The billion dollar Hubble Telescope has been assisting astronomers for nearly two decades now, gathering information about our own Milky Way galaxy and the rest of our universe. The entire project has not been without problems, however. Shortly after its launch in 1990, it was discovered that the mirror contained significant spherical aberration that affected the performance of the telescope. A system was developed called COSTAR, Corrective Optics Space Telescope Axial Replacement, which used two mirrors in the light path to correct for the aberration in the main mirror. With this adaptation, astronomers could achieve the accuracy and clarity that they were hoping for.

Adaptive optics relies upon a secondary set of mirrors that are in place to adjust for errors within the main optical system. While the Hubble is one example of this, our own eyes can benefit from the advances made through adaptive optics. The measured point spread function in our eyes is far from perfect. In people with keratoconus and other corneal diseases, these optical error are even more significant. It is possible, however, to reflect light through a mirror that adapts light to these optical errors and produce a clearer picture on the retina.

Deformable mirrors (DM’s) have become very important for this. Once a person’s point spread function is measured, a deformable mirror can adapt itself to these measurements. In modern LASIK surgery, surgeons are measuring patient’s point spread functions in order to customize the LASIK surgery to improve vision results. In keratoconus treatment, the progress of the disease can be tracked through the measurements of a patients “wavefront” or point spread function. In cataract surgery, newer lenses are using principles of optics to provide clearer vision through adaptive optics. Doctors can also use adaptive optics to view the back of a patient’s eye, the retina. In fact, adaptive optics now allows researchers to view individual photoreceptors in a live human eye.

As research continues, we expect to see greater improvement in the application of adaptive optics. Perhaps LASIK surgery will continue to improve or adjustments can be made to allow LASIK to correct not just myopia, hyperopia, and astigmatism but top also decrease the symptoms of presbyopia. Many companies are looking at multifocal or aspheric corrections with LASIK surgery. Researchers are using adaptive optics to measure the extent of the vision loss in keratoconus that is caused by the cornea and how much is caused by loss of neural information. The field of adaptive optics appears to be able to provide many new and interesting discoveries. Keratoconus is one important disease that stands to benefit from the advances in research of adaptive optics.

News has been released that British scientists are planning to use embryonic stem cells to cure age related macular degeneration, a common form of blindness. They are hoping to have the first patients receive test treatments within five years. This could be a major improvement in the methods of treating this common form of eye blindness that is experienced by millions of individuals throughout the world.

The pioneering project uses cells derived from human embryonic stem cells to repair damaged retinas. Those who support the research believe the process will involve simple surgery that could one day become as routine as cataract operations. Scientists are suggesting that the technique might be capable of restoring vision in patients with age-related macular degeneration (ARMD), a leading cause of blindness among the elderly that afflicts millions of people worldwide and is the leading cause of blindness in the USA and Europe.

If stem cell research can be used to cure age-related macular degeneration, could it also cure keratoconus? In April 2005, doctors in the UK transplanted corneal stem cells from an organ donor to the cornea of a woman who was blinded in one eye when acid was thrown in her eye at a nightclub. The cornea, which is the transparent window of the eye, is a particularly suitable site for transplants. In fact, the first successful human transplant was carried out in 1905 on a cornea by Dr. Eduard Zirm. The cornea has the remarkable property that it does not contain any blood vessels, making it relatively easy to transplant. The majority of corneal transplants carried out today are due to a degenerative disease called keratoconus which causes vision impairment and has no known cure even after corneal transplant. It is hoped that stem cell research will one day provide a cure to such debilitating corneal disorders.

The first step would be to grow corneas from a living donor. The corneas could then be transplanted into the person’s eyes. The advantage to using a patient’s own tissue would be a reduction in the possibility of rejection and a decrease in medications required to suppress a patient’s immune system.

Later steps might involve injection of healthy corneal cells into a keratoconic cornea in order to increase the strength of the cornea tissue. Stem cells could help reinforce the cornea and prevent the loss of vision that accompanies the progression of keratoconus.

New technology using adaptive optics is beginning to influence new treatments for keratoconus. Wavefront guided corrections have shown advantages in correcting optical aberrations that are caused by the corneal distortions occuring during keratoconus. We can expect that as researchers develop new treatments for keratoconus that they will be using the advanced measuring capabilities that are now available because of adaptive optics.

Keratoconus creates measurable optical distortions that can be corrected using specialized contact lenses. As these advanced contact lenses become more accurate in addressing the refractive errors, we can expect to see improved vision in patients with keratoconus.

Scientists are discovering new and better methods of measuring the optical aberrations and their effects on a patient’s vision. With the improvement in technology, we can expect improvements in treatment options.

I recently met a lady near Walnut Creek (in Conta Costa County) who was asking for the best corneal transplant surgeon in the San Francisco Bay Area. Her friend was located in the South Bay and San Jose and apparently was suffering from some form of degenerative corneal condition that eventually would require a corneal transplant. She was hoping to find the best surgeon to perform this procedure.

I began to quest the lady regarding the condition, which I had begun to suspect might be keratoconus. Apparently, her friend’s vision was fine until arriving into adulthood. At this time the vision deteriorated and needed to be corrected with hard contact lenses. I guess that soft contact lenses were not providing adequate vision. Her friend’s vision, however, was now becoming unsatisfactory even with hard contact lenses and she believed that a corneal transplant might be the only option now.

Her description of the patient’s symptoms sounded very much like keratoconus. I described to her the effects of keratoconus and told her that if her friend had keratoconus there was very likely to be a better option than a corneal transplant. While corneal transplants might still be performed, in the vast majority of cases, another option can either delay or prevent the need for a corneal transplant.

Many patients with keratoconus under intacs treatment. This requires placing a plastic band within the cornea which helps reinforce the cornea and can generally allow a patient with keratoconus to avoid needing a complete cornea transplant. The reinforced cornea can then often wear a hybrid contact lens designed to correct vision in a keratoconic patient. These contact lenses are part hard and part soft and are better for treating keratoconus because they provide the clear vision of a hard contact lens and the comfort of a soft contact lens.

The lady was grateful for the information a told me she would contact her friend. I am hoping that I was able to help. Keratoconus can often be a very painful and debilitating condition that requires long term care. Keratoconus patients often feel that they are not given the treatment that they require. Luckily, intacs and hybrid contact lenses have significantly improved the vision and comfort of patients with keratoconus.

If you have keratoconus or know someone who does, please contact Turner Eye Institute so that we can provide the best quality care and give them the chance to avoid a cornea transplant. There are option that exist that can provide better vision and greater comfort for patients suffering from keratoconus.

Frequently patients with keratoconus are choosing between wearing contact lenses and having intacs surgery. Hard contact lenses can improve vision much better than glasses for patients with keratoconus but some studies show that long term contact lens wear causes a deterioration in the cornea for keratoconus patients. This results in worsening vision that eventually can no longer be treated with contact lenses and requires surgery. Too often patients postpone surgery leading to a drop in vision and a loss in end visual acuity.

We recommend that patients with keratoconus be treated with intacs surgery as soon as the best corrected vision with glasses becomes inadequate. We do not recommend waiting until contact lenses can no longer correct the loss of vision due to keratoconus. We are finding that patients who wait until contact lenses can no longer correct keratoconus end up with significantly worse results after intacs surgery than those who are treated earlier.

Oftentimes, contact lenses (specialty lenses for patients with keratoconus) are still necessary following intacs surgery. In fact, the majority of intacs surgery patients must still wear contacts to see clearly. The difference is that long term visual prognosis is generally better for someone whose cornea is strengthened through intacs surgery.

If you are interested in learning more about treatments for keratoconus contact one of our refractive coordinators. Turner Eye Institute is located in San Leandro (near Oakland), San Francisco, San Jose, and Concord (near Walnut Creek). We are happy to evaluate your options and offer the best possible treatments to you.

Patients with keratoconus are constantly seeking the best treatment for their eyes. Many of those dealing with keratoconus feel that the treatment they have received thus far has been unsatisfactory. What can keratoconus patients expect for 2007?

FDA trials are already underway and past the early stages in a variety of vision related trials. Early results for C3-R treatment have been promising but this treatment has not yet been FDA approved. There are several surgeons who perform C3-R treatment off-label but thus far it is not yet endorsed by the US FDA. We will likely see further results at Ophthalmological Seminars regarding the efficacy of this treatment.

Contact lens treatments for keratoconus are also advancing and increased research in this area can be expected in 2007. Synergeyes offers a new hybrid lens for keratoconus patients and so far results with this treatment have been excellent. We can expect more keratoconus patients to be fit with the newer hybrid lenses (a blend of hard and soft lenses). As practitioners gain more skill in fitting these lenses, we can expect results to continue to improve.

The Help Keratoconus blog will continue to offer new information in 2007 and continue to provide new findings concerning keratoconus as well as offer new options in treatment. Continue to visit the blog on a monthly or biweekly basis as new blogs try to offer the newest insights into keratoconus.

Keratoconus patients are often difficult fits for contact lenses. The steepness of the cornea and the need to avoid contact with the apex of the cone requires that a specialized fitting or procedure be provided that not only allows for good vision but also prevents future deterioration of the cornea.

Keratoconus is a progressive thinning of the cornea. Hard contact lenses can hasten the corneal degredation if they rub against the steepest portion of the cornea. Many keratoconus patients have in the past experienced faster progression of keratoconus due to poor fitting contact lenses.

Dr. Turner has has significant experience in treating keratoconus with surgical methods, such as intacs and corneal transplants. He suggests that most keratoconus patients should be treated with intacs before the condition progresses significantly. Intacs treatments are more effective when used earlier. Once the keratoconus has cause a significant degree of vision loss and steepening of the cornea, intacs provide lesser results than if treated early.

Following intacs treatment, keratoconus patients will generally require continued contact lens care. The new hybrid lens, Synergeyes, has been very effective in fitting patients comfortably while providing much improved vision. Often a keratoconus patient’s best corrected acuity can be improved several lines with a good hybrid lens fitting.

Keratoconus patients are receiving much better care with these new technological advances. Intacs stabilizes the cornea and slows or stops keratoconus progression. Synergeyes allows for the comfort of a soft contact and the improved vision of a hard contact lens.

Medical Device may restore visual function for patients with keratoconus and could defer the need for corneal transplant for moderate to severe keratoconus

DES PLAINES, Ill. Aug. 4, 2004 Addition Technology, Inc., the manufacturer of Intacs prescription inserts for surgical vision correction, announced today that it has received approval from the U.S. Food and Drug Administration (FDA) for a Humanitarian Device Exemption (HDE) to market Intacs inserts for the treatment of keratoconus. Keratoconus causes a progressive thinning of the cornea and affects up to 300,000 people in the United States.

The FDA approval is based on Intacs excellent safety record, the relatively low number of U.S. patients affected by keratoconus, and the fact that no other treatment options exist for patients with keratoconus other than an invasive corneal transplant procedure. The approval allows Intacs inserts to be marketed for the reduction or elimination of myopia and astigmatism in patients with keratoconus, where functional vision is no longer achievable with their contact lenses or eyeglasses. In addition, Intacs inserts may defer the need for a corneal transplant for some keratoconus patients.

The FDA approval will allow Addition Technology to educate keratoconus patients about the potential advantages of Intacs inserts and is expected to help facilitate expanded health insurance coverage for the procedure in the United States.

“Keratoconus sufferers now have a new option when it comes to restoring and improving their vision,” said William M. Flynn, president and chief executive officer of Addition Technology. “Intacs inserts fill a significant gap between rigid contact lenses and corneal transplantation for these patients.”

“For many of my patients, Intacs provide a solution to obtaining functional vision where contact lenses no longer suffice,” said Yaron Rabinowitz, M.D., of Cedars Sinai Medical Center in Los Angeles, Calif. “Before Intacs inserts, the only option was a corneal transplant, which I prefer to be a last resort for these patients.”

“In the past few years my condition caused my astigmatism to increase to the point where I couldn’t wear contact lenses comfortably and my best corrected spectacle correction was deteriorating each year. Even though the morbidity risk was low, I was reluctant to consider corneal transplantation, since the convalescent period was lengthy and as an ophthalmic surgeon, I needed good binocular vision to continue to operate,” said ophthalmologist Leslie A. Eisner, M.D. of Stamford, Conn. “Intacs in my right eye has improved and stabilized my vision, allowing me to resume my normal activities without undergoing a highly invasive transplant procedure. I can now wear soft toric contact lenses comfortably and with good vision. I’m so pleased with the results that I plan to have the left eye done this winter.”

Addition Technology, Inc., a privately held company, is the manufacturer of Intacs prescription inserts, the only corneal implant approved by the FDA. Intacs inserts are also approved for distribution in Europe, Asia, and Latin American countries that include Mexico. For more information on Intacs prescription inserts, visit www.helpkeratoconus.com or call 1.800.339.2733.

Stephen Turner, M.D. has been helping Bay Area residents see for 30 years now. Even more impressive than the length of time that Dr. Turner has been in practice is the level at which he has been practicing. Consistently, Dr. Turner has been on the leading edge of the newest advancements in medical and surgical eye care, including advancements in the treatment of keratoconus.

Recently, Dr. Turner performed a live training for ophthalmologists from around the world to teach them the newest techniques and procedures available in eye surgery.

Dr. Turner is a pioneer in the field of LASIK eye surgery and as an FDA investigator was the first surgeon to perform LASIK in the Bay Area after its FDA approval. In addition, Dr. Turner introduced Wavefront LASIK and Intralase (also known as bladeless LASIK) to the San Francisco Bay Area. These technologies have increased the accuracy and safety of LASIK surgery. Dr. Turner also patented a technique known as TF LASIK and is currently the only surgeon in the world to perform this procedure. Dr. Turner also performs the newest treatments for keratoconus patients, including intacs for keratoconus patients.

With constant advancements in medicine it is often difficult for surgeons to stay updated. Dr. Turner has managed to remain at the forefront of research and was the first surgeon in the Bay Area to provide new treatments such as Visian, and Verisyse. These treatments allow very near-sighted patients to enjoy the benefits of good vision without glasses or contact lenses. Dr. Turner was also the first surgeon to perform Crystalens surgery, the first FDA approved cataract surgery that provides good vision restoration at both distance and near focus.

Dr. Turner’s experience is well-known in the ophthalmology and eye care community. He has performed over 30,000 laser eye treatments and over 15,000 cataract surgeries, allowing him to specialize in multiple treatments to provide the needed solution for a wide variety of vision needs. He has treated hundreds of cases of keratoconus as well.
Despite the restrictions in medical care imposed by HMOs and managed care approaches, Dr. Turner remains upbeat about the future of medicine and says that “with medical advances increasing in frequency the future is exciting.” He is looking forward to his next 10 years and plans to continue enjoying his practice in the San Francisco Bay Area.

Dr. Turner has practices in San Leandro, San Jose, San Francisco, and Concord. You can find more about his practice at www.turnereye.com or by calling Turner Eye Institute at 1-800-339-2733.

There is now a hybrid contact lens specifically developed for patients with keratoconus SynergEyes® KC. It is a cross between a hard and soft lens to provide the advantages of both in helping to treat patients with keratoconus.

The SynergEyes KC lens provides enhanced comfort and wearability and is expected to be a primary contact lens solution for patients with keratoconus. Every lens is custom made to provide the best lens to cornea match for optimized vision. The highly oxygen permeable rigid center of the SynergEyes KC lens promotes corneal health and optimizes vision while the soft outer skirt holds the lens in place better than a rigid lens and provides desired comfort throughout the day.

The best eye care practitioners go to great lengths to try any type of lens and combinations of lenses for highly irregular keratoconus eyes. Rigid lenses have been the method of choice for challenging keratoconic eyes. Practitioners also use “Piggy-back” systems comprised of a soft lens applied first and a rigid lens applied over the soft lens.

SynergEyes KC lenses offer good lens centration and freedom from lenses dislodging and debris under the lens that often occurs with rigid lenses. SynergEyes lenses also offer simplicity when compared to piggy-back systems.

Ultimately many patients with keratoconus consider surgery to allow them to obtain better vision. The surgical options include Intacts for Keratoconus or a corneal transplant (penetrating keratoplasty).

The SynergEyes KC lens may be an excellent alternative if your keratoconus has progressed to the point that you and your eye care professional are considering surgery. Your eye care professional will be able to tell if the SynergEyes KC lens is right for your specific prescription.