Turner Eye Institute wishes everyone a happy 4th of July.  We would like remind everyone to use protective eyewear where appropriate in using fireworks or other celebrations.  Eye safety should be on everyone’s minds when handling pyrotechnics or using fire, such as with grills.

The new C-3R treatment with Riboflavin has shown success since being introduced by Dr. Stephen Turner in Northern California.  Recent studies are showing that Riboflavin treatment followed by UV light can improve the cornea with keratoconus.

Patients with keratoconus should consult with a corneal specialist ophthalmologist regarding their condition.  The doctor might advise C-3R treatment with riboflavin or might suggest intacs.  Many surgeons have used both with good results.

Dr. Stephen Turner practices in the San Francisco Bay area and is a corneal specialist who treats patients with keratoconus.  He has offices in San Francisco, San Leandro (in the East Bay near Oakland), Concord (near Walnut Creek), and San Jose.  Patients interested in discussing their vision needs should contact Turner Eye Institute for an appointment.

http://www.pr.com/press-release/27461

Collagen Crosslinking treatment is a new hope for keratoconus patients. This treatment helps arrest the progression of the disease, and the first IRB approved study in India has been initiated at Cornea Clinic, Hyderabad, by Dr Rajesh Fogla, senior corneal surgeon. Keratoconus patients can enquire for eligibility for this treatment.

Hyderabad, India, January 19, 2007 — Keratoconus is a corneal disease affecting 1 in 2000 individuals. The disease usually starts in young adults, and is characterized by progressive thinning and outward protrusion of the cornea. (Cornea is the clear structure in front of the human eye responsible for focusing of rays of light into the eye for a clear image.)

The cornea takes a conical shape, and produces astigmatism due to which the rays of light cannot be focused properly, resulting in deterioration of the quality of vision. In the early stage of keratoconus, vision can often be improved using cylindrical correction in the glasses. However, in later stages most patients require rigid gas permeable lenses for improvement in quality of vision. Intacs are plastic ring segments which can be inserted into the mid-peripheral cornea to produce flattening of the central cornea. This results in reduction of the severity of keratoconus, and improves both vision & contact lens fitting to a certain extent. However it does not affect the progression of keratoconus. It is estimated that almost 21% of keratoconus patients ultimately progress to an advanced stage of disease requiring corneal transplantation surgery to restore corneal architecture and improve eyesight.

Dr Rajesh Fogla, Senior Consultant, Corneal Surgeon at Apollo Hospitals, Hyderabad, India, has special interest in Keratoconus & its management. He has been providing specialized contact lens fitting for keratoconus patients, and also performs deep anterior lamellar keratoplasty (DALK) surgery. Compared to conventional full thickness corneal transplantation surgery, DALK surgery has several advantages. Unlike conventional corneal transplantation surgery wherein a central disc of full thickness cornea is entirely replaced with donor tissue, in lamellar keratoplasty the healthy inner layer of the patient’s cornea is retained and not sacrificed. (This layer called the endothelium is the most vital layer of the cornea responsible for maintaining the corneal clarity). Only the outer 80 -90% of the cornea is replaced with healthy donor tissue.

The other advantage of lamellar keratoplasty, is that as the inner layer is retained, the immune cells of the body do not recognize the outer donor tissue as being foreign. Hence there is no risk of endothelial rejection with lamellar keratoplasty, unlike full thickness graft wherein steroid therapy has to be continued for years to prevent graft rejection episodes. Dr Fogla has been performing deep anterior lamellar keratoplasty since 1998, and currently performs the same in all his patients with advanced keratoconus. He has been conducting instruction courses at various national and international meetings on the same subject.

Dr Fogla, has started performing collagen crosslinking treatment using the photo-sensitizer riboflavin (Vitamin B2) and ultraviolet light (365nm) exposure for keratoconus patients. In extensive experimental studies, researchers have demonstrated a significant increase in corneal rigidity / stiffness after collagen cross-linking using this riboflavin / UVA treatment. The 3 & 5 year results of Dresden clinical study in human eyes has shown arrest of progression of keratoconus in all treated eyes. (Wollensak G. Crosslinking treatment of progressive keratoconus: New Hope. Current Opinion in Ophthalmology 2006; 17: 356 - 360).

Keratoconus patients now have a new hope, a new treatment modality which can arrest the disease progression and thereby prevent the need for surgical intervention in future. Although the procedure does not provide a cure for keratoconus, it certainly can stop its progression and patients can continue using their glasses or contact lenses for improved eyesight. Hence attempt should be made to diagnose keratoconus early enough and stop its progression using collagen crosslinking. Corneal topography can detect keratoconus much before it can be picked up on a routine eye examination. Hence this test should therefore be performed in all cases with high astigmatism, i.e., cylindrical power to detect keratoconus at an early stage. Further ongoing studies will help establish collagen cross-linking treatment as the primary modality of treatment for keratoconus.

Scientists are discovering new biomaterials for use in bones, tissues, and other locations throughout the human body.  We are following recent advances in corneal technology with interest.

Currently, one of the best treatments for keratoconus is through the use of intacs to help strengthen and support the cornea.  While this is not a cure for keratoconus it has helped many patients with keratoconus to see more clearly and perhaps avoid the worst of this often debiltating condition.

It is likely that future technologies will follow a similar method to intacs in providing a support structure for the cornea that can help withstand the weakening effects of this collagen disorder.  It can be expected that newer biomaterials will be developed that are smaller and stronger.  Future advances in nanotechnology might build strong support structures within the cornea that can help delay or counteract the effects of keratoconus.

Currently, patients with keratoconus will often be advised that intacs can provide a level of relief and perhaps slow the effects of keratoconus.  Some studies have shown that contact lenses might hasten the onset of keratoconus so many surgeons are suggesting that keratoconus patients using contact lenses should undergo intacs treatment before vision is substantially affected. 

Beginning October 1st, 2007, Turner Eye Institute and Horizon Vision Centers will relocate the Keratoconus Treatment Center branch in San Jose.  The new San Jose Keratoconus Treatment Center will be located at 50 E. Hamilton, Suite 100, Campbell, California.  The telephone number is 408-374-2020. 

The new Horizon and Turner Eye Institute Keratoconus Treatment San Jose branch is located in a small mall complex inside the two-story white spanish style building that fronts Hamilton Ave.

Directions:

From Santa Cruz Area:

Head North on CA-17 (signs for San Jose)   Take Exit 25 towards Hamilton Ave.  Turner Left at creekside Way.  Turner Left at E. Hamilton Ave.  End at 50 E Hamilton Ave.

From San Francisco/Peninsula

Take I-280 South towards San Jose.  Merge onto CA-17 South towards Santa Cruz.  Take the Hamilton Exit - Exit 25.  Keep right at the fork to go on E. Hamilton Ave.  End at 50 E. Hamilton Ave.

From the East Bay

Take the I-880 South towards San Jose.  I-880 South becomes CA-17 South.  Take the Hamilton Ave exit - Exit 25.  Keep Right at the frok to go on E. Hamilton.  End at 50 E. Hamilton Ave.

Welcome everyone to our new location in San Jose.  The San Jose Keratoconus Treatment center in Campbell will continue to provide the same advanced treatments and excellent service as all our Keratoconus Treatment locations throughout the San Francisco Bay Area, including Oakland, San Francisco, and Walnut Creek.

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.