Dr. Matthew Robinson and Dr. Jason Mayer are our board certified and fellowship trained corneal specialists.
Keratoconus is a disease that causes a progressive thinning of the cornea (the front clear portion of the eye). As a result, the normal outward pressure of the eye causes the cornea to bulge into a cone-like shape. Although keratoconus rarely results in absolute blindness, it can significantly impair vision and approximately 20% of patients may require a corneal transplant.
While the cause of keratoconus is somewhat unknown, there is evidence to support that it has genetic origins that are possibly worsened by environmental factors. Keratoconus typically affects both eyes, but progresses at varying rates. Characteristically it begins in the teen years, gradually worsening and eventually stabilizing in the 30s and 40s.
Keratoconus is estimated to affect 1 in 2,000 people of all races. Treatment typically consists of fitting the patient with rigid contact lenses to address the bulging cornea with the objective of improving vision. A proper contact lens fit by Dr. Chaney and Dr. Marske, trained professionals in the treatment of keratoconus, is essential in obtaining the best possible vision as well as physical comfort.
New Options for Keratoconus
The Eye Center of Northern Colorado now offers Intacs® corneal implants, a unique new option to improve vision and potentially postpone a corneal transplant for many patients. Intacs are indicated for the correction of nearsightedness and astigmatism for keratoconus patients who are unable to achieve proper vision with contacts or glasses.
Dr. Matthew Robinson, a fellowship trained corneal specialist at the Eye Center of Northern Colorado, performs the Intacs procedure as a less invasive alternative to a corneal transplant. Intacs can improve functional vision allowing the need for a corneal transplant to be delayed. Intacs patients who might later require a corneal transplant are able to do so without complications.
The objective of the Intacs procedure is to provide the keratoconus patient with ability to attain improved functional vision with glasses or contacts. Other benefits of Intacs include:
- Safe, removable, replaceable
- Lessening of myopia and astigmatism associated with keratoconus
- Restores the cornea to a more natural shape
- Minimally invasive surgical procedure
- Short recovery period
- Improved quality of life
- May delay the need for corneal transplant
Clinical trials are currently underway in the United States to evaluate the effectiveness of Corneal Collagen Crosslinking (CXL) for patients with keratoconus and other conditions that cause weak corneas. This procedure has been shown to strengthen the eye’s cornea by applying riboflavin, a form of vitamin-B2, followed by treatment with ultraviolet A light.
Types of Corneal Crosslinking:
- Epithelium off: The thin layer covering the eye’s surface is removed, allowing for faster penetration with liquid riboflavin
- Epithelium on (Transepithelial): The epithelial surface is left intact which requires a longer riboflavin loading time
A corneal transplant, also known as a corneal graft or penetrating keratoplasty (PKP), has been the standard treatment to restore functional vision to patients having diseased or injured corneas that cannot be resolved through other treatment. During transplant surgery, the damaged cornea is removed and replaced with a clear donor cornea. Your ophthalmologist will follow you closely during the healing process.
Prior to the development of DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty) eye surgery, penetrating keratoplasty (PKP) was the only method of replacing the diseased endothelial layer of the cornea. DSAEK is the new standard in corneal transplant surgery. With DSAEK, smaller incisions are made, fewer sutures are used and recovery time is reduced, allowing quicker restoration of visual acuity. Dr. Matthew Robinson is one of the few fellowship trained corneal specialists in the region qualified to perform DSAEK. He routinely performs DSAEK in our state-of-the-art outpatient surgery center located on-site at our Fort Collins facility.
Who is a candidate?
Patients who have corneal pathology in the endothelial layer of the cornea are the best candidates for DSAEK (for example, Fuch’s dystrophy). The cells that allow nourishing fluid from the inside of the eye to flow into the cornea are endothelial cells and when these cells become diseased or damaged the cornea may become cloudy. This cloudiness can impair vision to the extent that requires surgical intervention.
How does DSAEK work?
The procedure starts with the patient lying under a specially designed microscope with a topical (eye drop) anesthetic applied to the eye. This ensures no pain during the procedure.
There are two parts to the procedure. First, the unhealthy endothelial cells are removed, as well as the Descemet’s membrane, through a small incision in the side of the cornea. Next, the healthy donor tissue from the eye bank is inserted in its place. The entire procedure takes less than an hour. The patient is sent home and returns the next day for a follow-up appointment.