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.

As an assistant clinical professor at the University of California Medical School in San Francisco, Dr. Turner has the opportunity to train new medical students as well as experienced eye doctors from around the Bay Area.  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.

While help keratoconus is mainly a site dedicated to providing news and insights into treatments for keratoconus, with election day today we would like to remind everyone to get out and vote for your interests and improve the quality of life.

Election day voter turnout is an important indicator of the population’s interest in important issues in society.  An active engaged educated populace with high voter turnout can lead to a more productive and healthy government.  If voter interest is low and voters pay little attention to the issues that are being voted upon, there is a greater likelihood for problems to occur in the government which are not addressed.

Take the time to vote and increase your participation in the government.  Together we can make a difference.

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.  

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.