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.

Keratoconus patients are suffering from a disease that weakens the collagen structure within the cornea.  This results in vision with decreased clarity.  Many patients with keratoconus seek out surgical vision care in order to improve their vision.  Some even wonder whether LASIK can correct their vision.

I recently read a story of a Merritt Island doctor who was fined and ordered to perform 50 hours of community service for inappropriately performing Lasik surgery on a patient in 2000. According to board documents, the LASIK surgeon failed to recognize that the patient had a condition — keratoconus — that prohibits Lasik surgery.

LASIK eye surgery thins the cornea.  It can also lead to a condition known as ectasia.  In this condition, the cornea bulges outward as the pressure within the eye pushes on the thinned cornea.  Ectasia can appear remarkably similar to keratoconus and often a patient with ectasia following LASIK surgery will be diagnosed as having keratoconus.

With a keratoconus diagnosis the patient can then sue the LASIK surgeon for malpractice in performing LASIK upon an eye with keratoconus.  The question is whether the eye had keratoconus prior to LASIK or if the thinning of the cornea caused ectasia which was then diagnosed as keratoconus.  Other factors can also exacerbate the condition.  Some medical problems, such as uncontrolled diabetes, thyroid conditions, or collagen vascular diseases, could also weaken the cornea and result in problems following LASIK eye surgery.

Certainly any patient considering LASIK eye surgery must feel comfortable with the experience and qualifications of the surgeon that they are choosing.  The higher the prescription the more thinning is required so patients with a high amount of near-sightedness would then be at a higher risk for corneal ectasia.  There are in fact other options, besides LASIK, that do not thin the cornea.

While ectasia resembles keratoconus, they are not considered the same disease.  Keratoconus occurs in an eye that has not had LASIK treatment.  Ectasia is the bulging of the cornea that is resulting from a cornea that is too thin, perhaps caused by LASIK treatment.

Both conditions can often be treated similarly however.  Some LASIK patients who are suffering from ectasia can benefit from intacs treatment to strengthen the corneal foundation.  Patients undergoing intacs for ectasia are very similar to patients having intacs for keratoconus. 

If you are interested in having an eye examination to determine if intacs, LASIK, or other treatment is right for you, please contact Turner Eye Institute.  Turner Eye Institute is located in the San Francisco Bay Area and has vision clinics in San Francisco, San Jose, San Leandro, and Concord.  Dr. Turner treats patients throughout the San Francisco Bay Area, including Oakland and Walnut Creek as well as Santa Clara, Hayward, Fremont, and other East Bay cities.

Keratoconus Treatments require a trained corneal specialist with a high degree of experience.  San Jose patients seeking to consult with a corneal specialist about keratoconus are frequently referred by other eye doctors to Dr. Stephen Turner.  Dr. Turner is recognized as a top surgeon in the San Francisco Bay Area and San Jose and is frequently chosen by optometrists as the best selection for patients struggling with corneal problems such as keratoconus.

Dr. Turner has performed well over a hundred procedures on San Jose residents to improve keratoconus, using the intacs frequently to strengthen to cornea and improve stability.  The results have been very promising and have given new hope to many San Jose patients with keratoconus who felt that they were doomed to poor vision without any alternatives.  Dr. Turner’s experience in performing these treatments are further backed by 30 years of medical and ophthalmology experience, specializing in cornea and eye care.

Dr. Turner received specialty training at some of the most recognized eye surgical centers in the world:

While keratoconus is not extremely common, with millions of San Francisco Bay Area residents and millions of San Jose residents, it can be expected that hundreds if not thousands of people are suffering from the effects of keratoconus.  If you live in Northern California, San Jose, or the San Francisco Bay Area, contact Turner Eye Institute.  We can provide you with a complete examination to assess the cornea and determine the best treatment for your eyes.

Turner Eye Institute has offices throughout the San Francisco Bay Area that serve residents of San Jose, San Francisco, Oakland, San Leandro, Hayward, Concord, Walnut Creek, and other Bay Area cities.   If you are a San Jose who has been diagnosed with keratoconus are suspects keratoconus, please contact Turner Eye institute.  We can provide you with a comprehensive eye exam to evaluate your condition and recommend the best possible keratoconus treatment. 

Dr. Turner has now performed over 200 procedures with Intacs for keratoconus and/or ectasia within the San Francisco Bay Area and San Jose. Over the last 5 years we have devoted a significant amount of time investigating and researching the effectivness of Intacs. A successful Intacs implanted patient, will have a reduction in Rx, an improvement in UCVA and BCVA, an easier to fit soft contact lens with better quality of vision and  an arrest in the progression of the cone.

Depending on the case Dr. Turner uses his now significant experience to select one of the following options:

-Select the proper segment thickness, use one or two segments the same size, one or two segments of different sizes (disparate sizes), determine the tension left on the suture or no suture at all, determine if, in the case of just one segment being used, a tunnel should still be created on the unimplanted side.

As you can imagine choosing the proper segment and technique will render a significantly better outcome. We continue to believe that Intacs® are a good and safe alternative to RGP. Worldwide data and our own data indicates that Intacs are a safe procedure to arrest the progression of Keratoconus while improving the quality of vision.