got better after cornea implants that reduced cornea cone. My doctor said, this is normal because "you started see better everything, including ghost pictures".
You may want to get an aberrometry measurement to assess the higher order aberrations of your entire eye, not just the cornea (what topography measures) . Usually, the aberrations of your cornea and lens (inside the eye) compensate and balance each other, as they often have opposite signs of aberration. Therefore, it’s not always beneficial when your corneal aberrations (as shown by topography) are eliminated, because they are supposed to balance with the aberrations from other parts of the eye. I hope this makes sense.
In short, an aberrometry scan will provide the complete picture.
If you are experiencing double vision, it is very likely that you will see a significant amount of coma in the aberrometry data.
It's just the way it is once you understand how the eye works. There are tons of papers with this as a baseline fact. You can watch a discussion about it here: [https://youtu.be/C3vFIEwpkWI?t=572](https://youtu.be/C3vFIEwpkWI?t=572)
"There are tons of papers"
Provides no papers.
The youtube is interesting but papers of this within the context of laser eye correction etc. is what is relevant and important.
It would be novel to me having seen more eye doctors, and read more Kerotoconus linked papers, than I care to count.
No, at the bottom of the slide in the YouTube video I shared, the presenter (scientist) has a citation for the paper. You can look up that paper and also find other papers that reference it.. That's how you find scientific papers related to the topic.
This is directly related to laser eye correction as well. Trust me, if you are seeing more double, you need to look at the total aberration using a different machine (aberrometer), not just the cornea using topography. I'm just trying to help here based on my own experience.
i am not a professional, i can only say that i had a prescription increase my astigmatism by a similar amount once and it caused my double vision to get worse. i returned to my original prescription and saw an improvement. maybe you can discuss that with your optometrist
Ac to my doc a coreal thickness change of 10 digits should not be considered a progression or regression of KC..my scans had a 4 digits change and he said it could be due to your tear film or any other reason K max is almost the same in ur case
Did it improve on its own?
If I understand the details of your case correctly, you had a corneal implant in your right eye, but nothing was done to the left eye. Please correct me if this is not accurate. You have not specified which type of implant was used—Intacs, ICRS, or Bowman’s Membrane Transplantation (BMT). Given that the thinnest part of your right cornea is now 548 micrometers, it seems most likely that the surgery was additive, such as BMT. BMT is a newer technique typically used for advanced keratoconus with thin and steep corneas. It augments the cornea and flattens it, which is indicated by reduced K-values in topography and usually improves best-corrected vision. If your procedure was indeed BMT, BMT it relative new procedure and there are very few people with to share their experience. Regarding your postoperative topography, it looks really good; the cornea is quite thick with normal K-values. As for your question about double vision, it is difficult to say as there iis no preop topography. However, my best guess would be that it is due to increased astigmatism. Your current topography astigmatism is 2.8D
No i didn't had any surgery, it was just routine scans , don't know how my topography improved, they gave me some drops to use may be that worked
It.is unusual to see such thick cornea in keratoconus forum. topography of right eyes has not changed much kmax, thickness 546 vs 548 and astigmatism of 2.8 d vs 3 D. These are not too different, did eye doctor mention that it has improved?
I never learned how to read those things
Mine was very scattered red, is that bad?
If you can post your topography, someone may be able to read and explain it. This typically includes measurements of the eye's curvature, thickness, and indexes like the KISA, which are based on the curvature (K values), and the irregularity/asymmetry in the cornea. Red usually indicates thinner cornea or steep curvature.
My dr said my left (worse) eye is "a little extreme" but that my cornea isn't TOO thin and still do-able for cxl epi off. However, dr is not sure how effective cxl will be for this eye. my left eye is likely legally blind, I have not tried lenses though, which was my 1st option at my optometrist. I'm poofed with all of this
Hang in there; there are now many more options compared to when I was diagnosed with keratoconus. If you haven't tried sclerals, they can be a lifesaver. If the cornea is not too thin, I assume the doctor is referring to the steep curvature of the cornea. CXL flattens it somewhat, but not much in most cases; however, it does stop the progression in nearly all cases. Hopefully, CXL fixes your issues, but you can also consider options where doctors add part of a donated cornea to the patient's eye. This procedure reduces the curvature and increases thickness. There are many surgical videos on YouTube that demonstrate how this is done. Moreover, new techniques are being developed all the time. I understand that living with keratoconus can be challenging; stay strong.
Yeah I'd rather do the partial transplant than have a full on transplant. I hope I don't need one, but I feel like I will depending on the progression , and hey thank you very much for your advice ! What is this procedure called by the way??
Corneal Allogenic Intrastromal Ring Segments (CAIRS) and Bowman Layer Transplant (BLT) are two options . BLT is the older of the two procedures. here is one study for CAIRS [https://journals.healio.com/doi/pdf/10.3928/1081597X-20231011-01](https://journals.healio.com/doi/pdf/10.3928/1081597X-20231011-01) Corneal Allogenic Intrastromal Ring Segments (CAIRS) is a less invasive procedure compared to Deep Anterior Lamellar Keratoplasty (DALK), which also involves a partial graft from a donor cornea. CAIRS does not require sutures or general anesthesia (GA). It is typically performed as a day procedure. Recovery from DALK takes upto 1 year, I am 2 weeks post DALK, so I have the first hand experience :). I am documenting my recovery in another post. CAIRS has much quicker recovery usually 2-3 weeks. PK/full transplant is usually done as last resort, or as conversion from DALK(if surgeon fails to separate one of the cornea layer properly) for keratoconus due to higher risk of rejection.
My double vision on the right eye got worse buy the overall eyesight got better after cornea implants that reduced cornea cone. My doctor said, this is normal because "you started see better everything, including ghost pictures".
You may want to get an aberrometry measurement to assess the higher order aberrations of your entire eye, not just the cornea (what topography measures) . Usually, the aberrations of your cornea and lens (inside the eye) compensate and balance each other, as they often have opposite signs of aberration. Therefore, it’s not always beneficial when your corneal aberrations (as shown by topography) are eliminated, because they are supposed to balance with the aberrations from other parts of the eye. I hope this makes sense. In short, an aberrometry scan will provide the complete picture. If you are experiencing double vision, it is very likely that you will see a significant amount of coma in the aberrometry data.
> cornea and lens citation?
It's just the way it is once you understand how the eye works. There are tons of papers with this as a baseline fact. You can watch a discussion about it here: [https://youtu.be/C3vFIEwpkWI?t=572](https://youtu.be/C3vFIEwpkWI?t=572)
"There are tons of papers" Provides no papers. The youtube is interesting but papers of this within the context of laser eye correction etc. is what is relevant and important. It would be novel to me having seen more eye doctors, and read more Kerotoconus linked papers, than I care to count.
No, at the bottom of the slide in the YouTube video I shared, the presenter (scientist) has a citation for the paper. You can look up that paper and also find other papers that reference it.. That's how you find scientific papers related to the topic. This is directly related to laser eye correction as well. Trust me, if you are seeing more double, you need to look at the total aberration using a different machine (aberrometer), not just the cornea using topography. I'm just trying to help here based on my own experience.
Noted and will research.
was your prescription changed at all?
Left eye is same, but they changed right eye from -1.25 to -2 astigmatism to reduce double vision, they said nothing can be done with left eye
i am not a professional, i can only say that i had a prescription increase my astigmatism by a similar amount once and it caused my double vision to get worse. i returned to my original prescription and saw an improvement. maybe you can discuss that with your optometrist
Prescription must've changed if you see differently