Hi, ophthalmologist here :-)
The good news is that if there is no underlying pathology (such as keratoconus, which should be sought in case of progressing astigmatism), every ametropia can be corrected with the right glasses and allow a good working comfort.
First, check your prescription with an ophthalmologist (or optometrist, depending on your country). You may benefit from a cycloplegic refraction, to ensure that you don't have an undercorrected hyperopia.
Then, always wear your glasses when working.
Your floaters don't have a direct relationship with your astigmatism and you may need a fundus examination, which will be done at the same time as your cycloplegic refraction (pupils will be dilated using eye drops).
Reducing the screen light and using a blue filter may also help. But good prescription is key.
I had the opportunity to taste this berry where I live (French Polynesia) and indeed very surprised by its powerful sweetening effect. It looks like an under-exploited potential to me.
I'm genuinely interested in your testimony. Did you, by any chance, underwent a refraction after cycloplegia (cyclopentolate) anytime in your life?
Cyclopentolate suppresses the ciliary spasm and allows to measure the real, residual myopia.
I would be very impressed if I had the opportunity to observe a myopic regression in a patient after cycloplegia (for both exams, of course).
I have not done an official cyclopentolate on myself as it requires a prescription here, but in the past I believe it's standard practice at my ophthalmologist when I get checkups, but I haven't gone for one in years.
This is not the first time I hear about these methods of reversing myopia, you definitely should be able to find someone in your area doing this, if you post in one of the communities saying you're an ophthalmologist interested in measuring someone's progress (and willing to prescribe the glasses)
There is indeed much more evidence for this advice. This is my I do with my kids. Using your far vision a lot I childhood, with enough light exposure, could be a real preventive habit.
Their big breakthrough in understanding myopia occurred in 2008 when they studied a particular group of people who had a genetic form of myopia that’s very severe. They discovered a gene mutation that was causing the myopia.
“It turns out it was a mutation in the cone photoreceptors,” said Jay Neitz. “We then realized that it’s really just the way that the images are being encoded on the retina.”
What’s supposed to happen as your eye grows, is that things should begin to go out of focus in the periphery of your vision. That’s a signal for the eyes to stop growing.
But as long as things are still clear in the periphery, the eyes think this person must still be farsighted, because in the natural world things in the periphery are far away.
Neitz said his team was able to design a lens to make central vision clear and in focus, and give the peripheal vision much lower contrast.
“It recreates what is supposed to be going on with our eyes before we started putting all of these things in front of our face like computer screens and tablets,” he said.
Ophthalmologist here. The myopia epidemic is real thing. The advice given in this post is not a dangerous thing to try. However, I doubt that the theory is true, and I doubt that following this method will really help myopic patients. Let's try to justify this point :
"The long-term use of over-correcting glasses induces myopia"
This is quite true. But it induces a myopia which is reversible. Overcorrection (which we try to avoid) leads to ciliary spasm. When the patient gets older, the lens gets less flexible (for everyone, this is what leads to presbyopia) and the myopia, if it was overcorrected, diminishes. It is common to reduce the correction for patients around 40.
We have a good, natural model in nature for over-corrected myopic eyes: hyperopic patients. They don't become myopic with time. Around 40-45 years, their hyperopia becomes clinically significant (they didn't need glasses before and they progressively need to have their hyperopia corrected at 45, or a little bit later if the hyperopia is slight).
"Repair is fast at first as you clear the ciliary spasm, and then slows down as you work on shortening the eyeball itself."
No. Clearing the ciliary spasm (which is not present in every myopic patient, only the overcorrected ones) will indeed reduce the amount of myopia (the eye will return to its normal state: less myopia). However, we happen to have a very precise way to mesure the axial length of the eyeball (interferometry). While we commonly observe a lengthening of the eyeball in high, pathological myopia, I've never heard of an eyeball which shortened, nor read any paper which related this phenomenon.
We don't know why the eyeball elongates in high myopia. But, as far as I know, eyeball never shorten.
"If you are considering laser eye surgery, please skim Lasik Complications."
Yes, please do. You must be informed and your surgeon must inform you. However, you could also look at the number of refractive surgeons who underwent themselves this surgery, or operated their family. It is a common thing to operate our residents at the end of their internship because they saw the outcomes and want the procedure.
Please note that any serious refractive surgeon will perform a refraction after cycloplegia, to remove any ciliary spasm and correct only the "real" myopia.
My understanding was dopamine has the effect of stopping the eyeball from growing longer, which is released during exercise in the presence of bright sunlight. Hence a sedentary and indoor setting make you more prone to Myopia.
I don't have time to find a reference, but I have read research which shows that our eyes tend to grow longer when we are having any sort of trouble focusing, which is often the case with a weakened prescription or in dim light. As a result I stopped ordering slightly weaker glasses for myself and moved my office to a brighter room in the house.
Despite all that, my Myopia seems to be getting worse, wearing the appropriate glasses that ensure sharp focus for distance vision and ones that are less straining with a negative SPH value for computer work (hobby/weak reading glasses etc). I also have some astigmatism which my glasses are completely correcting now.
I would love for medical science to discover the means to reverse myopia, it seems like a solvable problem involving signalling/conditions which causes the eye morphology to change.
> dopamine has the effect of stopping the eyeball from growing longer, w
Bilberry has been proven for this.
If dopamine prevented myopia ADHD people on Adderall would not develop myopia. I'm aware that medical prescription correlates with symptoms are not public nor analysed but still that's a big if
Not sure if dopamine build-up in the striatum (or whatever the specific effect of dopaminergic amphetamines is) would be of any relevance. Could be a separate area of the brain, e.g. only specific to the visual system. Dopamine agonists reviewed in this journal article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653403/
I have had myopia since age 18 and it constantly worsened. I got diagnosed with glaucoma in my 30s as a result of high IOP, but only because I started to have bad vision because my right optic nerve is already damaged. I started taking medication to reduce IOP then (a few years ago) and since then my myopia stopped worsening.
I have this image of my eyeball in my head, being basically a skin sack full of water enclosed in the skull in all dimensions but one. My theory is my eyeballs lengthened because of the high IOP. My ophthalmologist says this is impossible. Unfortunately I am not scientifically literate enough to check that and I am not sure who to talk to.
What I am trying to say is, if your myopia is constantly worsening get your IOP tested - just in case.
There are devices to measure IOP, most used but kind of inaccurate with a small „air burst“ on your eye. There seem to be more accurate measurement methods but they involve „touching“ the eye.
well it can actually be bought for 700$ but yeah doctors are a thing.
also:
> Differences in pressure between the two eyes are often clinically significant, and potentially associated with certain types of glaucoma, as well as iritis or retinal detachment.
Regarding LASIK, I got my surgery in 2009, at 21 years of age. At the time I only did enough research to know to find a reputable surgeon in my area, and no more. Nowadays I would probably Google for more side effects and dangers. I'd likely hesitate at the risk of getting it so early and wonder if it'll be a waste as my eyes change, but at the time I just trusted what the doctor told me.
I still consider it to be one of the best things I've ever spent money on. I think the surgeon mentioned he over-corrected somehow, accounting for eyesight changes over the years. There's been some degradation. If I close one eye I can see that my right one is slightly less sharp and slower to focus than the left. But overall my eyesight is still excellent over ten years later, with none of the scary persistent complications I'd read about since the surgery.
Nowadays, I hear of newer methods of laser eye surgery that involve putting in lenses that you can replace with new ones when needed as opposed to resurfacing the eye itself. It makes me think about how much advancement there must be in the techniques since I'd gotten it done. If I'm still happy with my decade-old result, I imagine people getting it done today might find their procedures to be even better.
What I like about this theory is we can test whether or not it’s true for ourselves by simply wearing slightly weaker glasses and seeing if our vision improves. The cost is relatively low and it would be fun to do.
Interestingly enough, it does seem like eyeballs can shorten in many species, including chicks, shrews, and some primates. It only took a few seconds to Google.[1]
I’d be curious whether humans share a similar mechanism. I would be surprised if they didn’t, considering how this mechanism is common amongst such a diverse range of species.
> hyperopic patients. They don't become myopic with time
As a farsighted person who didn't get glasses until I was 30... I only wish it was as easy as sitting and waiting a few years.
Most of the advice in tech circles is about myopia, so whenever I see something like this I like to imagine the opposite advice to see if it would cure me in the opposite direction. Should I stare at something less than 20cm away for 20 seconds every 20 minutes? I don't think either near or far-sighted people are going to heal themselves with internet advice
Yes, hyperopia is a very ungrateful condition... The usual situation is patients which had a perfect vision all their life, and, around 40, lose their near vision, and their far vision a few years later. This is always a little bit depressing.
My only advice for hyperopia would be (I'm sorry for that) to not wait too long to wear a correction for near vision. Sadly you won't heal hyperopia by training your eyes to look closer, but you will certainly be very tired at the end of the day if you need convex glasses and don't have them.
You're completely right. Although I could see just fine, my eyes were extremely fatigued after every workday and I just never realized it. Glasses changed my life. In fact I'm about to go in again for a second stronger pair of reading glasses for computer work. I might as well embrace getting old!
There are many anecdotal reports about people seeing shorter eyeballs as measured by an autorefractor while doing the reduced lens method, one example that I recall is this one from cliffgnu[1].
For LASIK the real thing that isn't communicated is that it doesn't address the root of the problem which is that the eyeball gets longer, it only works as if someone carved glasses on your cornea.
The problem is that you can't measure axial length with an autorefractometer. You need a biometer. The autoref will tell you the objective refraction of the patient (which is quite imprecise).
The eyeball gets longer with time in high (pathological) myopia. Serious surgeons will check that the myopia is stable (1-2 years) before doing a surgery. The eye doesn't, usually, gets longer in patients with moderated myopia. All the work, in refractive surgery, is in good patients selection. It is very unusual to observe a significant myopic regression in patients with a stabilized myopia after 21 years. Of course the eye is an organ, there is no absolute rule in the human body. However, patients which were correctly selected for surgery don't, usually, see their myopia coming back with time.
Even for pathological patients, the solution is to reset their eye with e.g LASIK and to prevent growth via bilberry. It's non-prescription is one instance of the universal established deep mediocrity
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296196/
I don't know but you have to understand that in general, extracts achieve effective concentrations that are impossible to achieve naturally. Moreover, a pill is easy to take consistently in the morning, while eating a bunch of billberries every morning is a chore. Consistency is key for the goal.
I guess eating bilberries is better than nothing, you'd have to study the extract to infer how many bilberries per pill it represent.
Can't find it right now, but there was a retweet by longevity scientist David Sinclair about a study in mice that exposure to UV-C could potentially reverse aging (and myopia) of the eyes.
I'll edit if I find the reference.
What I do is regularly go for a walk in the sun for up to half an hour without wearing glasses or contacts. If it doesn't work, I'll be getting a good dose of vitamin D in any case.
As far as I understand it, David Sinclair lost all credibility when he was invited to debate scientists in real life and refuse. The rate at which he spins up companies is also a bit alarming. This is as someone who would love for what he is preaching to turn out to be true.
The site alleges that there are a number of positive self-treating anecdotes found on the internet. Is there a medically justified explanation for these? (It's ok if not -- an alternative is that they're cranks or lying, both of which are very plausible). What is the minimum vision improvement from behavioural adjustment that would be medically surprising to you?
I have severe dry eyes from unfortunately taking accutane in my teens. Will LASIK cause more dryness? I already tried restasis which did not improve the ability of ‘rewetting’ my eyes when the optometrist was testing for this towards the end of treatment.
Worsened dryness as an outcome from LASIK is the only thing holding me back from it. Would love some feedback!
Is it recommended to get two different pairs of glasses for both near sightedness and far sightedness? I have a -3.5D with astigmatism as well. I get the feeling I'd require only less powered glasses for screen time as opposed to using my regular glasses for it. What is your professional opinion about this?
I am not the expert you are replying to, and I have only anecdotal evidence. But for what it is worth, I have been using "computer glasses", which are midway between my reading- and distance vision prescriptions, for more than 10 years. I find that this prescription reduces eyestrain very significantly, and I can easily spend a whole day in front of the screen without fatigue.
> However, we happen to have a very precise way to mesure the axial length of the eyeball (interferometry).
Does this measure the length at the center only? Even if the eye cannot shrink there, it could possibly grow outside of the center or by inreasing its diameter causing a change of the shape.
Do they ever perform lasik under general anesthesia? My eyes react so strongly to overstimulation like bright light or being touched that I couldn't even get the pre-tests done.
No you can't do that, because the patient must look at a target. There is an eye tracker in the laser but you have to look in the right direction. The surgery is much less impressive that you can imagine. Take an advice with a reputable, trained surgeon which will carefully look for any contraindication !
(Ophthalmologist):
To any future HN reader scared by those intraocular injections: don't fear them. I'm on my way to the operating room and going to perform cataract surgery under topical (=eyedrops only) anesthesia, as I always do, and as most surgeons today do. Patients won't feel anything except water slightly flowing on the eye surface.
The surgical knife is 2.2mm wide : the 25 Gauge needle is 0.260mm wide. Anesthetic eyedrop work amazingly.
Patients can actually feel the eye speculum (pro tip: open wide both eyes++, it will be less disturbing) and the itchy feeling of Betadine, and the touch of the needle : that's usually all.
Don't postpone eye injections because of fear: if it is indicated, there is usually some degree of emergency.
No offense to you, but this attitude is exactly the problem here. I know it's not rational to be very concerned about this, but I also know that the entire duration of that procedure, I will be thinking "KNIFE. IN. EYE." In the world I normally inhabit, knives should not ever be in eyes, so this is an incredibly stressful thought, stressful enough that I might do something crazy like MOVE WHILE A KNIFE IS IN MY EYE. This thought is even more stressful.
The best advice for me personally is probably to breath deeply and try to relax.
Well, by looking at all the answers, I obviously missed my point. Sorry for that :-) (I'm not a native english speaker as you noticed so it may also explain the misunderstanding ?)
Of course this is not how I talk to my patients... I usually explain the cataract surgery procedure as follows : "the only thing you will feel is water on the side of your face, and the only thing you will see is a very powerful light. You won't see anything scary and you won't feel any pain. We will talk during the surgery and when it will be over, you will tell me that you shouldn't have been afraid". And that's how it goes.
The eye injection procedure is even faster and painless.
Sorry for the gruesome details I gave.
Also, yes, don't look any Youtube videos, because your experience will be totally different than watching the procedure. Youtube videos are scary.
I am Deaf. How would you proceed if you need to do eye surgery on a Deaf person. I think they need to be knocked out. First, they care about their eyes more than other people and second you can't communicate with them during the surgery.
My own experience. I had to do an examination of my nose and throat with a camera on a stick (don't know the exact terminology). The doctor wanted to tell me something and I couldn't react because I couldn't turn the head to lipread and finally I tried to tear out the stick out of my nose and I struggled with the doctor and got a heavy slap on my hand.
This. I have an extremely strong blink reflex which I cannot overcome. The one time they tried to put contact lenses in my eye it took them 15 minutes to get them in and another half an hour to get them back out. It was one of the most stressful experiences I have ever had. It was over 30 years ago and it still makes me shudder to think about it. There is no way that I can possibly rational-ize my way out of that stress and convince myself that injections or surgery would not be ten times worse.
Blink reflex doesn’t really matter. If it’s anything like my Lasik surgery, they insert devices (like Clockwork orange) to make it impossible to blink — who wouldn’t have the urge to blink when something is approaching their eye? It’s an involuntary reflex for self preservation. They also put a ring in my eye that made it impossible for me to move my eye whatsoever regardless of my urge to look away.
Yeah, I get that. The issue is not that it wouldn't work, the issue is that I think it would be more traumatic for me then a normal person, and I base that assessment on the fact that putting contacts in is more traumatic for me than a normal person (like "extremely traumatic" vs "something so non-traumatic that they voluntarily do it to themselves on a regular basis").
I wore contact lenses for 10 years, before getting lasik.
The first time, it took 30 minutes to get them in.
For the first few months, I really struggled. Eventually it got easier, and in a short time I could put them in first time, every time
We're taught from a young age to not put things in our eyes, and it does take time to overcome that. The thought of it might be extremely traumatic now, but if you did it every day, you'd find that disappearing quickly.
> We're taught from a young age to not put things in our eyes, and it does take time to overcome that.
I don't think we're really "taught" this, but is jut part of our innate programming. I never taught my cat anything, and I'm fairly sure if I were to put anything in her eye she would be less than happy about that, even if it doesn't hurt her.
I certainly never recall my mother telling me off for putting things in my eyes.
What happens if a patient accidentally looks left or right during the surgery? I would be afraid of subconsciously/accidentally looking one way or an other during the surgery, but would that not cause a catastrophe?
I've had multiple eye surgeries. Prep includes putting lidocaine jelly over the eye, which will immobilize your eye from movement during the procedure.
Same here. I've had surgeries for cataracts and detached retina (2 of each). Eye surgery has outstanding outcomes and involves virtually no physical discomfort.
I'm profoundly grateful for modern medical technology, as I would otherwise likely be blind in both eyes.
This is also my greatest fear. The lidocaine isn't much consolation as it seems like it could easily wear off or they don't get the dose right and you move you eye.. the stuff of nightmares.
The needle they use is short and does not extend very far inside the eyeball. (No, you can't see the needle.) If the eye jerks while the needle is inserted, it won't move far. Eyeball tissue is thick and strong and the presence of the needle will limit the eye's motion to only about 2-3 mm, doing no damage. The needle enters the side of the eyeball, peripheral to the sensory part of the retina.
An eye flinch is exactly what happened to me when I got my latest injection of VEGF-inhibitor to counteract macular degeneration due to 20+ years of diabetes. It was no big thing, just a little disconcerting.
My fun fun eye surgery was to remove a stye that had hardened into a chalazion. This didn't involve any actual needle/scalpel work on the eye itself, but did require flipping my eyelid inside-out and cutting into the back with a scalpel. The local anaesthetic worked great. A side effect of the eyelid-flip (I think) was that my eye rolled into a position that wasn't seeing anything.
Overall, it was kinda like going to the dentist, but I could keep chatting with the doctor through the whole thing. The ability to keep communicating was great for keeping things chill. (However, one must be careful not to laugh while there's a scalpel near one's eye.)
I used to experience blepharitis and occasional sties, but of all things what cleared everything up was tea tree shampoo and face wash with tea tree oil.
Keep any tea tree oil product well away from the eyelashes. It's not actually necessary to treat it there, and you'll regret it if you get any of the product in your eyes.
Mine was caused by doing stressful grad school things, keeping ridiculously bad sleep schedules, and staring at a too-bright monitor for dozens of hours per day. These added up to rubbing my eyes a lot, which led directly to styes.
After reducing my monitor brightness, the problem went away.
You can't tell me not to fear it. I have a HUGE eye phobia; I can't even open my eyes under water. It doesn't matter what anyone says, it isn't a rational thing.
Talking about eye surgery is like nails on a chalkboard to me. I don’t want to talk about yours, let alone think about mine.
I have joked with my friends and family about giving them a limited power of attorney that in the case of eye or testicular surgery they can dose me with tranquilizers or anti anxiety meds without my knowledge and deliver me to the surgeon, having not told me that my surgery is today.
They’re not sure if I’m kidding, and neither am I.
Have you tried watching videos of surgeries to see if you can acclimatize your fear? Starting with something trivial like a skin suture or mole removal might be tolerable. Exposure therapy is an established way to gradually inoculate yourself against a fear that seems inescapably overwhelming.
> Have you tried watching videos of surgeries to see if you can acclimatize your fear?
If you're anxious enough already, then: Don't. Ever. Do. This. Videos don't help, at all. And your brain is constantly thinking about ways things might have gone wrong, while simultaneously looking (no pun) for comments from people explaining how exactly things went wrong for them!
The trick is to take the entire day off of work, take xanax, and do the motions without panicking.
The feeling you're describing is literally panic from an anxiety disorder. If it it's interfering with your adult responsibilities (like going to the doctor), that's the right time to use medication to get through it.
My toddler recently scratched my cornea with a finger, and while I was completely traumatized, I was able to go to the doctor and allow them to treat me. The phobia is not quite debilitating, just strong.
I have pretty high pain tolerance, but I can't handle eye injuries. I had a scratch on my cornea back in high school and I still remember how there was no ignoring it and nothing that alleviated the pain. Got a corneal ulcer a few months ago from the fancy 24/7 contacts the optometrist sold me. It wasn't near as bad as I remember the scratch being, but I definitely called into work and hid under the covers for a full day.
Pre-surgery benzodiazepines might fix that and are given to particularly anxious patients - I was terrified going into a surgery and was given those, ten minutes later there was total relief. I can easily understand the addiction risk (and haven't had them since), but for acute anxiety it was wild how much of a relief it was.
I went from nervous with fairly intense physical symptoms to being totally chill.
I'm the same way. I even have a hard time with drops despite using them regularly for years. I understand perfectly well that it's completely irrational yet I have not found a way to gain control over it.
Yeah if you are afraid to open your eyes underwater there is no way your letting a needle come near your eye when you are conscious and can see it. I have never heard of this eye phobia very interesting
I don't open my eyes either but mostly in swimming pools full of chlorine. Didn't know it was a phobia, because all I'm trying to do is avoid annoying eye irritation.
This is so bizarre to me, to be an adult and just unable to control your own body? I guess I'm lucky to not have this issue, but man it's so foreign to me that you can't even open your eyes under water.
Would you also not struggle to touch a hot stove? I think it is a similar feeling. Genuine question too - I've got a friend who is comedically brave and doesn't experience pain the way that other people do who might express a similar idea. He just already knows that its unusual and not the default.
That’s an interesting idea. I think I’d be able to touch it, I know I’d dislike it immensely though.
But this question helped me clarify my thoughts around this more. It’s the distinction between rational fear vs irrational fear. Assuming clean water the fear of opening your eyes underwater is irrational, it’s not going to hurt you or do any long term damage. The example from the story about getting an injection on your eye is maybe someplace in between, needle in the eye is much more invasive, but also deemed medically necessary where the risk of not doing it is greater than the risk of doing it.
Not having the ability to override your own emotions in cases where they are irrational is interesting to me. It’s like giving agency to an “external other” that you have no control over.
Well, I think you're getting close, but you still seem to be coming at this from a place of presumed superiority, mostly due to the separation of fears into 'rational' vs 'irrational'. Part of TFA is that they were not given enough information - is it irrational to fear some one stabbing your eye just because they are also confident that it will be for your betterment? From your water example it is clear also that you've learned that some water is safe to open your eyes in and built confidence in that knowledge - what if you hadn't had those experiences? Where I grew up the water was painfully cold, frequently polluted, and silty enough that I wouldn't be surprised if you got a scratch on your eye from doing that. I learned to open my eyes in the water in a public pool and discovered that I could do so with only minor irritation. If the chemical balance had been different that probably would not have been the case.
I think another perspective that might be helpful is to think of this in terms of the flinch reflex. Anyone can control theirs (this is an emotional process, sure), but the difficulty involves how sensitive they are, how strong the input is, how necessary they deem the action, and how afraid they are of potential consequences. Again, I don't think 'rational' or 'irrational' comes into play here or explains anything extra, I think in your case for example you are probably not jumpy (overly sensitive), and confident that your outcomes will be acceptable. I think the author was probably a little jumpy and was not confident in the outcome of an eye-poke.
If I absolutely needed to open my eyes under water for an important reason, I likely could. That is just not a common situation and I haven't encountered it.
I don't think not opening my eyes under water is THAT irrational, really. My reason for keeping my eyes closed (my fear and not liking the feeling of water touching my eyes) is greater than my need to open my eyes under water (which has been no real reason so far).
I seriously doubt you can rationally override your own emotions at any situation. And you should doubt that too, it can make you biased to think you're being rational without noticing you're not.
Phobias are very common. Almost everyone has one, like fear of heights or being trapped in a small space. The fear is not rational, and the phobic is well aware of that, but simply knowing it's irrational doesn't help rid you of it.
I think you might be overestimating what I mean by "can't" open my eyes under water. I think the 'touching a hot stove' metaphor is a good one. It feels like that to me.
I was born with cataracts and had the natural lenses in my eyes removed when I was days old. Fast forward to 2018 and I had intraocular lens implants (I believe it's called) under general anaesthetic. Went fine for the most part, however I had to go to A&E because the pressure in one of my eyes was ~65.
The cause was blood leaking into the back of one of my eyes (if I remember correctly), and they had to use the drops you mentioned. At the time I was a bit concerned with what they were going to do, but obviously was willing to have whatever done to get back to normal.
I'm still impressed by how well those drops worked. And, yeah. All I could see was red (blood), and all I felt was just a prick of something sharp. Was done within probably 10-15 minutes.
Thanks for this! Mind you, as much as I understand the importance and need of such procedures, that doesn't make me any less terrified. I've had all sorts of absurd injuries over the years all over my body and I am in no ways frightened or disguised of any bodily fluids. That said, I am terrified of the idea of such a procedure. Same with dental work - I abhor the feeling of anything being done to my teeth. Getting a wisdom tooth pulled out was arguably the most terrifying thing I've ever experienced. A needle going into my eyeball wouldn't feel any less terrifying.
I had a detached retina a couple years ago and it was super scary experience. I am back at 20/20 with some wonderful work by my doctors (and some intraocular injections, for sure), although I am terrified of it happening again with permanent vision loss
How are you using the surgical knife in your intravitreal injection procedure?
Any thoughts on how often patients can see the needle? I always thought it was out of the visual axis, but some reports in this thread mention seeing it !?
I've had eye injections three times now and never saw the needle. I can't imagine you you could, since the eye can't focus on the needle since it's inside the lens which is necessary to focus what you see outside the eye onto the retina. I don't see how the fovea could receive a focused image of the needle without help from the lens.
One of our friends has been having monthly eye injections for macular degeneration for a couple years. At this point, I'm more freaked out than she is.
Jesus Christ, you have managed to make it worse than I thought it would be (and I expected it to be very bad). This is the stuff of nightmares, I would never do this while I was conscious. Hell, it would be better if there was pain.
Hi, I'm an ophthalmologist, corneal specialist (and regular HN reader). I just would like to draw your attention to the absolute necessity to avoid any eye rubbing. This point is very often ignored by some colleagues, for various reasons. CXL will never increase your visual acuity, it is aimed at stabilizing the evolution (it is a controversial procedure).
The most effective thing to stabilize your pathology is to avoid any eye rubbing.
Please inform yourself about scleral lenses, too. Write me if you need to.
Thanks for your response. I had my CXL procedure 3 years ago and afaik I have avoided eye-rubbing completely since then. I also wear scleral lenses but I can only get 8 hours at best on a good day due to eye dryness. Even with lubricating eye drops.
8 hours but I would have to remove them once or twice a day, which is a whole other rigamarole.
Shit, I have keratoconus with rigid lenses and been constantly rubbing my eyes for more than 10 years now. Been to two ophthalmologist and a couple opticians and no one ever mentioned that. Thanks for the warning!
I'll ask my ophthalmologist about scleral lenses or maybe hybrid or K-rose lenses as some other comments mentioned.
This is infuriating. This is why I always comment when I see people talking about KC on HN (guess what? There is a lot. I won't do the research but I'm almost sure that this is the most frequent pathologie people here talk about. Lots of computers, lots of concentration, lots of eye dryness,lots of eye rubbing).
There is more and more evidence to support the fact that KC is purely induced by eye rubbing.
For a complete argumentation and discussion about the case for the role of eye rubbing in keratoconus genesis, please look at this website : https://defeatkeratoconus.com/
(Disclaimer: I work closely with one of the main proponent of the eye rubbing hypothesis. However, please believe that I don't have any conflict of interest in this topic. I don't have anything to gain in raising awareness about this problem, except feeling that I'm doing something right)
I also saw a study semi-recently about sleeping on stomach as a possible cause as it increases the pressure on eyes during sleep. Not sure how accurate the study is but I did used to do it a lot.
I sympathize. I don't know what kind of procedure you underwent. If the blurry vision comes form an irregular anterior corneal surface, scleral lenses can be a game-changer. Also, cellular therapy could be an option in a few years, you're not condemned to another surgery with a little bit of luck. Don't hesitate to write me if you need an informal, general advice.
Corneal surgeon here ! (Note : I never implanted a keratoprosthesis. This is an extremely unfrequent procedure, usually performed by a handful of surgeons in a given country).
Some insights about this topic.
This looks like a great device (never heard before !).
This is a keratoprosthesis, meaning this is a last recourse, "no-hope-except-maybe-that", procedure.
However it looks infinitely more simple and respectful of the eye integrity than current keratoprosthesis, and, if it really acts like a scaffold for native corneal cells and allows a colonization and the obtention of a satisfying corneal surface, it could be a game changer. It is way too soon to know.
A significant percentage (I would say around 40-70%, depending on the
country) of corneal graft indications originates from pathologies coming from the inner layer of the cornea (corneal endothelium). Posterior lamellar graft (DMEK) allows today to change only the thin cellular layer which is pathological, with an usually quick recovery. Even the best performing keratoprosthesis won't replace this procedure, because we care to preserve the eye's integrity as much as we can.
It is interesting to remember that corneal transplantation is a very special topic because the cornea is not vascularized, meaning less rejection. There still is, of course, but the outcomes as usually good. Keratoprosthesis are today indicated when previous grafts where rejected, when the other structures of the eye are healthy, and when the vision is extremely low. This allows to gain a few years of very low vision before, usually, losing the eye due to infection or high ocular pressure.
The technology presented has the potential:
- to replace current keratoprosthesis and lower the threshold to decide to perform the procedure : yes, almost sure if the device is well-tolerated
- to replace perforating keratoplasty (full corneal replacement, unfrequent today) where the cornea is damaged in its entirety: maybe, highly uncertain for the moment. That would be an incredible step forward, a revolution in our practice.
- to replace anterior lamellar keratoplasty, where the anterior wall of the cornea is replaced : highly unlikely
- to replace posterior lamellar keratoplasty, where the cornea lacks transparency because of inner layer cellular dysfunction: almost impossible.
I would also like to raise awareness on the topic of eye rubbing. The eye surgeon community progressively discovers the highly harmful consequences of vigorous and daily eye rubbing. A few teams (mine, notably) even think that it is the single trigger for keratoconus. You will find a nice illustrations of what a rubbed eye looks like in MRI I by googling "don't rub your eye" (this is me in the MRI ;-) and more explanations here : https://defeatkeratoconus.com/
I would like to second the eye rubbing awareness. I have keratoconus in both eyes, and had two (donor) corneal transplants in the 1990s, in my teens. Even with them, my sight is not great, as the distortions from the transplant scarring and residual keratoconus around the edges are only partially correctable with regular glasses lenses (I think these artificial corneas would not be better). I had bad hayfever as a kid (and still do sometimes now) and rubbed my eyes a lot. I now think it's the most likely cause.
I am in a similar boat-- fairly bad animal allergies and hay fever as a child accompanied with frequent and vigorous eye rubbing and now keratoconus (though, fortunately, not so far-progressed as to need corneal transplants).
My daughter has the same characteristic long eyelashes that I do, and exhibits allergies (though much less severe than mine). My wife and I have made a very strong effort to prevent her from eye-rubbing. She's old enough now to understand why we were so adamant about it.
I'm seeing elsewhere in this thread that nocturnal eye rubbing can be a problem. I never thought about that and it's a bit disturbing. I do remember waking-up with my eyes plastered shut with hardened mucus as a child.
To start with, full disclosure : this is a controversial topic. The majority of eye surgeons are still convinced that there is a genetic predisposition to keratoconus, and that eye rubbing is an optional trigger. Other (a growing number) think that this is the sole responsible of keratoconus.
My mentor is the main proponent of the eye rubbing theory. I was a skeptic, and became convinced by learning with him how to properly interview patients on this subject, how to prevent eye rubbing, and by seeing the absence of progression after full awareness of the patients (without cross-linking. We don't do any CXL in my department, ever. KC screening and care is one of our main activity: not doing CXL is a financial loss).
My mentor's website : https://www.gatinel.com/recherche-formation/keratocone-2/no-...
(No conflict of interest except loyalty).
The main difficulty is that it is almost impossible to design an experiment to prove the theory (if someone has a genius idea, please don't hesitate). Usually other surgeons or students become convinced after visiting the department and spread the good practices back home : still a long way to go.
The harmful eye rubbing is made with the hard parts of the hand (knuckles). It is frequently nocturnal and almost everytime ignored. Awareness comes when the patient has been informed and told to look for this habit. At the second consultation, the eye rubbing is reported in the vast majority of cases. I count the keratoconus patients that deny eye rubbing after 2-3 consultations on one hand. We prescribe a transparent eye shell to sleep with when the patient denies eye rubbing : it allows them to realize that they rub during the night. We prescribe eye drops to ease the eye irritation which triggers rubbing, and instruct to rub the inner part of the eyelid, against the nose (no eye deformation) if necessary. Sleep position is frequently pathological too (eye vs hand or arm contact. In those cases the KC is very asymetrical).
Doctors in our team can predict the eye rubbing habit frequency and intensity by looking at a corneal topography. It is incredible that the role of this habit was ignored so long. I suppose that we doctors don't talk enough with our patients. The financial incentive of performing CXL and surgeries is so clearly detrimental the the adoption of those practices.
Hi, I am really interested in reading this conversation, as I have keratoconus and had CXL surgery about ten years ago, and am very happy with it. The CXL stopped the keratoconus progressing and I only need to wear glasses instead of the more invasive things other patients mention (contact lenses, corneal grafts and transplants, etc).
It would be good if this intervention to convince patients to cease eye rubbing was more common in keratoconus patients. There is often a delay of several months between when keratoconus is suspected or diagnosed and CXL is carried out (in my case I had to wait 6 months in one eye and 9 months in the other, during which time it got a bit worse).
About eye rubbing, yes there should be more awareness of it! In practical terms, I would recommend that everyone tries wearing an eye-mask when they’re asleep (I recently bought this one, and I'm happy with it https://www.amazon.co.uk/gp/product/B07DW32QYJ ). This is because it's more difficult to notice and prevent yourself from rubbing your eyes when you're half-asleep.
There are several reasons why I like wearing an eye mask while in bed, and some even apply to people who don’t have keratoconus:
1. It stops me rubbing my eyes when I'm in bed.
1. It might stop allergens getting into my eyes when I'm asleep, for example I notice much less rheum on my eyes when I wake up in the morning. When I’m in bed is when I notice that my allergies are worst.
3. It helps me sleep better, it's like having blackout curtains in my room.
4. If I want to get up in the middle of the night, I will be able to see better in the dark.
Are there any correlations between people who wear contacts and have keratoconus? I'm asking, because handling contacts effectively requires you to rub the eyes a little every time you take the contacts out. Or is that kind of deformation not enough?
(empirical, non scientific opinion): usually, wearing contact lenses tends to prevent vigorous eye rubbing, during the day. Also, people with sensitive, itchy eyes tend to avoid contact lenses: this is a two-way relationship. Nefarious eye rubbing is usually related to a daily, compulsory "habit", involving a vigorous pressure on the eye using the knuckles or the side of the index, also frequently present while sleeping.
I'm curious if you're familiar with the stromal stem cell research for regenerating deeper corneal tissues?
Research from University of Pittsburgh, successful on mice/rat models, was taken to India for human clinical trials with pretty great success healing severe chemical burns and scarring to the cornea. Here's video of them talking about their effort to get it FDA approved (will take 5 years), I linked it to where it shows the before and after results: https://youtu.be/q_obgXSeLaU?t=1586
(Not remotely competing) neurosurgeon here. Vision never ceases to amaze me in its robustness. Patients with long-standing (years) visual field defect from pituitary tumour will recover their vision within minutes of it being decompressed. One of the most satisfying things I do is ask the patient in the recovery area if they can see the time on the clock opposite them, - the operation having finished 30 mins ago. Most can, - this says much more about nature, nerve compression and neuronal plasticity than the surgery.
This is really fantastic reply and context. Thanks for posting this!
When you see research like this, assuming all things trend positive (big if of course) what is the timeframe one expects to see it make its way to mainstream application?
If the outcomes are as great as they look, I think one could expect "mainstream adoption" (specialized centers and unfrequent indications) in 2-3 years ? This is a hard guess!
First, check your prescription with an ophthalmologist (or optometrist, depending on your country). You may benefit from a cycloplegic refraction, to ensure that you don't have an undercorrected hyperopia.
Then, always wear your glasses when working.
Your floaters don't have a direct relationship with your astigmatism and you may need a fundus examination, which will be done at the same time as your cycloplegic refraction (pupils will be dilated using eye drops).
Reducing the screen light and using a blue filter may also help. But good prescription is key.