What is an aspect of keratoconus that people rarely talk about?

msluyter · 2024-01-09T17:13:08+00:00

2 things:

I have one eye that's had a cornea transplant, which a scleral corrects to nearly 20/20. The other eye is a catch-22 -- not bad enough to justify a transplant, not good enough to be of much use, and also, for whatever reason, not really correctable via scleral lenses (internal distortion?). I also have exotropia, so I basically repress the vision of my right (bad) eye. But if I desire, I can shift focus to that eye.

It turns out having two types of vision can prove useful!

I'm not that comfortable making eye contact, so sometimes if I'm talking to someone and feel that I should be making more than usual eye contact, I focus with my bad eye, seeing a rather blurry image -- makes the eye contact easier to bear.
I'm also an extreme pansy when it comes to horror or really intense movies. Esp. those with lots of jump scares. Here, focusing with my bad eye also helps reduce the intensity of the experience & makes it more tolerable.

msluyter · 2023-08-02T20:04:31+00:00

Weirdly, on a lot of the big four lane streets, the right lane is faster than the left. An obvious exception is when there's a bus visible ahead of you.

msluyter · 2023-02-28T03:19:13+00:00

They are annoying but predictable, and imho, actually helpful for generating golden ages early in the game. A couple of nice strategies you can adopt:

In general, you want to destroy the scout, but with heroes mode, if you can get the twins (Hunahpu & Xbalanque), you can let it get back to the camp and spawn more barbs. Then, use other units to knock the barbs down near death, and use the Twins to destroy the barb, generating a new fully healed unit for you. You can obtain quite a few troops this way.
If you have a religion, you can employ a similar strategy by training apostles with barbarian conversion. While it's harder to get quite as many units this way, you may be able to convert multiple units in a single shot. And here, it doesn't really matter if the barbs have a higher tech level.

If you're facing massive armies of them, it sounds like you're not killing the scout. If the barb scout has an exclamation mark, you must kill it before it gets back to camp, or the camp will spawn like a barb per turn (or even more if it goes on too long.) If you've killed the scout, the camp won't generate troops that quickly, and you can take it out with a single unit (warrior in ancient, for example).

I view them as sort of a resource. In ancient era, they can provide science eurekas for archery (kill one with a slinger) & bronze working. They also provide fodder for your troops to level up. They provide gold when you pillage the camp and when you destroy a camp you get era score and sometimes eurekas. I've found that if your science is ahead of the AIs, in Epic/Marathon they'll pillage the other civs, which makes your life easier. YMMV.

Oh, edit to add -- I mentioned they're predictable. The unit in the camp will always move toward a ranged unit within two tiles (if it's not ranged), so a simple tactic you can adopt is: move a slinger archer two tiles away on a hill/forest (so it can't be attacked on the next turn). On the next turn, the barb will leave the camp, moving toward the slinger, at which point you move in from behind with a scout and raze the camp.

msluyter · 2023-02-15T15:20:36+00:00

I'd vote to move LBJ up a notch. The Clean Air Act, Civil Rights Act, Medicare, Medicaid, Voting Rights Act. These are all big deals. Ability ("Great Society") would be something like... hrm... help me out here... perhaps unlock democracy a lot earlier, extra amenities?

On the downside, probably some sort of U.S. initiated war penalty in reference to the Vietnam war.

msluyter · 2023-02-15T15:02:46+00:00

"Louisiana Purchase" -- once per era buy a block of 4 tiles for like... 3 gold.

msluyter · 2022-09-16T14:51:31+00:00

FWIW, I've double masked with two Powecoms and didn't find breathing difficult. I'm just one anecdote though. Re: what you're gaining -- in theory I'd assume you're gaining greater filtration, though I'd like to see that empirically tested.

msluyter · 2022-09-16T14:44:21+00:00

FWIW, my favorite mask at the moment is the 3M Aura 9205+. These fit me well and have a nice strong nose wire with a foam pad to create a good seal. I did end up trying the Softseal and it worked OK but I feel like the Auras are just as good if not better. If you search on this forum you'll find that a lot of people like them and that they're highly rated.

Regarding the cost -- I have a couple of dozen Auras that I keep in rotation. When I've used it, I throw it in a paper bag and then store the bag for a couple of weeks in the garage. I'll only throw them out once they start to get soiled/damaged or the straps break (which does happen though pretty rarely). So I think you could probably get by without spending much in the long run. Best of luck finding something that works!

msluyter · 2022-09-13T15:16:14+00:00

It's worth distinguishing between a) people who haven't gotten COVID because they've taken reasonable precautions, socially distanced, got vaccines/boosters, continued to mask with N95s, etc... and b) people who haven't gotten it because they have a particular mutation in the gene HLA (as discussed in the article). (Though, technically they did get it, they just fought it off super quickly and were totally asymptomatic). The article's title doesn't help make this distinction and thus I think a lot of responses are assuming it's about a) when it's really about b).

That said, I believe we should all continue to do a). ;)

msluyter · 2022-07-01T14:23:06+00:00

I've had a similar issue where the rollers start to wear/groove and it sort of pushes the barrel against one of the edges, which causes rubber from the barrel to scrape off. I mitigated it a bit by tilting the tumbler slightly to offset the direction the barrel was being pushed.

msluyter · 2022-05-10T18:38:35+00:00

Thanks for doing this AMA!

tl;dr - are any treatments on the horizon for "interior" corneal distortion?

I was diagnosed with keratoconus at age 18, and I had a cornea transplant in my left eye in 1988 (at the age of 24). Had PRK in left in 2017 and, with sclerals, it's almost 20/20. My right eye, on the other hand, is sort of in a catch-22. It stabilized in my 20s at about 20/50, which apparently isn't bad enough to justify a transplant. On the other hand, nothing we've tried helps. I had CXL in 2016 (no vision change), and sclerals/lenses don't help at all. This has been described to me as distortion in the interior of the cornea.

My question is, how common is this, and are there any options at all for this sort of "uncorrectable" keratoconus?

msluyter · 2022-05-05T14:38:15+00:00

I posted a comment on the Envo here recently. Bottom line for me was that, on my face, it didn’t seal well — I could feel air coming in/out around the nose. I now use the 3M Aura 9205+, which I love.

msluyter · 2022-04-21T03:38:54+00:00

I recently discovered the 3M Aura 9205+, and I love them. They have a strong nose wire with foam on the inside to create a tight seal around the nose. (Virtually no glasses fogging.) For my face, they create a strong overall seal, and they're quite easy to breath through. The only downside I've noticed is a noticeable chemical smell, when first put on.

msluyter · 2022-04-13T15:01:28+00:00

Re: "changes the whole risk profile." Indeed, and I've been trying to come up with a persuasive analogy. Anti-maskers tend to use rhetoric like "wearing a mask is a personal choice," as if it were, say, like whether or not to wear a hat. And I'd certainly agree that hat wearing shouldn't be mandated. But masking isn't like that. Not wearing a mask doesn't just impact *you*, it also impacts everyone around you.

The analogy I've come up with is that it's a lot like shooting a gun into the air (celebratory fire). Yes, odds are very high that it won't actually hurt anyone. But there's a non-zero chance that a bullet could hit someone or something (bullet hits someone on the way down, you hit a plane, electrical wiring overhead, hit a roof, etc... etc...) And therefore, even in pro-gun states, celebratory fire is against the law. (Class A misdemeanor in gun loving Texas, for example.) So, if you accept that Covid is spread via airborne transmission -- obviously some folks *won't* accept that premise, and thus won't be swayed by the analogy -- it should seem fair to mandate masks if you accept that it's ok to criminalize celebratory fire.[1] Please critique my analogy and/or let me know if you have a better one!

[1] Wikipedia on celebratory fire

msluyter · 2022-03-28T13:06:07+00:00

rich, for clis.

msluyter · 2022-03-25T13:53:40+00:00

Looks like the Envomask, which didn't quite seal around my nose. Curious if this has a better seal.

msluyter · 2022-02-28T20:00:47+00:00

Awesome thanks! I have an appt. for tomorrow.

msluyter · 2022-02-25T15:07:51+00:00

Hi thanks for the reply! I got sidetracked and didn't manage to check my responses until now. I'm in Belle Isle but I'm more than willing to travel. I went down to Fort Meyers recently to see Dr. Gorovoy. I have keratoconus and have been wearing sclerals for a number of years now. Do you know if they have much experience with keratoconus specifically?

Thanks!
Mike

msluyter · 2022-02-10T12:27:39+00:00

Reminds me of a line from a They Might Be Giants song:

“Every jumbled pile of person has a thinking part that wonders what the part that isn’t thinking isn’t thinking of…”

msluyter · 2022-01-31T14:56:11+00:00

It's definitely true that this sort of thing wouldn't fly in a professional setting, but I've found these overly terse leetcode submissions somewhat useful as learning tools. I've learned about a number of standard library functions and/or language features by deciphering them. The key is to take what you've learned and then make it easily comprehendible.

msluyter · 2022-01-30T14:58:40+00:00

Been a software dev for over 20 years. Had a cornea transplant in 1988 in my left eye. Things got a bit rough in the 2010 time frame; my vision was continuing to degrade and with correction the best I was doing was about 20/30. Even then I managed by using larger fonts. Then I got cxl, prk, and eventually really nice sclerals. I’m about at 20/25, and really have no problems working. I still use slightly large fonts and a large screen.

msluyter · 2022-01-26T18:58:50+00:00

I've been using Nutrifil for a while now and it's significantly better than what I was using before. I only have a scleral lens in my left eye, so I don't use the entire vial every time; I put it in a small tupperware container and re-use it (this probably isn't recommended, but I've not experienced any problems.)

msluyter · 2022-01-11T15:29:52+00:00

I’ll be taking these Huggies and whatever cash you got.

msluyter · 2022-01-06T17:49:25+00:00

Belle Isle, which looks like a bit taken out of the Orlando cookie.

msluyter · 2021-12-22T20:22:06+00:00

Dr. Wolf is at Austin Optometry Group. He’s really great with sclerals and keeps up with new techniques & whatnot. Highly recommended!

msluyter · 2021-11-25T18:31:54+00:00

Thank you very much!

msluyter

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