The Cornea Research Foundation is actively involved in evaluating a new corneal strengthening treatment that may help patients with keratoconus.
.: National Keratoconus Foundation
Keratoconus (KCN) is a disease characterized by thinning and protrusion of the cornea, resulting in an irregular, conical shape. Irregular astigmatism occurs as the condition progresses, and results in blurred vision which can be impossible to correct with spectacles. Usually the disease occurs in both eyes, and involves the central cornea with the apex of the cone just below the visual axis.
Approximately 100 to 200 of every 100,000 people are afflicted with keratoconus and it occurs in all races and usually affects both eyes. Sensitive techniques, such as corneal topography, often detect KCN in both eyes in cases thought to be only in one eye based on physical examination and refraction. The disease often starts in puberty and slowly progresses over decades and then stabilizes. In progressive cases, severe irregular astigmatism and scarring may require a corneal transplant in order to restore useful vision to the eye.
Heredity of the disease has not been clearly established. While there are families in which multiple persons are affected, factors such as allergic conditions and contact lens use make analysis difficult. As a general rule, chances of a blood relative developing clinical keratoconus are less than 10%.
Associated conditions include atopic disease (atopic or allergic dermatitis, allergic rhinitis, asthma), Down's syndrome (5-8 % of Down's patients), and connective tissue disorders (Ehlers-Danlos syndrome and osteogenesis imperfecta). Chronic eye rubbing is associated with KCN and may accelerate progression of the disease.
Findings in keratoconus include protrusion of the cornea, striae or wrinkles of the posterior cornea (Vogt's striae), superficial scarring of the anterior cornea, and staining of the corneal surface epithelium with iron (Fleischer ring). Corneal hydrops, or marked swelling of the cornea may occur when severe bulging of the cornea results in a tear in the deepest layer of the cornea (Descemet's membrane), allowing fluid from the inside of the eye to permeate the cornea. Severe haziness, often accompanied by blisterlike lesions of the superficial cornea, result in impairment of vision and discomfort.
Treatment of keratoconus can be divided into three tiers. For patients who can be corrected with spectacles, no other treatment is necessary, although behavior such as eye rubbing should be modified. Control of systemic allergic disease with antihistamines may help achieve this goal by decreasing itching of the eye and eyelids.
When irregular astigmatism makes clear vision with spectacles impossible, rigid gas permeable (RGP) contact lenses are the next stage of therapy. The rigid lens masks the underlying irregular cornea and functions as the new refractive surface of the eye, with the tear film filling in the space between the back of the contact lens and the front of the eye. However, the irregular shape of the cornea makes fitting these lenses difficult, and the experience and expertise of the contact lens fitter is very important in determining the success of this intervention. New surgical techniques such as deep anterior lamellar keratoplasty and intrastromal ring segments (Intacs TM) are also surgical options.
If the condition progresses to the point where a contact lens cannot be fit, surgery may be indicated. Small plastic ring segments placed in the cornea can produce a more regular corneal surface in about 2 out of 3 KCN patients. A new treatment to strengthen the cornea is also being evaluated to halt the progression of keratoconus. As a last resort, a cornea transplant may be considered to restore a more normal shape to the cornea. Data from the CRFA database of corneal transplant shows that transplants performed for keratoconus are in the highest category for successful outcome. Newer transplant techniques, such as deep anterior lamellar keratoplasty (DALK) are used by surgeons at Price Vision Group to help minimize the risk of graft rejection.
For more information, go to: www.nkcf.org.
Life Changing Surgery Described in Celebration of Light
Restored sight is a miracle for energetic Pastor Clarence Moore
Pastor Clarence Moore of the Northside New Era Baptist Church regards his inner city ministry as his life’s calling. He’s grateful for the life-changing surgery he had with Dr. Francis W. Price, Jr. which has enabled him to carry out his life purpose.
Pastor Moore’s vision challenges began in his early twenties. One day a co-worker came to his cubicle and said, "Clarence, do you realize how close you are holding that paper to your face?" It dawned on him then that he had gradually adjusted to a significant loss of sight and it shocked him to learn how much accommodation he had made just to carry out his work. By the time he graduated seminary and became a minister, he could not see his Bible or sermon notes. As a result, he felt these limitations were not what God wanted. There had to be a better way and he decided that it was time to do something about his sight.
His optometrist treated him for keratoconus and astigmatism and referred him to an ophthalmologist in Kokomo, Indiana. After the exam, Pastor Moore told him he wanted a second opinion and asked him to recommend someone. It was Dr. Francis W. Price, Jr. in Indianapolis.
Pastor Moore describes his first meeting with Dr. Price, “Although Dr. Price was a young man, he seemed very knowledgeable and he had experience with all kinds of things that impacted the cornea.” It was the year 2000 and he had his left cornea, the “worst” eye, replaced with a transplant. During surgery, he was put to sleep and when he woke up, he had no pain in his eye at all. Twenty-four hours later, Dr. Price took the bandages off. Pastor Moore looked at him with awe and said, "Wow, I can see you really well. I know that God has used you to work a miracle.”
In 2004, he had a corneal transplant in his right eye. Dr. Price predicted that it would do better than the first transplant because, in the interim, he had gained even more experience and the technology had gotten better. Pastor Moore’s left eye had become dominant and the right eye had become dependent. With correction in both eyes his overall vision was much better. Dr. Price did two relaxing incisions after the transplant to improve his vision as much as possible and he has had LASIK twice. His restored vision became 20/30 – another of God’s miracles from his perspective.
Pastor Moore summarizes the experience this way, “The miracle of sight allows this preacher to “…rightly divide the word of Truth…” as I preach the Gospel. The sight that has come through the hands of Dr. Price allows me to not just function as an average pastor, but my sightedness has allowed me to use all of my gifts with greater confidence. I owe my ministerial work to him and his staff. God uses each of them to bring miracles into our lives.”
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