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Cornea

The cornea is the clear tissue on the front surface of the eye that allows light to enter the eye and be focused on the back of the eye. It also acts as a protective barrier from dirt, germs, and other debris that may enter the eye and cause damage. There are numerous eye conditions and diseases that can affect the cornea. The fellowship-trained cornea specialists at Vantage EyeCare have experience in treating the full range of corneal diseases including:

Corneal Dystrophy

Corneal dystrophies are a group of rare genetic eye disorders. Because they are a genetic disorder, corneal dystrophies run in families. There are many different types of corneal dystrophies but they all cause a buildup of foreign material in the cornea. The foreign material may develop in one or more of the individual layers that make up the cornea. In most cases of corneal dystrophies, both eyes are affected. 

Corneal dystrophies tend to develop slowly over the years. Some people may not show any symptoms, while in others, the cornea will become cloudy, leading to blurry or loss of vision. Other symptoms include corneal erosions, watery eyes, and sensitivity to light.

Treatment for corneal dystrophies will vary based on the type as well as severity of the disease. If there are no symptoms, then it may only require monitoring to observe any changes. If the disease progresses, eye drops or ointments may be needed. For persistent corneal erosion, other treatment options include specialty contact lenses, cornea scraping, and laser therapy. In severe cases, corneal transplant surgery, DSEK, or DMEK may be recommended.

Corneal Edema

Corneal edema is the excess buildup of fluid in the cornea which leads to swelling of the cornea. If corneal edema is left untreated, it can cause cloudy, blurry vision, haloes around light, and eye pain. Corneal edema can occur as a result of trauma to the eye, having cataract surgery, using certain medications, or increased eye pressure. Depending on the cause and severity of corneal edema, treatment options can range from eye drops and ointments to corneal transplant surgery.

Keratoconus

Keratoconus is an eye disorder in which the normally round cornea is irregularly shaped like a cone. This causes the light entering the eye to be focused incorrectly and vision becomes distorted. People diagnosed with keratoconus may experience blurry, distorted vision, sensitivity to light, and glare. As it progresses, increased nearsightedness or astigmatism may also occur. The exact cause of keratoconus is not known but it often develops as a teenager or young adult. Risk factors of keratoconus may include family history of keratoconus, eye rubbing, and certain conditions such as Down syndrome. To treat keratoconus in the early stages, glasses and soft contact lenses can help correct vision. If glasses and soft contact lenses no longer provide adequate vision correction, other specialty contact lenses such as rigid gas permeable, hybrid, and scleral contact lenses may be used. For advanced keratoconus, other treatment options include corneal collagen crosslinking, Intacs (corneal inserts), and corneal transplant surgery.

Pterygium

Pterygium is a benign growth that forms on the white of the eye. It is often called surfer's eye because it affects those who spend a lot of time in the sun. It typically starts to develop on the side of the eye closest to the nose and spreads to the pupil area. Often, the pterygium may be mild and there will be no symptoms. In other cases, symptoms of pterygium can include:

  • Feeling like something is in your eye
  • Red, irritated eye
  • Burning sensation
  • Itchy eye
  • Gritty sensation

The main cause of pterygium is long-term exposure to UV light. Therefore, it is important to wear sunglasses to protect your eyes from the damaging effects of UV light. Other causes of pterygium include exposure to dusty and windy environments. If the pterygium is mild, treatment is typically not necessary and may only require monitoring by your eye doctor. Lubricating eye drops may be used to help relieve irritation. If the pterygium grows larger and begins to interfere with your vision, your ophthalmologist may recommend it be surgically removed.

Corneal Treatments and Surgeries

There are many conditions which can cause damage to the cornea including corneal dystrophy, kerotoconus, and pterygium. Many corneal conditions can be treated using medications while others may require more advanced treatment or surgery. The cornea specialists at Vantage EyeCare perform state-of-the-art procedures to help improve vision problems caused by cornea disorders. Common procedures utilized include:

  • Corneal collagen crosslinking
  • Corneal transplant surgery
  • DSEK - Descemet's Stripping Endothelial Keratoplasty
  • DMEK - Descemet's Membrane Endothelial Keratoplasty

What is Corneal Collagen Crosslinking?

Corneal collagen crosslinking is a minimally invasive procedure performed in-office. It is an effective technique for treating keratoconus, a disorder in which the cornea is cone-shaped rather than round. Corneal crosslinking is performed by applying riboflavin, also known as vitamin B2, and UV light onto the surface of the eye. This combination helps strengthen the thin cornea and prevents further changes from happening to the shape of the cornea.

The procedure takes approximately 60 minutes. First, an anesthetic eye drop is applied to numb the eye. Then, the epithelium, the outer layer of the cornea, is removed before applying the riboflavin. This helps the cornea absorb the riboflavin and UV light better. Next, riboflavin eye drops are applied and the patient is directed to look into a soft blue ultraviolet light for 15-30 minutes. After the procedure, a bandage contact lens may be used to help with the healing process. The recovery time will vary for each patient.

What is Corneal Transplant Surgery?

Corneal transplant surgery replaces damaged corneal tissue with healthy corneal tissue acquired from a donor. Several corneal conditions can be treated with corneal transplants including keratoconus, Fuch's dystrophy, corneal ulcers, and corneal scars as a result of trauma or infection. Corneal transplant surgery is typically performed if other treatment options have not been successful.

A corneal transplant surgery typically takes less than an hour to complete. Before beginning the procedure, anesthetic eye drops are applied to numb the eye. During the procedure, a circular section of the cornea, containing all layers of the cornea, is removed and replaced with the donor cornea of a similar size. Sutures are used to secure it in place and the recovery period is long, often taking up to a year before vision is at its best.

What is DSEK?

DSEK, or Descemet's Stripping Endothelial Keratoplasty, is a type of corneal transplant surgery. In this procedure, only the innermost layer of the cornea, called the endothelium, is removed. However, it is replaced with both an endothelium layer and a stroma layer from the donor, providing added thickness for easier management during the transplant. A small incision is used to perform this procedure so sutures are generally not required.

What is DMEK?

DMEK, or Descemet's Membrane Endothelial Keratoplasty, is a type of corneal transplant surgery. It is similar to DSEK in that the damaged endothelium layer is removed. However, DMEK only replaces it with an endothelium layer from the donor; it does not use the stroma layer. As a result, the transplant tissue is very thin. This makes it more challenging to work with but it does have a quicker recovery time.

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