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Archive for October, 2006

Contact lenses may cause progression of Keratoconus

Wednesday, October 25th, 2006

There is some evidence to suggest that contact lens wear can increase the likelihood of progression of keratoconus. While the studies are not conclusive, there is significant literature that points to contact lens wear as one possible trigger for the onset of keratoconus.

It is easy to theorize how this could occur. Perhaps the contact lens is irritating the eye and increasing inflammation. Significant inflammation could then lead to a triggering event which resulted in a deterioration of the links in the collagen within the corneal stroma. Once a patient’s cornea began to deteriorate, the increased pressure on the thinning cornea would easily cause a chain reaction of events leading to keratoconus.

Many ophthalmologists or optometrists in the past have tried to keep patients in contact lenses for as long as possible, fearing the only option would be a corneal transplant. With intacs it is no longer necessary to remain in contact lenses forever and certainly a corneal transplant is not the final solution in all cases.

We would suggest that it is important to preserve the health of the cornea. In some cases this would mean that a patient with keratoconus should not be kept in contact lenses once vision began to degrade sufficiently. Instead, the keratoconus patient should be given the opportunity to have intacs placed into the cornea to strengthen the cornea against increasing elasticity of the tissue with the resultant thinning.

Intacs have been shown to be most effective when the candidates for surgery are chosen early. Late cases of keratoconus which have progressed significantly generally have poorer results after intac surgery than those which are selected for and treated earlier. While intacs can still prevent these moderate to severe keratoconus cases from requiring a corneal transplant, the vision results are not quite as promising as a person with keratoconus who is treated early.

We recommend for optometrists seeing keratoconus patients to refer early in cases that might require intac surgery. It is important not to wait until contact lenses are no longer effective. At that point the end results are less promising.

Intac Surgery More Effective for Early Keratoconus

Thursday, October 12th, 2006

Turner Eye Institute is seeing an increased number of keratoconus patients in the practice. Many of these patients with keratoconus are being referred from optometrists who are comanaging the keratoconus patients. We are excited to offer our patients with keratoconus the newest treatments.

Intac surgery has allowed many keratoconus patients the chance to avoid corneal transplants. We are very happy about this. Unfortunately, many cases that we are seeing are moderate to advanced cases of keratoconus. While we are able to improve their vision, results are not as good as cases of early keratoconus.

We advise patients with keratoconus to seek care early. While contact lenses can provide good vision for some patients with keratoconus, there is evidence that contact lenses can actually speed the onset of keratoconus. If that is the case, it would be recommended to have intac treatment for keratoconus sooner.

Intac treatment for keratoconus has been much more successful for patients with early keratoconus. Vision gains and other improvements are more evident with early treatment.

We would like to thank all of the eye doctors who refer to Dr. Turner for treatment of their patients. If you have a patient that is interested in keratoconus treatment please call our center so that we can provide you with the best service possible and offer your patients the best possible care for their keratoconus.

In the future, Implantable Contact lenses might replace LASIK Surgery

Tuesday, October 3rd, 2006

In the future, Implantable Contact lenses might replace LASIK Surgery.

While LASIK is the most popular form of surgical vision correction today with over a million Americans undergoing the procedure each year, that might change in the future. Implantable Contact Lenses, such as Visian ICL, might be the next wave of vision treatments. Unlike LASIK, Implantable Contact Lenses can treat high amounts of near-sightedness, dry eyes, thin corneas, and possibly even patients with diseases such as keratoconus.

In a comparative study of patients who underwent LASIK and/or Visian ICL it was discovered that the Visian ICL not only compared favorably to LASIK surgery but in fact exceeded the results of LASIK surgery in many categories.

Patients who were in the 8-12 range of myopia were seen to favor Visian over LASIK in a majority of cases. While LASIK has been clinically approved for near-sighted prescriptions as high as -14.00, many doctors avoid LASIK in prescriptions higher than -8.00 or -9.00. Cases of higher near-sightedness, occasionally have problems with dry eye, glare, haloes, and even more serious complications such as corneal ectasias or loss of best corrected vision.

In one study of 769 eyes that underwent LASIK or Visian ICL, the results demonstrated that the visian icl provided better quality of vision. After 1 year 90% of eyes (-8 to -12)that underwent treatment with the Visian ICL were able to read 20/20 visual acuity. LASIK eyes (-8 to -12) showed a much lower percentage of eyes seeing 20/20. While LASIK has a very high percentage of patients seeing 20/20 for low prescription cases (often more than 95% in cases below 3 diopters of near-sightedness), the success rates are lower for patients with high amounts of near-sightedness.

In fact, the Visian ICL has demonstrated that as many as 50% of patients will have vision that is significantly better than their glasses or contact lenses (1 line or more of increased best corrected visual acuity). While Wavefront custom LASIK has proven better results for LASIK, it still does not reach the level of improvement that is achieved by high myopes with a Visian ICL lens.

Not only are the results with a Visian ICL more accurate, but they are also more stable and more predictable. LASIK tends to cause vision fluctuations throughout the first year as the cornea’s tear film changes, healing occurs, and the shape of the cornea reacts to the thinning that occurred. Visian ICL showed a 99% stability in comparison to LASIK which was considered to be 91% stable.

Visian ICL is often recommended for patients with high amounts of near-sightedness, thin corneas, or irregular corneas. It can also be recommended for cases where dryness is a problem or where glare and haloes could cause serious difficulties.

Visian ICL and other phakic IOLs are likely to increase in popularity. Advances in lens technology could eventually overtake LASIK technology. Lenses can avoid the necessity of thinning the cornea and can be designed with superior optics. Lenses can also be placed closer to the nodal point of the eye allowing greater magnification and improved acuity.

While LASIK surgery has been very effective in treating near-sightedness, far-sightedness, and astigmatism, some people believe that the future of refractive eye surgery might lie in intraocular lenses, especially with reversible procedures such as the phakic IOL.

Look to see future advances in these lenses make headline news and eventually perhaps replace LASIK surgery as the standard for vision correction.

Turner Eye Institute was the first LASIK and refractive surgery center in the San Francisco Bay Area to provide Visian ICL treatments. Dr. Turner has trained numerous doctors in this procedure and has performed Visian treatments upon patients from San Jose, Oakland, Walnut Creek, San Francisco, and other Bay Area locations.

If you are interested in learning more about Visian ICL treatment or LASIK please contact our LASIK coordinators. They will be happy to discuss your options and arrange for you to meet with Dr. Turner for an evaluation.

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