Cornea Research Foundation of America

We Pursue Eye Research

What Our Studies Mean To You

One of the ways we share our research findings with people around the world is by publishing articles in peer-reviewed eye journals. Below we provide user-friendly explanations of our recent findings.

One Out of a Hundred
What’s inside your eye?
LASIK Update
New transplant technique
Glaucoma and DSEK Transplants
Preventing Rejection
Transplants That Last a Lifetime
Will DSEK grafts survive as long as traditional transplants?
Cornea transplant rejection – who’s at risk?

December 2009

Did you know that one out of every 100 people who has a corneal transplant in the USA has it done at Dr. Price’s private practice, Price Vision Group?  People come here from all over the country for transplants because of Dr. Price’s experience and reputation and because we are continually improving techniques through our research at the Cornea Research Foundation. Patients come expecting us to be skillful. They often leave surprised and touched by the care and compassion they receive from Foundation and Price Vision staff.

Many of our transplant patients come to have DSEK (also called DSAEK), the small incision technique that allows them to recover quickly with minimal activity restrictions. Recently we’ve found that making the transplant extremely thin - just a single cell layer - can give patients the crispest, clearest vision.  However, such a thin graft is very fragile - it can tear easily and is hard to attach. So we’ve been working for the past 2 years to make this technique, known as DMEK, more reliable. 

In order to share our findings with eye surgeons around the world, we recently published an article in the leading clinical eye journal, Ophthalmology, describing the DMEK technique we use and reporting the outcomes in our first 60 patients.  Ours was one of five articles highlighted in “This issue at a glance”.  Here’s a link: http://www.ncbi.nlm.nih.gov/pubmed/19875170

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December 2009

Surprisingly little is known about the composition of the fluid that fills the front part of your eye. This fluid, called the aqueous humor, supplies nutrients to your cornea and bathes other structures in the front part of your eye. Understanding the composition of the aqueous humor may help in our work to expand cells from donor corneas to extend the limited supply of donor corneal tissue. 

To determine the composition of the aqueous humor, we asked 12 healthy patients scheduled for cataract surgery if they would allow us to keep and analyze the fluid removed from their eye during the procedure – this fluid is normally just discarded. We analyzed the aqueous humor from these patients using a cutting edge technique that provided much more detailed information than previously available. We published these findings in the journal, Molecular Vision. To access the article please click the following link: http://www.molvis.org/molvis/v15/a289/

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November 2009

Did you know that it’s been almost 20 years since Dr. Francis Price, Jr. pioneered LASIK in Indiana?  Since then we have continued to introduce the latest technology to minimize complications or the need for an enhancement. 

For example, 5 years ago, Dr. Price introduced “all laser LASIK” to Indiana, because making the flap with a laser practically eliminates flap-related complications.  Dr. Price also noticed that if the flap ever needs to be lifted to perform an enhancement, laser-created flaps resist growth of surface cells into the interface.

Dr. Erik Letko, an ophthalmologist and staff physician at Price Vision Group, has written an article sharing this important finding with other LASIK surgeons in the December 2009 issue of the Journal of Refractive Surgery.
The article describing these results is on this link: http://www.ncbi.nlm.nih.gov/pubmed/19921773

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October 2009

Today, many cornea transplant patients benefit from the small-incision technique known as DSEK or DSAEK, which provides faster recovery with fewer activity restrictions than a traditional full thickness transplant. However, vision is not always quite as clear as we would expect with DSEK or DSAEK.  Therefore, Dr. Price has developed a new technique known as DMAEK, that provides clearer vision – typically a line better on the eye chart. With DMAEK the donor tissue is very thin in the center and the edges are somewhat thicker for easier handling. We described this new technique in the October issue of the Journal of Cataract and Refractive Surgery. The article is available through this link:  http://www.ncbi.nlm.nih.gov/pubmed/19781456

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September 2009

Glaucoma and corneal problems often go hand in hand.  Unfortunately, glaucoma patients tend to have poorer outcomes with standard full thickness transplants than patients without glaucoma.

We were interested to learn how our glaucoma patients would do with the new small incision DSEK transplants. In collaboration with glaucoma specialists at University of Illinois, we reviewed outcomes from 400 patients and found that DSEK provides our glaucoma patients with the same good visual results that it provides for our patients without glaucoma.  This is very good news for glaucoma patients.  We published these findings in the October issue of Opthalmology: http://www.ncbi.nlm.nih.gov/pubmed/19643499

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September 2009

We know that using steroid eye drops helps prevent cornea transplant recipients from rejecting their new donor graft. Yet we aren’t sure how long or how much is the right amount to both minimize the risk of rejection and also minimizing the risk of harmful side effects.

To determine what dosing regimen corneal specialists think works best for their patients, we surveyed 250 doctors from around the world who took our DSEK cornea transplant course. The variation in their responses was surprising!  You can access the article we published in the journal Cornea through this link:  http://www.ncbi.nlm.nih.gov/pubmed/19654531

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May 2009

When a young person needs a cornea transplant, we would like to give them one that will give them excellent vision and last the rest of their lifetime. We’ve found that standard full thickness transplants (penetrating keratoplasty) provide good vision, but eventually the endothelial cell layer on the back of the donor cornea wears out and the graft has to be replaced.

What can we do to help someone’s graft last a lifetime? For patients who have scarring or distortion in the front part of the cornea, we can replace everything down to the endothelial cell layer. This will give them excellent vision, fast healing, and a graft that may never need to be replaced! 

This procedure is called deep anterior lamellar keratoplasty or DALK. It’s more challenging than a regular graft because it’s hard to cleanly separate the endothelial cell layer from the rest of the cornea.  Dr. Price has found a way to make it easier by using a femtosecond laser to precisely cut a zigzag shaped incision very deep into the cornea.

We described this technique in the May issue of the Journal of Cataract and Refractive Surgery. If you’d like to learn more about it, a copy of the article may be found using this link: http://www.ncbi.nlm.nih.gov/pubmed/19393877

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March 2009

Since 2003, we have helped pioneer the small incision transplant technique known as DSEK. This technique is safer than a traditional full thickness transplant and allows patients to recover more quickly.  One concern was that inserting the donor tissue through a small incision seemed to cause some damage to the endothelium, the critical cell layer lining the inner surface of the cornea. So it was not clear whether DSEK grafts would last as long as full thickness grafts. Therefore, over the past 6 years we have carefully monitored the health of the corneal endothelium in hundreds of transplant patients. Fortunately, we’ve found that within 3 to 5 years the corneal endothelium appears at least as healthy in DSEK grafts as in traditional full thickness grafts. We shared this information with other eye doctors in the March issue of Ophthalmology in an editorial entitled: “Does endothelial cell survival differ between DSEK and standard PK?”

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February 2009

The new small incision transplant technique known as DSEK or DSAEK now accounts for over 1/3 of the transplants performed in the USA, yet no one had studied the signs and risk factors for transplant rejection with this type of transplant.  Therefore we carefully documented the signs, symptoms and occurrence of graft rejection episodes in almost 600 of our DSEK and DSAEK graft recipients. 

Welcome news is that the risk of a graft rejection episode seems to be slightly lower with DSEK compared with a full thickness transplant. We also learned that compared with Caucasians, African Americans had 5-fold higher risk of experiencing a graft rejection episode. We think this is because darkly pigmented eyes may be more prone to develop inflammation and an aggressive immune response.

We found that almost 1 out of every 3 patients develops elevated pressure inside the eye sometime during the first year after the transplant because of the steroid eye drops that are used to help prevent graft rejection. To reduce the eye pressure in these patients, who are known as “steroid responders”, we often have to reduce the steroid strength or dosing frequency. Unfortunately, this increases the risk of a graft rejection episode. Luckily, we were able to save the graft in most of the patients who experienced a corneal transplant rejection episode. The key is early detection!  To learn more about our findings in this study, please click the following links: http://www.ncbi.nlm.nih.gov/pubmed/19019931 and http://www.ncbi.nlm.nih.gov/pubmed/19019938

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