April 2023

The gas bubble (N20)continues to shrink (silver dollar size to penny size) and increase mobility around the field of view. Had the 7-week post-op visit with the ophthalmologist. Healing appears on track although the doc sounded a little disappointed it wasn’t further along. Well, welcome to my world. Down to just one eye drop prescription (2x daily). New question – how long will it take pupil to return to normal size after 6 weeks of atropine? Had a mini eye exam for the left eye: 20-200 (-1) and 20-80 (-2) with the pin hole cover. Field of view is getter brighter, just not clearer. Nearsighted vision is completely rubbish – can barely read anything without the reading glasses. Even a struggle sometimes with them. No change in activity level for the next 4 weeks. Disheartening news as hoped a little more intensity would be possible. Discovered the underlying reason for the irritated eye – developed a dellen which is a thinning of the cornea. Received a referral for a corneal specialist who confirmed the initial diagnosis. Come to find out, the cornea isn’t as smooth as it appears. It has peaks and valleys. One particular peak isn’t receiving the normal amount of lubrication from the tear ducts and is a little dry. Have the pleasure of wearing a temporary contact lens and picking up new eye drops (4x daily). Follow up three days later showed contact is doing its job by trapping fluid and keeping the peak moist. Answer to the dilated pupil condition – at least 2 weeks. Maybe the vision will improve then?

No change to the exercise (hard to all it that) routine: 75’ spinning at less than 110 average HR and no spikes greater than 115 bpm and 2-3 mile walks. Even the spinning was less than rewarding as initially average power (AP) values increased to a peak of 191 W for a 75’ session but then dropped. Able to maintain near 180 W for 45 minute or so but then had to decrease the effort to remain within HR limits. AP for entire rides were now upper 160s-lower 170s.

Returned to the corneal specialist 3 days after the initial consult. Played the silly eye test game. Winner, winner chicken dinner when there’s only one letter on the screen. When there’s more than 2 letters, able to discern the number of letters but not which letters. Again, vision much better when using the pin-holed paddle. Dellen is healing but much slower than expected. Doc removed the temporary contact lens but during the exam, discovered the cornea over the iris has no sensation. Doc poked it with a swab; nope. No blink, no response. Naturally, the condition has a name: corneal hypoesthesia, a symptom of neurotrophic keratopathy. NK is a degenerative disease, the primary side effect of a vitrectomy, of the corneal epithelium resulting from impaired corneal sensation. Naturally it’s considered a rare disease with an estimated prevalence of less than 5/10,000. Untreated, NK can lead to epithelial breakdown, impaired healing, and ultimately corneal ulceration, melting, and perforation). So, how does this condition contribute to the slow/lack of healing of the dellen? Since there’s no sensation where the dellen is, the cornea doesn’t realize there’s an injury and doesn’t activate the typical healing response. Increased use of erythromycin ointment (2x daily) and preferably an eye patch to keep the eye closed and corneal bathed in the antibiotic is the plan for the next week. 

75-min spins on Zwift continue although did increase to 90-min for weekend rides only. Able to remain with ride leader Maria at 2.1 w/kg on generally flat courses. HR governor usually spits me out the back of the peloton on long climbs.

Eye was uncomfortable, painful, for the week following the visit. Different than the discomfort post procedure as that was more localize to the cornea. Entire eyeball ached this time. Returned to the corneal specialist for a PROKERA procedure.  This involves placing an amniotic membrane on the eye covered by a thicker contact lens to keep the membrane in place to help kick-start the healing process. If that fails to heal the dellen and the lack of sensation continues, the next likely treatment is Cenergermin. It’s a very expensive ($80,000 for a prescription) beta-nerve growth factor. Because of the cost, there’s a lengthy ordering, review, and approval process that can take weeks to complete – but that’s been initiated. Vision is worse with the membrane but there’s no additional discomfort. Quite the opposite actually – no eyeball achiness or any other irritation. The gas bubble continued to shrink it size while increasing mobility in the field of vision with head movement, especially downward. As the diameter of the bubble decreased, the border of the circle thickened and the interior progressed from light to darker shades of purple. A couple days short of 10-week post procedure, the bubble disappeared. No change in perception, vision, or anything.

Will be able to increase the intensity a little (2.5 w/kg) until the next visit with the retina specialist in a week. Update on the bikes: Synapse is repaired but waiting in Shimano to deliver cables to wire the aerobar shifters to the Di2. Supply-chain woes continue as they were supposed to ship 2 weeks ago. Something screwy is going on with the lower part of the headset that may have damaged the frame. Still waiting on Cannondale to come to a resolution on the warranty. The Topstone overhaul is complete and ready for pickup.

Did manage to bake the Missus a batch of buttermilk biscuits before the eye patch. Kitchen time isn’t nearly as enjoyable when visually challenged.

Returned to the corneal specialist for the PROKERA treatment. Used a numbing drop, not sure why as cornea doesn’t have any sensation, laid the membrane on the eye then placed a contact over it. Procedure took maybe 30 seconds – come back in a week. Didn’t feel anything different until a couple of days before the follow-up visit. Felt like an eyelash poking me but there wasn’t one. That went away and replaced by the familiar feeling of a contact on the eye. Seemed positive as previously wasn’t able to feel anything. Follow-up visit was mixed – seems the membrane had gotten out of position (related to the ‘eyelash incident?’) but the dellen was mostly healed. Doc was pleased about that and cornea did have some sensation on the out half but she still didn’t rule out the potential for the $ drops. Still have a greenish mass, scab tissue near in inside corner of the eye (location of the dellen) and pupil remains dilated; no real change 3 weeks after last atropine drop and eye remains ultra-sensitive to sunlight.

Same discomfort 48-72 hours after visit – eyeball aches after all of the prodding and poking at scar tissue. Can’t really take comfort in the achiness as it’s not on the cornea. Sometimes it feels like a good old fashion eye rubbing is necessary. But there’ll be none of that. Keeping the eye lubricated with twice daily application of erythromycin ointment and drops for dry eyes. Learned Visine for red eyes is not a good solution for dry eyes as it primarily acts to constrict the blood flow to the cornea, thus reducing the red eyes. Drops specifically for dry eyes are recommend – currently using Systane.

On the cycling front, Zwift remains the only outlet although it was refreshing to just ride along with Maria, even Coco a couple of times, and completely ignore heartrate. Made the rides far less stressful and enjoyable while lowering the RPE. Even made another trip up AdZ although couldn’t match the plan, it was still the longest, hardest effort since early February.

Kitchen duties returned to normal after the Missus returned from being with her mother as her health precipitously declined and passed away. Nothing fancy but nice to have her back and even an occasional Sunday family dinner with girl child and hubby. Did make Irish Soda bread for but she had to cancel the family dinner as her hubby contracted Covid while attending a wedding the previous week. Just means the Missus and I will have to eat it.

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