Health Screening at ICLDC

Today I had a health screening done at the Imperial College London Diabetes Center in Abu Dhabi. It involves various blood tests and a urine specimen to check for cholesterol, diabetes and liver health as well as performing an ECG to check heart health. Other standard measurements taken include weight, blood pressure, vision and checking if motor functions/senses are fine.

As expected, the first point was I gained weight from the last time I took the test (74kg in Nov 2010, 82kg in Sep 2011). 8 kilos gained!

Second point was an increase in LDL cholesterol (the bad cholesterol). Here is the cholesterol breakdown:

As you can see above, LDL cholesterol is very elevated and classified as “HIGH” while total cholesterol is high. What are the next steps? Exercise, eat fruits, avoid unhealthy processed food (i.e. lifestyle change) and a follow up appointment at the Imperial College in January 2012.

Two different types of corneal haze

Haze after Corneal Cross-Linking (CXL) is different in clinical character from haze after other procedures, such as PRK.


CXL associated haze is a dust-like change in the corneal stroma or a midstromal demarcation line, whereas haze due to other procedures (like PRK, LASEK etc...) has a more reticulated subepithelial appearance. Similarly, the mechanisms leading to haze formation may be different.
 
When I spoke to my doctor about the different types of haze he said they are very different.  One is a "good" haze that will disappear with time (associated with CXL), whereas the "nasty" haze, caused by PRK/LASEK can be permanent and very difficult to get rid off.
 
As strange as this sounds, I am really happy that I have the "good" haze!  It just means I have to be patient for around one year or so to have a clear haze-free cornea!

Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia

I found an interesting research paper titled "Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia" (Author: Steven A. Greenstein, Kristen L. Fry, OD, MS, Jalpa Bhatt, Peter S. Hersh, MD)

Since I had both LASEK and Corneal Cross Linking, and currently suffering from moderate (which I consider severe) corneal hazing, the below graph shows how corneal haze induced specficially by Corneal Cross Linking (which is different from other surgical procedures like LASEK or PRK) is reduced over time.  Research has shown 1 year is a good time for the haze to be reduced to levels a little over before the operation.  I am at 3 months now and I just can't wait.  I wish the haze would just go away but patience is the only thing that's left to do :(

Source: You can view the original article here

Day 87 Post-Op (Sep 15)

It has been a little over 12 weeks since the surgery. Things are a lot better but I have yet to achieve crisp vision. There is some minor ghosting in the left eye and major ghosting in the right eye. This is probably due to corneal hazing (I am approximating haze grade 0.5 on left, 2.0 on right). It could also be due to the cornea still thickening and smoothing out.

Apart from the technical details, things are getting better every week, but at the usual snail pace. I can drive comfortably during the day and night now but at times I wish things were a little crisper and clearer.

A little over a week ago I had another follow up appointment. It was supposed to be with another doctor I did not see before since my main doctor would be on leave. Lucky for me, when I arrived there, I saw him walk out of his office and seeing other patients. I requested they let me see him since he was back in the office now (he had a change of plan in his leave schedule).

The follow up was good news. Corneal hazing density has decreased and I was instructed to stop using the dexamethasone eyedrops (strong corticosteroids) and was switched to Fluorometholone (FML) instead, which are weaker corticosteroids. Based on the booklet I received after the surgery the standard practice is to start the FML eyedrops 4 weeks or so post surgery. Again, I’m special, and only started using them 12 weeks post surgery.

I started with FML 2 drops in the left and 4 FML drops in the right eye per day. Every week, I would reduce the frequency by 1 drop. Just yesterday I started with 1 drop left/3 drops right. So in 3 weeks time I should be off the FML and healing should speed up (corticosteroids slow healing but prevent inflammation and reduces corneal hazing).

On the not so great news (which I was expecting due to the extended use of the dexamethasone drops), intraocular eye pressure (IOP) in both eyes was elevated. I was given new eyedrops to use twice a day around the same time as the FML drops to reduce eye pressure. These drops sting every single time I place them in my eyes but their purpose is quite important. Elevated IOP is not a major issue if it persists for a short time, but longer periods can cause glaucoma (retina detaching due to pressure, can lead to blindness!!) So yeah, these pressure reducing drops are VERY important, and frequent follow-ups are just as important to monitor IOP,

I am scheduled for another follow-up on Saturday Sep 24. Hoping for greater news, faster healing and clearer vision! Patience is key, and I am hoping with time I will achieve vision better than pre-surgery where I had significant astigmatism, keratoconus and had to wear glasses which made the world smaller and shifted.