Rae Lovejoy 26 April 2024, London UK

Back to Moorfields Eye Hospital after 5 years

Having had issues with my right eye for around 6 months after years of uninterrupted RGP lens wear and stable keratoconus, I had really started to struggle. My eyes were really dry and the lens kept slipping down, was it time to look at new options? I was using HycoSan eye drops which were helping but there was definitely something amiss with my normally very good vision in the right eye. I had seen a specialist in Kent but really wasn’t getting anywhere.

I hadn’t see Mr Daniel Gore at Moorfields since 2019 when he did wide diameter cxl on the edges of my corneal graft to strengthen it before inserting a Morcher pinhole lens (very new at the time). The results of this were superb, no more contact lens in this eye and I can now wear glasses to sharpen up my vision for driving. So I was excited to see him again and hear what he could do for my right eye, and discover what the issue was.

I met the team and had pretty much every test you can have, some old familiar machines and new ones too. ‘Open your eyes wide’ and ‘don’t blink‘ are words we with keratoconus hear a lot, especially with the tests being repeated many times as our pesky eyes are often to tricky to get good readings from.

Below you can even see eyelids and lashes- amazing!

I also had a blood test as I volunteered to help the Research team at Moorfields into their studies around KC and genetics- happy to help with research and development wherever I can!

We persevered with the machines and after a few hours I was able to meet Mr Gore and talk about options, once he had a look at the scans and results.

Turns out I have a very early but significant cataract on my ungrafted eye, bang in the middle of my field of vision which explained a lot of my frustrations with my sight at this point. Ordinarily this is a simple op but with KC nothing is straightforward. The eye is stable and has moderate keratoconus. I can wear an RGP, but I cannot wear any glasses. So Mr Gore is proposing the following:

• XCimer Laser Trans PRK to improve vision and smooth out the cornea, and collagen cross linking to strengthen the cornea

• 3 months later replace the lens (cataract op) and really improve the vision

Then I should be able to wear glasses and a soft lens in the right eye- no more RGP! Amazing news.

It isn’t going to improve on its own and so I feel I have nothing to lose.

Surface laser treatment (LASEK and TransPRK) and Excimer

Surface laser treatments are performed directly beneath the clear skin layer of the cornea (the corneal epithelium), which is removed by the laser (TransPRK) or the surgeon (LASEK) before laser reshaping to correct vision. Visual recovery is slower than for LASIK eye surgery because it takes the skin layer a few days to grow back and a few weeks to smooth off optically. Surface laser treatments are often the best option for patients with thinner corneas.

Once the surface cell layer has healed, the vision starts to improve and typically reaches the driving standard in 1-4 weeks after TransPRK or LASEK eye surgery, depending on the prescription treated. Most patients require a week off work after surgery. The Excimer laser changes the focusing ability of the eye by vaporizing the top layer of the eye’s surface (the cornea) at the molecular level. In this way, refractive errors of the eye such as near-sightedness (also known as myopia), farsightedness (hypermetropia), and astigmatism can be corrected.

Treatment for cataract

The most common cataracts treatment is a refractive lens exchange operation to remove the cloudy lens and replace it with a clear artificial replacement. This treatment is quick, taking between 30-60 minutes, and can greatly improve vision.

Laser cataract surgery

The consultant will use femtosecond laser to partially breakdown the cataract. Removal of the cataract then proceeds as for conventional (non-laser) cataract surgery, with a clear artificial lens (intraocular lens implant or IOL), made of a plastic-like material, placed inside the eye. Current available evidence shows that both conventional and laser cataract surgery are as good as each other in terms of vision and safety.

Lens options (I don’t know which I will have as yet)

Mono focal lenses

Monofocal lenses have a fixed focal point. This means they provide clear vision at near, intermediate, or distance vision. As a result, many patients require glasses after cataract surgery.

Combining a clearer distance focus in one eye with a clearer focus at arms’ length is a good option if you have no strong preferences and had good vision in both eyes, with or without glasses before the cataracts developed. Spreading the focus between the eyes in this way does not normally stop them working together or make you feel unbalanced, and it helps you to do more activities comfortably without glasses. You will probably still prefer to wear glasses for at least some activities after surgery and it may take you a few weeks to get used to the new vision.

Multi-focal lenses

Multifocal lenses are lenses that work to correct vision for both near and distance vision. This means that patients can reduce or remove the need for glasses after their cataract surgery.

There are many types of multifocal lenses that each have advantages and disadvantages. it is important to discuss your options with your consultant in the context of your eye health, prescription and lifestyle so you can choose the right lens for you.

Toric lenses (astigmatism correcting lenses)

Toric lenses are available for patients who have moderate to high astigmatism. A toric lens is made of the same material as a standard lens, but also incorporates astigmatism correction as well. The aim is to improve your vision so that the need for distance glasses is minimised but, as with standard lenses, you will still need to wear glasses for close up work.

I am excited to have these treatments and carry on my Keratoconus journey- which I think is over 20 years now! As ever grateful to the NHS, my long time corneal surgeon Mr Masoud Teimory, a consultant eye surgeon, a visionary poet, photographer and entrepreneur, Moorfields and Mr Dan Gore – MD FRCOphth CertLRS is a highly qualified consultant eye surgeon at Moorfields Eye Hospital in London, a world-renowned institute for ophthalmic care.

And a shout out to the team at Eye Folk opticians in Folkestone for my groovy Cocoa Mint specs!

Rae Lovejoy

The Keratoconus Journey:

Left Eye – corneal graft, cataract op, Morcher pinhole lens, wide diameter collagen cross linking

Right eye – RGP for years, and now…. stay tuned!