What I have found out is that you really need to have the highest cover money can buy for a corneal transplant to be covered by private insurance (e.g. medibank private). It is best to check with your insurance company whether or not they cover the operation before you proceed so you know the costs. I failed to do this and my claim has been rejected. Oh well - at least my corneal transplant has not been rejected! It is best to call up and quote the specific item numbers (listed below) to the insurance company and if they agree to cover the surgery also get them to send you a letter that they have accepted the claim. The items numbers are:
42653 - Full thickness (PK) corneal transplant.
42656 - Second subsequent procedure.
42659 - Superficial or lamellar cornea transplantation.
17610 - Pre-anaesthesia consultation
20144 - Anaesthesia for corneal transplant
23091 - Anaesthesia time - around 2 hours for DALK.
If your private cover does not include major eye surgery you can go to a public hospital (Eye and Ear in East Melb) as a public patient. You will not be able to choose your surgeon but will avoid about $2500 in hospital costs. You will still have to pay the gap between what medicare pays and what the surgeon and anaesthestist charge. I estimate this to be around $2000.
Wednesday, February 10, 2010
Tuesday, February 9, 2010
What to do with my Left Eye?
I have decided that it is not too soon to start thinking about what to do with my left eye. I have an optometrist appointment tomorrow. The lens is another Synergize KC which has been adjusted to try and stop it hitting my cornea and/or intact. Hopefully it will work! If not I will ask the optometrist to try and source a clearkone sceleral lens.
I have also made an appointment to see an opthamologist who has access to a femtosecond laser. The appointment is in late March. There has been a lot of discussion in the medical community about the use of a femtosecond laser to cut the donor and recipient cornea. The advantage of using the femtosecond laser is that the donor cornea and recipient eye can be cut so exactly that it fits together like a jigsaw puzzle. The laser can do any pattern and is so accurate that it cuts to within one third of a hair! For Keratoconus some research in the US has found that the zig-zag or mushroom pattern is best. The benefits are that the grafted eye requires fewer stitches, the graft is stronger, heals quicker, has faster visual recover and less astigmatism. However, as with a lot of new things the picture is not clear. Some researchers have found that the trephine (cookie cutter type surgical tool) works best for Keratoconus patients as the Keratoconic eye is an irregular shape such that the cutting of the cornea by the femtosecond laser causes a mismatched recipient/donor interface. I am guessing that it depends on the shape the Keratoconic eye is in which is unique to every case so that is why I booked an assessment with the opthamologist.
I have also made an appointment to see an opthamologist who has access to a femtosecond laser. The appointment is in late March. There has been a lot of discussion in the medical community about the use of a femtosecond laser to cut the donor and recipient cornea. The advantage of using the femtosecond laser is that the donor cornea and recipient eye can be cut so exactly that it fits together like a jigsaw puzzle. The laser can do any pattern and is so accurate that it cuts to within one third of a hair! For Keratoconus some research in the US has found that the zig-zag or mushroom pattern is best. The benefits are that the grafted eye requires fewer stitches, the graft is stronger, heals quicker, has faster visual recover and less astigmatism. However, as with a lot of new things the picture is not clear. Some researchers have found that the trephine (cookie cutter type surgical tool) works best for Keratoconus patients as the Keratoconic eye is an irregular shape such that the cutting of the cornea by the femtosecond laser causes a mismatched recipient/donor interface. I am guessing that it depends on the shape the Keratoconic eye is in which is unique to every case so that is why I booked an assessment with the opthamologist.
First Checkup - 8th of Feb
Prof Vajpayee told me that everything is going well. He seemed quite pleased with his work which gave me confidence that I could really get a good result. I don't have much vision out of my right eye yet. I can see somewhat but it is very blurry! My eye is looking much more normal. There is only one big red spot to the right of my iris. I still have a bit of pain but now it is mainly itching. I was reminded not to do any heavy lifting - nothing over 7kg. The Chlorsig drops were reduced to 3 times per day. I can go walking or jogging for exercise. I was told that my next checkup will be in a month.
Day of Surgery - Feb 1st 2010
I arrived at the Eye and Ear Hospital in East Melbourne at about midday. I had been fasting since 7am as per normal general anaesthetic procedure. I met with the anaesthetist for about 10 minutes. He asked all the usual questions. I was second on the surgery list for the afternoon. At about 3:20 it was time for surgery! This was the moment I was waiting for as it takes about 9 months to get a donor cornea. Not many people donate organs. The figure for Australia is 9 organ donors per million people!
I was required to sign for two operations - one was DALK (partial transplant) and the other PK (full transplant). There is a lot of debate in the medical community over which is better. I am no doctor - I am an engineer but from what I have read the main advantage of DALK is that there is much less chance of rejection as the patient keeps their endothelial cells which comprise the bottom layer of the cornea. Endothelial cells are what keeps the cornea clear. If you lose too many then the cornea becomes opaque - like looking through a glass bottle filled with milk! With DALK around 90% of the endothelial cells survive the surgery. With PK at best only 50% are alive and they are not the patients own cells so rejection becomes a bigger issue! Also with DALK the patient only has to use steroid drops to stop rejection for a few months whereas with PK it can be up to a year. The drawback of using steroid drops is that they are known to raise eye pressure increasing the risk of getting Glaucoma. The disadvantages of DALK are that some Opthalmologists have reported that the BSCVA (best corrected) vision obtained is usually only 6/9 (20/30) whereas with PK it is more likely that the patient will get 6/6.
DALK surgery is a more tricky procedure than PK. My surgery took 2 hours and 10 minutes. It was performed by Professor Rasik Vajpayee who is an expert Opthalmologist. The main risk during surgery is perforation of the Decemetes membrane. If this happens sometimes DALK can still proceed but sometimes it has to be converted to PK. The important aspect is that the Decemetes membrane needs to be bared such that the donor cornea can be attached to it.
I saw none of this happening of course as I was under general anaesthetic! I had no dreams. All I remember was waking up in recovery. I had a fair bit of eye pain when I woke up. I asked the nurse if this was normal. She said some patients have pain and others don't. My right eye was bandaged.
I was taken back up to the ward and was given a few sandwiches and some juice. This was good as I was hungry! I stayed overnight in hospital. Initially I was given panadol for pain. It made no difference! I could not sleep due to the eye pain. At about midnight I asked the nurse for some proper pain management. I was given two tramadol. This helped a lot. I got about 3 hours sleep!
In the morning the operated eye was briefly checked by an Opthalmologist. He said the vision was 6/60 and pressure was 23 (a little on the high side normal is 9-21) but OK. He said I had 16 stitches and everything looked good! I was given 2 bottles of drops. One was Chlorsig (an antibiotic). I have had this one prescribed to me regularly to treat the damage that wearing RPG's did to my cornea! The other one was Prednefrin Forte (a steroid) to help stop swelling and prevent rejection. I was told to put them in 4 times a day in intervals of 4 hours. I also got a tube of Chlorsig cream to put in my eye at night and an eye patch to wear while asleep to prevent anything touching the graft. The bandage was removed by the opthamologist during the examination so I had a look at my eye in the mirror. It was red and a bit bloody but I could see the stitches quite clearly. My eyelid was also swollen. I was impressed by the stitches. They were in a perfectly round configuration. They looked really neat and orderly!
I went to the hospital cafe for a coffee. There was no expresso on the menu for ward patients so I thought I would have one while waiting! My brother picked me up from the hospital. I was feeling OK - had some pain but OK. I wore sunglasses to protect my eye and keep the sunlight low. I went to his house. The cat was scared of me! I guess it was my eye!
I was required to sign for two operations - one was DALK (partial transplant) and the other PK (full transplant). There is a lot of debate in the medical community over which is better. I am no doctor - I am an engineer but from what I have read the main advantage of DALK is that there is much less chance of rejection as the patient keeps their endothelial cells which comprise the bottom layer of the cornea. Endothelial cells are what keeps the cornea clear. If you lose too many then the cornea becomes opaque - like looking through a glass bottle filled with milk! With DALK around 90% of the endothelial cells survive the surgery. With PK at best only 50% are alive and they are not the patients own cells so rejection becomes a bigger issue! Also with DALK the patient only has to use steroid drops to stop rejection for a few months whereas with PK it can be up to a year. The drawback of using steroid drops is that they are known to raise eye pressure increasing the risk of getting Glaucoma. The disadvantages of DALK are that some Opthalmologists have reported that the BSCVA (best corrected) vision obtained is usually only 6/9 (20/30) whereas with PK it is more likely that the patient will get 6/6.
DALK surgery is a more tricky procedure than PK. My surgery took 2 hours and 10 minutes. It was performed by Professor Rasik Vajpayee who is an expert Opthalmologist. The main risk during surgery is perforation of the Decemetes membrane. If this happens sometimes DALK can still proceed but sometimes it has to be converted to PK. The important aspect is that the Decemetes membrane needs to be bared such that the donor cornea can be attached to it.
I saw none of this happening of course as I was under general anaesthetic! I had no dreams. All I remember was waking up in recovery. I had a fair bit of eye pain when I woke up. I asked the nurse if this was normal. She said some patients have pain and others don't. My right eye was bandaged.
I was taken back up to the ward and was given a few sandwiches and some juice. This was good as I was hungry! I stayed overnight in hospital. Initially I was given panadol for pain. It made no difference! I could not sleep due to the eye pain. At about midnight I asked the nurse for some proper pain management. I was given two tramadol. This helped a lot. I got about 3 hours sleep!
In the morning the operated eye was briefly checked by an Opthalmologist. He said the vision was 6/60 and pressure was 23 (a little on the high side normal is 9-21) but OK. He said I had 16 stitches and everything looked good! I was given 2 bottles of drops. One was Chlorsig (an antibiotic). I have had this one prescribed to me regularly to treat the damage that wearing RPG's did to my cornea! The other one was Prednefrin Forte (a steroid) to help stop swelling and prevent rejection. I was told to put them in 4 times a day in intervals of 4 hours. I also got a tube of Chlorsig cream to put in my eye at night and an eye patch to wear while asleep to prevent anything touching the graft. The bandage was removed by the opthamologist during the examination so I had a look at my eye in the mirror. It was red and a bit bloody but I could see the stitches quite clearly. My eyelid was also swollen. I was impressed by the stitches. They were in a perfectly round configuration. They looked really neat and orderly!
I went to the hospital cafe for a coffee. There was no expresso on the menu for ward patients so I thought I would have one while waiting! My brother picked me up from the hospital. I was feeling OK - had some pain but OK. I wore sunglasses to protect my eye and keep the sunlight low. I went to his house. The cat was scared of me! I guess it was my eye!
Background
I have an eye disease - Keratoconus. I was diagnosed when I was about 25. I am now 37. For over 10 years I wore RPG (hard) contact lenses to correct my vision. I have had all the usually RPG problems - you don't have to catch the red eye flight to have red eyes if you wear RPG's! For the past few years a number of specialist optometrists have been unable to fit my eyes with RPG lenses that I have been able to tolerate for more than a day or two. My right eye has more advanced Keratoconus than my left - both create a challenge for the best optometrists!
About a year ago I had intacs surgery. This improved my vision somewhat during the day. However at night the intacts added a lot of glare due to the light reflecting off the plastic. This made it almost impossible to drive safely at night and made anything metallic or any source of light look very shiny! Personally I would not recommend intacs unless your Kerotoconus is very mild so that the result of the surgery lets you wear glasses or soft contact lenses and throw out your RPG's! From my experience specialist optometrists cannot fit an RPG to an eye with intacs as intacs leave the eye with a slightly uneven surface such that the intact hits the RPG which really stings! My current optometrist advised me to get the intacs removed!
I was not a candidate for collagen crosslinking as my corneas' were too thin to handle the laser without burning my retina! However, to me this procedure sounds mandatory for anyone who is recently diagmosed with Keratoconus or who has enough of their cornea left as it has been pretty much proven to halt the progression of Keratoconus and even reverse it in some cases.
Recently a company called Synergise has come up with some special lenses for Keratoconus patients. I tried the KC lenses in both of my eyes - without major success. I was able to wear them for about a week. There is now a Klearcone scleral lens available. It was released in the US around June 2009. If I can get it here in Australia I plan to try that in my left eye! This lens has won an engineering award in the US so it may do the trick!
I have just had a DALK corneal graft on my right eye about a week ago and my surgery experience and recovery will be the subject of this blog. I hope that this blog provides useful information to those who are Keratoconus patients and also for people who want gain a patient perspective into DALK corneal surgery.
About a year ago I had intacs surgery. This improved my vision somewhat during the day. However at night the intacts added a lot of glare due to the light reflecting off the plastic. This made it almost impossible to drive safely at night and made anything metallic or any source of light look very shiny! Personally I would not recommend intacs unless your Kerotoconus is very mild so that the result of the surgery lets you wear glasses or soft contact lenses and throw out your RPG's! From my experience specialist optometrists cannot fit an RPG to an eye with intacs as intacs leave the eye with a slightly uneven surface such that the intact hits the RPG which really stings! My current optometrist advised me to get the intacs removed!
I was not a candidate for collagen crosslinking as my corneas' were too thin to handle the laser without burning my retina! However, to me this procedure sounds mandatory for anyone who is recently diagmosed with Keratoconus or who has enough of their cornea left as it has been pretty much proven to halt the progression of Keratoconus and even reverse it in some cases.
Recently a company called Synergise has come up with some special lenses for Keratoconus patients. I tried the KC lenses in both of my eyes - without major success. I was able to wear them for about a week. There is now a Klearcone scleral lens available. It was released in the US around June 2009. If I can get it here in Australia I plan to try that in my left eye! This lens has won an engineering award in the US so it may do the trick!
I have just had a DALK corneal graft on my right eye about a week ago and my surgery experience and recovery will be the subject of this blog. I hope that this blog provides useful information to those who are Keratoconus patients and also for people who want gain a patient perspective into DALK corneal surgery.
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