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Also, even though you've got curse of the blind, try and buy as much as you can from the shops. Go to every single one because you might end up buying a stopwatch or sackhead something else extremely helpful.
Even if you don't want to hold R though, you should do it anyway until you get at least a somewhat decent item. A floor 1 holy water for instance is going to be agonizing ESPECIALLY if you're not a patient person.
If i get hurt I drop coins and bloodied penny makes coins have a chance to drop health along with head of the keeper dropping coins from hurting things, just make sure you grab coins before ultra greed does.
Want to get 15 cents before boss fight to buy item in shop
Is lil baggie and automatically drops joker
Now have 2 makes you larger pills
Don't make the same mistake.
Also I feel like most runs there is one amazing item. Then an item placed somewhere to ruin it or make it worse. Like if you find ipec there may be a my reflection or mom's eye somewhere. If theres polyphemis a guilitieen is probably around. If an item gives you magic mush there might be one makes you larger pills in rotation.
So if your build gets good enough it might just be better to stop taking items from pools with the potental to ruin you.