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.

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.

A recent study of the effects of intacs on patients treated for keratoconus summarized that intacs are useful in the management of keratoconus. It concluded the careful patient selection and a complete explanation of surgical objectives is vital to provide the best possible care for patients with keratoconus.

Corneal transplants are a radical surgery that often requires more than 1 year and long-term medication to provide satisfactory results. Patients find the surgery to be unpleasant and the low availability of donor corneas makes corneal transplants to be difficult surgeries overall.

Intacs, on the other hand, is a surgery with minimal risk and a high chance for a rewarding outcome. Keratoconus patients can often notice immediate visual benefits to keratoconus surgery using intacs. Results of the long-term study showed that 20% of patients had more than 3 lines improvements in visual acuity. 88% of patients has some improvement in visual acuity.

These results are remarkable. Intraoperative complications are rare and corneal topography shows decreased irregularity and improved quality of surface wetting.

Contact lenses have been used commonly to treat keratoconus patients but contact lenses have shown a tendency to cause a worsening in the cornea with long-term use and often result in neovascularization of the cornea.

Intacs are also reversible, although it is rare that an intac patient would choose to reverse a procedure that was providing improved quality of vision.

If you have been diagnosed with keratoconus or suspect possible keratoconus, contact Turner Eye Institute and our counselors can schedule an evaluation to determine the best treatment for you personally.

This article about a patient with keratoconus was in the Concord Monitor Newspaper:

She came to see again
By SARAH LIEBOWITZ
Monitor staff
September 11. 2006 at 8:00AM

Near-blindness forced Ndofor Claire, 13, to leave school. In her native Cameroon, Africa, she held books inches from her face, straining to read. Without a corneal transplant, her local doctor said, Claire would go blind.

In Concord, Claire found her sight.

Two weeks ago, a local ophthalmologist transplanted a donated cornea into one of Claire’s diseased eyes. The procedure - which Erin Fogel, a doctor at the Eye Center of Concord, performed free of charge -will allow Claire to wear glasses, restoring her sight. The transplant took place at Concord Hospital, which donated its services.

Claire’s left eye will take time to heal. “But when the days pass, it becomes clearer and clearer,” she said.

Claire’s path to Concord began with a Cameroonian doctor.

She suffers from keratoconus, which causes a distortion or thinning of the cornea. Last year, her sight deteriorated rapidly. Her local ophthalmologist contacted Munro Proctor, a retired Concord doctor who has made numerous trips to Cameroon to provide medical assistance, Fogel said. Leaving the country was Claire’s only chance, Fogel added: There are no corneal surgeons in Cameroon.

Proctor asked Fogel to donate her services. Concord Hospital provided an anesthesiologist and a surgical room, free of charge. Tissue Banks International, a nonprofit network of eye and tissue banks, donated the cornea. Claire’s family organized the trip to Concord, sending Claire first to Baltimore, where she stayed with family friends, and then to New Hampshire.

Claire “is very sweet and very good and has been grateful at every step,” Fogel said. “She told me she wasn’t scared, and I didn’t believe her. But I think she may not have been.”

Keratoconus usually strikes in late adolescence or early adulthood, Fogel said. Often, glasses or contact lenses can rectify the disease. Claire - who has the disease in both eyes - suffers from a particularly severe case, and she could need another transplant on her right eye.

The transplant was the first one that Fogel has donated. It likely won’t be the last. “I always had plans, not so much to bring patients here, but to go somewhere to do eye care in a Third World country. And that will happen,” she said.

To hear Claire tell it, the surgery didn’t faze her one bit. “I didn’t even know they were doing something,” she said. “I was happy to see again.”

In the meantime, the surgery has afforded Claire a lengthy visit to the United States, and, by extension, her first glimpse at MTV, super-sized grocery stores and late-summer leaves beginning to change hue. In New Hampshire, where Claire will remain for two more weeks, she fell in love with pizza, mashed potatoes and Dunkin’ Donuts hot chocolate. She learned she doesn’t like oatmeal and put the English she learned in school to use. Last week, she took her first boat ride.

The trip has seemed so vacation-like that Claire isn’t ready to fly home. “I’d like to stay,” she said, shyly. Claire has lived with a host family in the Concord area. (Family members didn’t want their names included in this story because they don’t want the recognition.) Mary Peteh, a native of Cameroon who lives in Baltimore and is a friend of Claire’s family, accompanied Claire to New Hampshire. When Claire leaves the state, she’ll head to Baltimore with Peteh.

Two months later, she is due to return to Bamenda, a city near Cameroon’s western border, where her father is a math teacher and her mother works as a nurse. She’ll see her ophthalmologist, who will remove the remaining sutures holding Claire’s new cornea to her eye. She’ll trade mashed potatoes for rice and local fruits. And she will return to school, with the hopes of one day attending a university.

But Friday afternoon, Cameroon seemed a long way off. Claire and Peteh were headed for a distinctly American destination: the mall.

This story discusses one person’s treatment of keratoconus.
In many cases a corneal transplant is not necessary and there are other options that can help treat and improve the possible symptoms of keratoconus. If you have been diagnosed with keratoconus and/or suspect that you might have keratoconus, we recommend that you meet with a corneal specialist to determine what is the best treatment for you.

The following was written by members of the Wayland Girl Scout Troop #3178:

Last spring, Wayland Girl Scout Troop #3178 visited the Boston Foundation for Sight in Needham as part of their Bronze Award community service project. After months preparing and learning about the foundation’s work and studying journalism, the fifth-graders were lucky enough to have an insider’s view of the foundation and to meet with the staff and several patients to conduct interviews.

The troop members are Abi Agoos, Courtney Bolivar, Hannah Brigham, Paige Gould, Sarah Kaye, Bar Kinreich, Julia Lavenson, Regan McLaughlin, Kira Palmer, Melissa Sax, Natalie Shear and Kruti Vora. Troop leaders are Nancy Gould, Barbara Krause and Cynthia Lavenson. Lavenson was a longtime board member of the foundation.

The Boston Foundation for Sight is a nonprofit dedicated to helping children and adults who suffer from various types of corneal illness or disease, regardless of their ability to pay.  Founded by Dr. Perry Rosenthal, the treatment involves custom-fitting a special contact lens which serves as a liquid bandage, relieving eye pain and enhancing vision.

Cyndee Williams of Dexter, Mo., is one patient who was interviewed by the Girl Scouts. She is a stay-at-home mom, and she and her husband have two young children. She was blind which was difficult. She has been diagnosed with “keratoconus,” a disease that thins the cornea, which is the clear, dome-shaped surface on the front of the eye.

After a frightening experience with her son running off from the backyard, Williams decided she needed to find help. She learned of the Boston Foundation for Sight from “The Oprah Winfrey Show.” Dr. Perry Rosenthal, MD, a Harvard ophthalmologist, appeared on “Oprah” to talk about the “scleral” lens he invented. This lens was able to help people like Williams to see again.

Williams had been suffering with the disease for eight years. She also has two cousins with the same disease. One cousin had a successful corneal transplant, but Williams didn’t want the transplant because it can be dangerous and not always successful.

The Foundation for Sight collects donations for help people who need it, and Williams’ lenses were free. After she got the lenses she was so happy she wanted to hug the doctor. “I could see everything!” she said. She told us she was the most excited to see her husband and kids again. She said the lenses do not hurt to wear and took about three days to learn how to put in and take out each day. Williams has to come back once a year to have the lenses checked.

The troop also met another patient named Ellen Kelly of Santa Barbara, Calif. Because of her leukemia and lymphoma she had a bone marrow transplant. Often with a bone marrow transplant the new blood cells attack the cells of the cornea in addition to fighting the cancer. Kelly was in terrible pain because she suffered from extreme dry eye. When her doctor told her about the foundation she was so nervous she was not able to make the call for four months. “I kept putting it off,” she said.

When she finally came to the foundation she found out all the workers and doctors were very nice. The doctors fitted her with special lenses, and the pain stopped as soon as the lenses were put in. When we met Kelly she had just been fitted with the lenses and was learning how to put them in and take them out, and how to clean them several times a day.

Kelly is a children’s book writer so the lenses make her work much easier. “Because this problem affects people’s lives so much, it’s so great these people can help,” she explained.

Lynette Johns is an optometrist who works at the Boston Foundation for Sight and treats almost 30 patients a week. She has been working there for about a year and loves her job because she feels good about helping other people.

After college she attended optometry school for four years. Then she began to work as a resident and that’s how she found out about the Boston Foundation for Sight. There are many patients and success stories she remembers. One person that Johns has treated was blind and now she is able to see! Another patient got married after coming for treatment and is now the mother of six! Johns is a great optometrist who loves her job and her patients.

We also met with Steve Corlett who works in the lens lab at the Boston Foundation for Sight. He had a person in training, learning how to work the special machines. These machines make custom fitted eye lenses for individuals.

At the foundation, they use a special machine called lathe. It has sharp diamonds for cutting the quarter-sized piece of oxygen permeable plastic to make the lenses. They use diamonds because they are hard enough to cut the tough material. One of the great things about these lenses is that they don’t hurt, as the lenses only touch the white part of the eye which is not very sensitive.

The executive director of the Boston Foundation for Sight is Mark Cohen. The creator of these miracle lenses is Dr. Perry Rosenthal. They are great people working to help others.

“Since the lenses can be very expensive, the BFS will pay if you can’t afford it. That is why this nice organization needs donations,” observed one of the Girl Scouts.

Here is a press release regarding new contact lenses for patients with keratoconus:

InovaOne recently launched a new interactive broadband website that showcases the company’s products and services in a multimedia environment and provides valuable information for eye care practitioners.

Conforma, a leader in contact lenses and low vision optics, now offers eye care practitioners the ability to research information about custom GP lenses and low vision enhancement online.

The new website features seamlessly integrated video and a custom video player in the Learning Center, where visitors can learn about important industry issues. Informational videos demonstrate the proper fitting and troubleshooting techniques and design videos provide detail about Conforma’s products and services.

As part of the branding process, InovaOne also provided a full suite of new logo designs to showcase Conforma’s GP lens products. These have been integrated throughout the website, and visitors can select a logo at any time to discover more about innovative lenses such as Conforma-K for keratoconus and VFL3 multifocals.

“Conforma’s website now truly showcases the company’s commitment to the eye care professional,” said Conforma President Kevin Sanford. “We are excited to be building a library of integrated video, high-quality design and intuitive navigation allowing visitors to get the information they need quickly and easily.”

All websites designed by InovaOne feature full cross-browser compatibility, meaning that they load properly in all modern web browsers. Conforma Laboratories, Inc. is a creator and provider of specialty contact lenses, tools and calibration units. Specializing in GP lenses and low vision enhancement, the company is dedicated to helping eye care practitioners meet their patients’ unique vision needs on a daily basis.

More and more patients from Oakland, San Jose, San Francisco, and Concord are undergoing treatment for keratoconus with Dr. Stephen Turner. Since obtaining FDA approval for intacs for treating keratoconus, patients with keratoconus are now seeking help from one of the San Francisco Bay Area’s most experienced corneal surgeons, Dr. Stephen Turner.

At one time, patients with keratoconus were forced to use either hard contact lenses or they had to undergo a corneal transplant. The hard contact lenses were often uncomfortable and even worse could hasten the need for a corneal transplant. With newer treatments, such as intacs, patients with keratoconus are now receiving medical care to strengthen their corneas more quickly and might be able to avoid the need for a corneal transplant.

Dr. Turner has performed hundreds of procedures for patients with keratoconus in the San Francisco Bay Area at his clinics in Concord, San Leandro, San Jose, and San Francisco. These procedures are very important in improving the eyesight of people with keratoconus.

A former keratoconus patient with the eye patch she wore after a cornea transplant saved her from blindness in her left eye. She may need a transplant in her right eye as well.

Despite her diagnosis of a progressive eye disease 18 years ago, the keratoconus patient has not only Rollerbladed in 23 different countries, but she has also lost her delicate $80 gas permeable contact lenses in many of those countries as well.

“Down the drain in London, and on the dance floor in Rome,” she said. “It’s actually kind of depressing to think of how many I’ve lost.”

This long time flight attendant for American Trans Air is now able to enjoy her active lifestyle of travel thanks to what she calls her new youngest part. Last November, she received a cornea transplant in her left eye from a 24-year-old male. The transplant at New York Eye and Ear Infirmary stopped the disease, keratoconus, from eventually blinding her.

Keratoconus causes thinning of the cornea, the clear outermost layer of the eye, producing a cone shaped bulge. Many people suffer from refractive errors, like nearsightedness, farsightedness or astigmatism that also affect the shape of the cornea, but these disorders may be corrected with soft contact lenses. However, in the early stages of keratoconus, the only way to correct for vision is to wear gas permeable contact lenses. Over time, the disease causes intense blurring and sight impairment due to tissue scarring.

She still wears one gas permeable lens for the keratoconus in her right eye. Even though it’s uncomfortable, she is thrilled to have one eye strong enough not to require a second gas permeable lens. “They’re very painful,” she said of the lenses. “Any time you blink, it rubs up and down.” Optometrists have to constantly refit her gas lenses because the disease causes the shape of the cornea to change.

The rubbing from the left lens created so much scar tissue that her doctors told her a cornea transplant would be the only thing saving her from eventual blindness in one eye. Her name was placed on a waiting list and for a week, she was prepared to be rushed to the hospital for the surgery. On Nov. 15, after the three-hour procedure Heap left with a brand new cornea.

Her transplant was made possible through The Eye Bank for Sight Restoration Inc., located at 120 Wall St. The world’s first eye bank, since 1944 it has collected, processed and distributed donor eye tissue for thousands of sight saving cornea transplants throughout the city, Long Island and the lower Hudson Valley. The Eye Bank works with a number of hospitals, including New York Downtown Hospital in Lower Manhattan.

The Eye Bank’s executive director said the process of matching donors and recipients was gratifying.

“Working here gives you a perspective that you don’t get in other places because on a daily basis we’ve got this list of patients waiting for cornea transplants,” she said. “How is that going to happen? To know there is only one way for that to happen; that life and death are what makes the world go round and each day we hope that someone does hear the message that they can make a difference in somebody else’s life and consent to donate.”

Currently there is state legislation being debated which would give people who join the New York State Organ and Tissue Donor Registry the final say in the decision to donate organs. Today, even if a person is listed in the registry, the family of the deceased still makes the final decision if the organs are donated. The Eye Bank encourages early discussion among family members of wishes for organ donation, and hopes more people sign up for the registry.

Last week, The Eye Bank honored its first recipient Young Ambassador Scholarship. The program was created to encourage young people’s efforts to educate the community about eye donation. The recipient won the $1,000 scholarship for collecting the largest number of donor registration forms recorded in a single drive.

The patient with keratoconus wrote to her donor family through the Eye Bank, thanking the family for the donation and telling them a little about herself. She hasn’t heard back yet, but understands that it may take some time before a family is ready to communicate.

“I can see now because of someone that gave up their cornea. I’m able to travel the world, I’m able to Rollerblade, I’m able to be normal,” she said. “You just get a very different perspective; I think you’re more thankful of little things when you receive a gift like that.”

Since keratoconus worsens over time, the keratoconus patient knows her right cornea may reach the stage where it will also need to be replaced. If she reaches that point, she is willing to go through with another transplant. Until then, she takes the recovery process very seriously and looks forward to an even more active life full of scuba diving and traveling.

“I think about the guy that gave up his cornea for me and the people that donate,” she said. “They really gave me a gift.”

To learn more about becoming a cornea donor, call 212-742-9000 or visit www.eyedonation.org.