About Cornea Treatments at
Hudson Eye Physicians
& Surgeons, LLC
The corneal specialists and ophthalmologists at Hudson Eye Physicians & Surgeons, LLC, are dedicated to providing you outstanding vision care. We treat diseases related to the cornea and perform corneal surgery, such as PKP, DSEK, and keratoconus in our Essex County and Hudson County offices.
About the cornea
The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. It can be described as being like a window onto the interior of the eye. The main function of the cornea is to allow light to pass into the eye, so that it can reach the lens and then the retina. For this reason, the cornea must be transparent. A second chief function is to help focus light, like a camera lens. Cornea-related issues for our patients in Jersey City, Bayonne, Millburn and the surrounding areas is a vital concern for us at Hudson Eye Physicians & Surgeons, LLC. They will be referred to our Cornea Specialists, Dr. Constad and Dr. Schneider.
Health of the cornea depends on a number of factors, including the health of the conjunctiva and of the eyelids. The conjunctiva is the tissue which covers the front part of the eyeball (but not the cornea) and lines the back of the eyelids. Both the conjunctiva and the eyelids contain glands which make tear fluid. Tear fluid is an essential part of the systems which maintain the health of the cornea. Diseases of the cornea can cause distorted vision or even loss of vision.Keeping the cornea healthy is a vital part in protecting your vision and the health of your eyes.
Corneal Transplants & PKP
Penetrating Keratoplasty (PKP) involves replacing an eye’s scarred, diseased or damaged cornea with clear corneal donor tissue. This procedure can improve visual acuity as it is replacing the cloudy cornea with clear donor tissue.
The donor cornea is prepared to create the corneal “button.” The corneal button will become the transplanted cornea. The diseased, or scarred, cornea is then removed, creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approximately one-third the thickness of human hair, or less). Stitches are typically removed at one year.
Postoperatively, patients should expect very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases.
PKP is suitable for those with corneal decomposition, corneal dystrophies (other than keratoconus) including Fuch’s Dystrophy, corneal trauma, and corneal scarring. Let our corneal surgeons assist you in determining if PKP is the correct option for you.
Descemet’s Stripping with Endothelial Keratoplasty (DSEK) is a newer cornea transplant technique that replaces only the damaged cell layer instead of replacing the entire thickness of the cornea. With this technique, the cornea heals much faster and stronger and the patient’s visual recovery is better. Because this technique leaves a smoother interface and significantly improves the visual results, it has become a preferred method for treatment for Fuch’s Dystrophy and pseudophakic bullous keratopathy. Hudson Eye Physicians & Surgeons, LLC, corneal specialist, Dr. William Constad, is fully trained and experienced with this new procedure.
The DSEK procedure can overcome many of these problems associated with a standard corneal transplant. With a DSEK procedure, only the abnormal inner lining of the cornea is removed. A thin, circular disc is then removed from the inner lining of a donor cornea. This is folded and place inside of the eye where an air bubble pushes it in place until it heals in an appropriate position. No sutures are required and the structure of the cornea remains intact, leading to a faster visual recovery and less astigmatism.
The DSEK procedure is done under local anesthesia and takes approximately 45 minutes. For the first 24 hours after surgery, you will be asked to lie on your back with your face pointed directly to the ceiling for as much time as you can tolerate. This will help the graft stay in position as the air bubble holds it up into place on your cornea. You will be given several drops to use to prevent infection as well as to help the eye heal comfortably. After the first 48 hours, there are minimal restrictions to your activities. The vision is usually better within one week. 80% of the healing has taken place by one month, but the vision can continue to slowly improve over the next four to six months.
In patients with keratoconus, the cornea is cone-shaped. The surface of the cornea is also irregular for those with keratoconus resulting in a distorted image being projected onto the brain. Because the cornea is irregular and cone-shaped, glasses do not adequately correct the vision in patients with keratoconus since they cannot conform to the shape of the eye. Patients with keratoconus see best with rigid contact lenses since these lenses provide a clear surface in front of the cornea allowing the light rays to be projected clearly to the retina. This is how most cases of keratoconus are treated. However, there are some excellent new surgical options for patients with keratoconus who cannot tolerate these lenses.
Many patients are initially unaware they have keratoconus and see their eye doctor because of increasing blur or progressive changes in their prescription. Keratoconus may occur in one eye only initially, but most commonly affects both eyes with one eye being more severely affected than the other. Both males and females and all ethnicities are equally affected.
The treatment approach to keratoconus generally follows an orderly progression from glasses to contact lenses to more interventional approaches.
INTACS is the insertion of plastic ring segments to help support and improve the corneal shape.
Collagen Cross Linking (CXL) uses riboflavin eye drops and ultraviolet light to strengthen the cornea, and sometimes improve the corneal shape.
For those cases recalcitrant to these less aggressive measures, we have corneal transplantation.
Glasses are an effective means of correction for mild keratoconus. As the cornea steepens and becomes more irregular, glasses are no longer capable of providing adequate visual improvement. Corneal transplant surgery at HEPS is indicated when a patient cannot wear contact lenses for an acceptable period of time or when the vision, even with contacts, is unsatisfactory. A gas permeable contact lens is the most highly effective way to manage keratoconus, and 90% of all cases can be managed this way indefinitely.
The use of gas permeable contact lenses has been the mainstay of the optical management of keratoconus. These lenses, manufactured in a large variety of unique designs, provide a regular surface over the cornea to neutralize the distortion brought on by the irregular cornea. No one design is best for every type of keratoconus. Since each lens design has its own unique characteristics, the practitioner needs to carefully evaluate the needs of the individual and find the lens that offers the best combination of visual acuity, comfort and corneal health.
Fitting contact lenses for keratoconic eyes is by no means simple. Numerous lenses are often fit, and it can take a great deal of time. If the cornea becomes too scarred or painful, a corneal transplant may be necessary.
Get a free patient guide through the National Keratoconus Foundation
Book a consult today to discuss your options with a skilled ophthalmologist in our Bayonne, Jersey City, or Millburn, NJ offices.