The incredible progress made in the management and maintenance of clear corneas has been inspiring. In my career we have gone from primitive treatments to try to restore sight to advanced micro-surgical and medical management that seems almost like a dream.
The cornea is the “watch glass” cover of the eye. The color of the eye is the iris, which is like the face of a watch, the cornea is like a watch glass cover that domes over the front of the eye. The pupil is a “black hole” in the center of the iris that allows light to strike the most posterior structure of the eye, the retina.
If we start from the front, we do not look through the front of the “watch-glass” like the face of our wristwatch but the all-important film that coats the front of the eye with a critical tri-layer film that acts like a lens due to its following of the curve of the front of the eye. We can alter that curve with contact lenses and those lenses rest on the film Any disturbance to this film results in poor vision. Google “Gulden Ophthalmic Siepser Dry eye model to learn some interesting facts”. Our dry eye center devotes itself to improving the tear film and maximizing patient’s vision.
There are now exciting new drugs that can stimulate the eye to regenerate certain layers with drops alone. Oxervate is a growth hormone and Nitursidil is thought to stimulate the inner most layer of cells called the endothelium. The results of these drops along have been just short of a miracle.
The tissue of the cornea can display a multitude of genetic defects, from roughening to nodules, to lose layers and disturbances that inhibit focus. The superficial layers of the eye can now be replaced with Stem Cells to replace genetically defective cells with more robust on lays of healthy stem cells. The treatment of Saltzman’s Nodular Degeneration. Anterior Basement Membrane Disease and superficial corneal scarring have been revolutionized with the use of stem cell transplants. At SLEC we have done thousands of these procedures.
The most exciting part of deep cornea disease is our ability to remove the offending layer and replace that alone. In the past if some part of the cornea was damaged our only option was to replace the entire thickness of the cornea, a full thickness Penetrating Keratoplasty. This operation took almost 2 hours and needed 32 sutures to fix the graft in place. Now we can repair Fuch’s dystrophy and other endothelial diseases that lead to blindness with the replacement of the thin inner layer called Descemet’s membrane, now a 20-minute operation with amazing results.
Of course, using layers on the Cornea to correct for refractive error is our stock in trade. We have done tens of thousands of LASIK and that is a sculpting of the front surface of the cornea to decrease the dependence on contacts and glasses. This creates a type of living contact lens right on the surface of the cornea.
Yes, corneal care has been revolutionized and these are just a few of the latest techniques we use for a myriad of corneal diseases.