Corneal Donor’s Age Not Critical for Transplant Success

6/17/14

In the United States, more than 40,000 corneal transplants are performed each year with a high success rate in comparison to other types of organ transplants. According to the Eye Bank Association of America (EBAA), keratoconus was the leading cause of anterior lamellar keratoplasty (DALK/ALK partial thickness transplant) and was the fourth most common indication for penetrating keratoplasty surgery in 2012 (their last reporting period).
corneal transplant-original size
Advances in technology have led to increasingly successful outcomes for all who need corneal transplants. New long-term research of corneal transplant patients have shown that the age of corneal donors is no longer as important as once thought by eye health providers. According to a study funded by the National Institutes of Health, ten years after a transplant, a cornea from a 71-year-old donor is likely to remain as healthy as a cornea from a donor half that age.

The Cornea Donor Study (see www.ClinicalTrials.gov), funded by NIH’s National Eye Institute (NEI), was designed to compare graft survival rates for corneas from two donor age groups, aged 12-65 and aged 66-75. It was coordinated by the Jaeb Center for Health Research in Tampa, Fla., and involved 80 clinical sites across the United States. The study enrolled 1,090 people eligible for transplants, ages 40-80. Donor corneas were provided by 43 eye banks, and met the quality standards of the Eye Bank Association of America. The study found that 10-year success rates remained steady at 75 percent for corneal transplants from donors 34-71 years old. In the United States, three-fourths of cornea donors are within this age range, and one-third of donors are at the upper end of the range, from 61-70 years old.

Prior to this study, many surgeons would not accept corneas from donors over 65. Since the supply of young donor corneas is limited, these study results are encouraging for those who face a corneal transplant . The high level of success rates using corneas from older donors (over age 60) greatly increases the pool of donated corneas and corneal tissue available for transplant. In 2012, corneal donors under age 31 comprised less than 10 percent of the U.S. donor pool. “Our study supports continued expansion of the corneal donor pool beyond age 65,” said study co-chair Edward J. Holland, M.D., professor of ophthalmology at the University of Cincinnati and director of the Cornea Service at the Cincinnati Eye Institute. “We found that transplant success rates were similar across a broad range of donor ages.”

“Overall, the findings clearly demonstrate that most corneal transplants have remarkable longevity regardless of donor age,” said Mark Mannis, M.D., chair of ophthalmology at the University of California, Davis, and co-chair of the study. “The majority of patients continued to do well after 10 years, even those who received corneas from the oldest donors.”

SOURCE: National Eye Institute Press Releases

For information about Eye Bank Association of America

CathyW headshotCathy Warren, RN
Executive Director
National Keratoconus Foundation

What You Need to Know About Cataracts

6/5/14

Do you feel like your vision is getting worse? Do you feel like colors are not as vibrant as they used to be? Are you having more trouble with glare? If you have any of these symptoms, you may be experiencing the effects of cataracts.

Cataracts are a normal aging process of the crystalline lens in the eye. Well you may ask — what is the crystalline lens? It is easiest to think of the eye as a camera. The eye has a lens (actually two) – the cornea (the front window of the eye) and the crystalline lens (inside the eye). It also has an aperture (the colored iris), and film (the retina). All these structures work together to focus light and allow us to see – just like a camera. When we are young (less than 40), the crystalline lens is flexible. This is why we are able to see distance and then near without the need for reading glasses. The crystalline lens is able to change its shape depending on where one is looking.

Figure 1 – Slit-lamp photo of a visually significant cataract.
Figure 1 – Slit-lamp photo of a visually significant cataract.

As we age, the crystalline lens becomes less flexible, thereby causing one’s near vision to be more blurry. This necessitates the need for reading glasses. As the crystalline lens become less flexible with age, the lens also starts to become more yellow and can also become cloudy. When the yellowing and/or clouding become visually significant, we refer to this as a cataract (figure 1).

Are cataracts dangerous? The simple answer is no. In the vast majority of cases, a cataract can be monitored until it becomes visually significant (drop in vision, glare, decreased contrast, vision related difficulties with day to day activities, etc). However, there are a few instances in which cataract removal is a medical necessity. Routine examinations by your eyecare provider can help you determine if you are at risk for these less common instances.

Figure 2 – Intraoperative photo during cataract surgery (prior to cataract removal).
Figure 2 – Intraoperative photo during cataract surgery (prior to cataract removal).

What can I expect during cataract surgery? Do you have to replace the crystalline lens with anything? Cataract surgery involves removing the clouded crystalline lens (figure 2) and replacing it with an artificial lens known as an intraocular lens (IOL) (figure 3). Surgery generally takes 10-15 minutes under a mild sedative, and you don’t have to stop any of your current medications. Anesthesia is achieved with drops and you will only feel mild pressure during the surgery. IOLs come in different styles – Standard IOLs grossly correct your vision and you can fine tune your vision (distance and near) with glasses post-operatively;

Figure 3 – Intraoperative photo during cataract surgery (after implantation of an IOL).
Figure 3 – Intraoperative photo during cataract surgery (after implantation of an IOL).

Toric (astigmatism correcting) IOLs allow for increased spectacle independence, but glasses will still be needed for distance or near; Accommodating IOLs “flex” within the eye to decrease your dependence on distance and near glasses; Multifocal IOLs allow spectacle independence for distance and near. I always counsel patients that there is no perfect IOL and you have to determine which IOL is best for your particular situation. Your doctor can help you decide which IOL is best for you. Generally, cataract surgery is extremely safe. Your doctor will discuss particular risks specific to your eye.

How do I know if cataract surgery is right for me? The best way to know if you have a cataract and if it time to consider surgery is to consult with your local ophthalmologist. If you have experienced a recent drop in vision, that is not correctable with glasses, cataract surgery may be able to restore your vision!

Garg feb 2014 thumbSumit “Sam“ Garg, MD
Medical Director
Vice Chair of Clinical Ophthalmology
Assistant Professor of Ophthalmology
Gavin Herbert Eye Institute – UC, Irvine

Little Bottle, Big Relief

6/3/14

What you need to know about eye drops.

Have you been staring at a computer all day and your eyes are tired? Have allergies been making your eyes watery and itchy? Are your contact lenses irritating your eyes? If you have experienced any of these conditions, you have probably turned to eye drops for relief.

While eye drops are an easy and effective means of treating a number of eye issues, there are many different eye drops available, both over the counter (OTC) and by prescription. It is wise to know what your underlying condition is before trying to get relief.
eye drops 6.3.14
If your eyes are red and you may want to try a decongestant eye drop, which will shrink the tiny blood vessels in the “whites” of your eyes (sclera), but they also cause dryness so may not be a good choice if you wear contact lenses.
For lens wearers you are better off with a re-wetting drop to lubricate the eye and lens making you more comfortable. Another problem with the decongestant eye drops is over use – which can cause irritation and an increased tolerance that could lead to more redness.

If you suffer from allergies and antihistamine eye drop would be the best choice for relief from itchy, watery, red and swollen eyes. They work by reducing histamine in the eye tissue.

Lubricating eye drops, also known as artificial tears, are for short-term relief caused by temporary situations such as eye strain form computer use, being tired or being outdoors in windy and/or sunny conditions. If the condition is chronic, a prescription eye drop will be the best choice.

It is important to remember that if any of the above symptoms worsen or continue for an extended period of time, it is time to see your eye doctor to determine the underlying cause of your issue and to rule out eye disease. Postponing a visit could also lead to an eye infection.

Prescription drops are used to treat a wide variety of eye diseases such as glaucoma, dry eye and the symptoms of ocular herpes. They are also used to help with healing from cataract surgery, corneal transplants, glaucoma surgery and even Lasik. it is extremely important to use them as often as your ophthalmologist recommends to improve healing and prevent infection.

Because of the ease of applying eye drops researchers are working toward using them to treat other eye diseases. Ocular herpes symptoms are sometimes treated with antiviral and steroid drops. But this only is targeted at the symptoms and not the underlying cause, the herpes simplex virus. Lbachir BenMohamed, PhD and Steven Wechsler, PhD at the University of California, Irvine, Gavin Herbert Eye Instittue have been working to determine what reactivate the herpes simplex virus and develop an eye drop that would either stop the reactivation of the virus or kill it.

Using eye drops to treat age-related macular degeneration (AMD) is also being explored. Researchers at the Institute of Ophthalmology at University College London are working with nanoparticles to deliver anti-VEGF drugs such as Lucentis and Avasitn to the back of the eye via drops. “The study shows that Avastin can be transported across the cells of the cornea into the back of the eye, where is stops blood vessels from leaking and forming new blood vessels, the basis for wet AMD.” While researchers in the Department of Ophthalmology, Tufts University School of Medicine in Boston “reported in their “proof of concept” study that topical application of a compound called PPADS inhibits damage to the tissues in the eye that impacts the individual’s ability to see color and fine detail, as well as reduces the growth of extraneous blood vessels in the back of the eye related to AMD.” It would work in both dry and wet AMD reduce the need for direct injections.

Eye drops, when properly applied, can provide temporary relief from symptoms of eye discomfort. But if the symptoms worsen or continue for an extended period of time, consult your eye doctor. To make sure you apply the eye drops correctly check out the article in our February 2013 newsletter for 12 easy steps to get the drops into your eyes and avoid infection.

One final note – keep your eye drops out of reach of children. Eye drops come in small bottles that are the perfect size for small hands and don’t have the same security tops found on other medications. The FDA has warned that ingredients found in some eye drops that relieve redness have caused abnormal heart rate, decreased breathing, sleepiness, vomiting and even comas in children five and younger that have ingested them. If you child has swallowed eye drops, call the Poison Help Line 800-222-1222.

Susan DeRemerSusan DeRemer
Vice President of Development
Discovery Eye Foundation

Four Tips For Buying Sunglasses

4/29/14

May will be here this week, and in Southern California we are looking at bright, sun-filled days with temperatures in the upper 80s and low 90s. This means that thousands will be heading to the beaches or their own backyards to enjoy the warm weather.

Now is the perfect time to review one of the biggest contributing factors to vision loss – sun exposure. And it’s not just about sunglasses, but also brimmed hats.

from esty.com
from esty.com

First let’s talk about sunglasses. There are three things to think about when selecting your sunglasses:
1. Lens tint
2. UV protection
3. Glare
4. Frames

Lens Tint
There is a misconception that the darker your sunglass lens, the better protection for your eyes. No true. The color or darkness of your lens is personal preference and often based on the activity you are doing while wearing sunglasses or the sun conditions. At the beach in bright sunlight you are subject to more reflective light and may prefer dark amber, copper or brown lens, if you are on the ski slopes when the skies are overcast you may prefer yellow or orange lens to increase contrast and fight “flat light.” If you are looking to increase contrast on a partially cloudy day, and if you don’t mind distorted color perception, you might prefer amber or rose lenses.

Other considerations include mirrored sun lenses that can block 10-15% more of the sun’s visible rays, or photochromic lenses that darken automatically when you go outside and then quickly become lighter when you come inside.

UV Protection
While darker lenses don’t offer better eye protection, controlling the UV exposure does. Research has found links that extended exposure to UVA and UVB rays can result in eye damage such as cataracts, photokeratitis and macular degeneration. By wearing sunglasses that block these harmful rays your eyes should remain healthier as you age. Also know that some parts of the country receive more UV rays than others – here is a wonderful chart from The Vision Council to let you see how your location rates.

Glare
Another problem when out in the sun, and especially driving, is glare. Making sure your lenses are polarized is a great help. They work by only letting in specific amounts of light at certain angles and reducing the brightness of that light.

Because I am light sensitive I find I use polarized lenses when I am reading outside is helpful. The reflected light from the page of a book can cause me to squint or fatigue my eyes if I read for a long period of time. The only other option is using a paper-ink e-reader which also helps cut down on glare.

Another way to deal with glare is the use of an anti-reflective (AR) coating on your lenses. It reduces eye stain by preventing light from reflecting off lens surfaces. When applied to the back of your lenses it can help with problems when the sun is behind you or to your side.

Frames
Not all light hits your eyes from directly in front. It can come through the top, sides and bottom of your frames. The smaller the frames, the more unfiltered light makes its way to your eyes. This is where a brimmed hat can help keep the sun coming in from the top while also providing protection for your face.

Fitovers - Auroa in Claret
Fitovers – Auroa in Claret

To provide you with the maximum protection, “fit-over” sunglasses, that you can wear over your regular prescription glasses, are a great idea and more economical. Cocoons Eyewear and Fitovers Eyewear are two of several companies that make them. They filter the light from the top, sides and even below to give you the maximum protection and come in a wide variety of lens colors. It is also nice not to have to get new sunglasses when your eyeglass prescription changes.

Whatever frames you choose make sure they fit properly and will not keep sliding down your nose or fall of when being active. You may even want to purchase a band-style foamed neoprene retainer that attaches at both temples, sometimes known as a gator.

Also remember, it is not just the direct sunlight you need to worry about. Water reflects up to 100% of the harmful UV rays, dry sand and concrete up to 25% and even grass reflects up to 3%.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Corneal Transplant Surgery Options

In this day and age of advancing technology, corneal transplants have changed from a long arduous ordeal to a more simple and precise procedure that offers faster visual recovery.  Instead of replacing the entire cornea for any and all corneal diseases, we now perform disease targeted partial corneal transplants.  If the disease involves the back layer of the cornea, we perform endothelial keratoplasty and replace only the diseased inner layer of the cornea.  Conversely, if the problematic portions are the front layers of the cornea, we perform anterior lamellar keratoplasty.  The co-morbidity and risk of rejection from partial corneal transplants are significantly less than the traditional full thickness transplants.

With endothelial keratoplasty, a small incision, about 4-5 mm is made and a sheet of donor endothelial cells are placed into the anterior chamber of the eye.  A large air bubble is then used to float this sheet up so that it opposes the posterior or back portion of the cornea.  The patient is asked to position face up for 24 hours.  Over this period of time, the cells will “stick” on their own and thus no sutures are required to keep the graft in place.,/span>

Figure 1 - corneal transplant
Figure 1

Anterior lamellar keratoplasty is done for superficial scars and opacities of the cornea or for keratoconus, a genetic degeneration of the cornea that is seen in younger individuals.  In this case, the native endothelial cells of the patient are healthy and therefore are left intact while the remainder of the cornea is transplanted.  This significantly lowers the risk of rejection, which is traditionally a much higher risk in young patients.  Multiple sutures are required to maintain this graft in place however, with the advent of femtosecond laser technology, the wound configuration is made in such a way as to promote rapid healing and visual recovery. (Figure 1)  Sutures are removed at an earlier time than with traditional surgery and the eye is able to undergo visual rehabilitation with glasses or contact lenses in 3-6 months’ time.

Corneal transplantation does not require waiting on a list for a donor to become available like it once did.  There are now multiple excellent eye banks across America that harvest, screen, and distribute donor tissue to surgeons.  This way, tissue is readily available and patients only need to schedule a time based on their own and their surgeon’s time schedule.  Post operatively, patients are asked to return to regular activity with the exception of no heavy lifting or bending for a period of 2 months.  Antibiotic and anti-rejection drops are started immediately after surgery and continued for several months after.  No oral medications aside from the patient’s regular medications are required.

Farid 3.6.14Marjan Farid, MD
Director of Cornea, Cataract, and Refractive Surgery
Vice-Chair of Ophthalmic Faculty
Director of the Cornea Fellowship Program
Associate Professor of Ophthalmology
Gavin Herbert Eye Institute, University of California, Irvine