Macular Degeneration

Macular degeneration is the number one cause of blindness in the United States. It occurs when the macula -- a part of the retina in the back of the eye that ensures that our vision is clear and sharp -- degrades or “degenerates,” causing a progressive loss of vision.

The “dry” form of macular degeneration has no treatment, but the “wet” form may be helped by laser procedures if it is detected early. Because of this, and because vision lost to the disease is irrecoverable, regular eye exams are highly recommended. Certain vitamins and minerals may also aid in slowing or preventing vision loss.

Symptons often associated with macular degeneration include:

• A gradual loss of ability to see objects clearly
• A gradual loss of color vision
• Distorted vision
• A dark or empty area appearing in the center of the vision

Dry eye is the term for when your eyes are insufficiently moisturized, either because they do not produce enough tears or because the tears have an improper chemical composition. It often occurs during the natural aging process, but it can also form as a result of eyelid or blinking problems, certain medications (antihistamines, oral contraceptives, antidepressants), climate (low humidity, wind, dust), injury, and various health problems (arthritis, Sjogren’s syndrome).

In addition to being uncomfortable, dry eye can damage eye tissue, scar the cornea and impair vision. Dry eye is not preventable, but it can be controlled before harm is done to your eyes. Regular eye exams can detect dry eye early, even before symptoms become noticeable.

Symptoms include:

• Irritated, scratchy, dry, uncomfortable or red eyes
• A burning sensation or feeling of something foreign in your eyes
• Blurred vision

Treatment for dry eye can take many forms. Non-surgical methods include blinking exercises, increasing humidity at home or work, and use of artificial tears or moisturizing ointment. If these methods fail, small plugs may be inserted in the corners of the eyes to limit tear drainage, or the drainage tubes in the eyes may be surgically closed.

Corneal Transplants/DSEK

Bubble Vision

By David Bruce

david.bruce@timesnews.com

Jane Mallory's left eye was betraying her. Her vision was so cloudy that she needed a magnifying glass to read. Every time Mallory blinked, it felt like someone had tossed gravel in her eye. "It's irritating more than anything, " said Mallory, 73, while awaiting a cornea transplant at the Saint Vincent Surgery Center. "I use drops and ointments, but it seems to be getting worse." Mallory's ophthalmologist, Rob Haverly, M.D., diagnosed her with Fuch's dystrophy, an inherited disease that damages the cornea, the clear surface on the front of the eye. The only way to restore Mallory's vision was with a cornea transplant. Instead of a traditional transplant, however, Haverly offered her a new version called Descemet's Stripping Endothelial Keratoplasty, or DSEK.

"Full cornea transplants work, but the recovery time can take six months to a year, " Haverly said. "With DSEK, a patient can regain their vision within six to eight weeks." Patients recover quicker because Haverly doesn't replace the entire cornea with a donor cornea. He instead removes only the diseased layer of cells at the back of the cornea, an area called the endothelium, and replaces it with a donor's endothelium. "You also don't have the same risk of bleeding or infection because you haven't removed the entire front of the eye and exposed it to the elements, " Haverly said. A shorter recovery time and less chance of infection appealed to Mallory, who underwent DSEK on Wednesday at the Saint Vincent Surgery Center.

Haverly began the procedure before Mallory was wheeled into the operating room. He used a specialized tool to slice the endothelium from a donor cornea, then punched the center out of it for transplant. "You could use one donor cornea for two transplants, if the patients required different parts of it, " Haverly said. "Usually we use each one once, though."

Mallory was awake but lightly sedated when she was wheeled into the operating room. Her eye was then numbed with a local anesthetic. Haverly cut a flap in the side of Mallory's cornea and cut out her diseased endothelium. He slid the donor tissue, which was folded like a soft taco, into the gap and opened it up. The entire procedure took less than 20 minutes and required one suture, compared to about 45 minutes and between 16 and 20 sutures for a full cornea transplant. Once the donor tissue was placed into position, Haverly added an air bubble beneath it. "We do that to hold the donor tissue in place until it attaches to the patient's tissue, " Haverly said. "If we didn't, the donor tissue would just float around in the eye."

Mallory had to lie flat on her back for an hour after surgery to keep the air bubble in place, and was asked to lie that way as much as she could for the next 24 hours. The donor tissue eventually attaches itself and the air bubble dissolves on its own, Haverly said.

DSEK isn't an option for every patient who needs a cornea transplant. Only people who have damage or disease to their endothelial cells can have the procedure, which would account for two-thirds of the 35,000 cornea transplants done each year in the United States. Mallory will know by the first day of spring if her vision will be strong enough to read without a magnifying glass.

Betty Wilson, who received a DSEK transplant from Haverly in October, said her vision is good and her right eye no longer feels like it has an eyelash in it all the time. "He had to readjust the air bubble a couple of times, but the result was good, " said Wilson, 79, who needed the procedure after her a previous cornea transplant failed. "I was fully healed in a little more than a month, and my vision is almost good enough now that I don't even need glasses."

Reprinted with permission of Times Publishing Company, Erie, PA. Copyright 2007