Keratoconus: an irregular, protruding cornea.  Photo via clspectrum.com

In my last post about keratoconus, I mentioned a promising new treatment called corneal cross-linking.       This procedure is still undergoing FDA approval, but more and more ophthalmologists across the states are starting to offer this treatment. Because this procedure is so new in the States, there is still much to learn.  Here is a breakdown of the information I have about corneal cross-linking:

What is corneal cross-linking?

The cornea is made up a collagen fibers that are woven together to make a tight and strong (and clear!) tissue.  In keratoconus, these collagen fibers are somehow weakened, causing the cornea to become misshapen, irregular, and scar over.  This results in devastating vision loss.  Corneal cross-linking is a process where the collagen fiber connections are strengthened again, so that the cornea can maintain its shape and clarity.   Cross-linking actually happens naturally as we age (the collagen fibers tend to strengthen their attachments around age 40) which is why keratoconus tends to be a degeneration of the young eye, and stabilizes later in life.

The Treatment Procedure


I won't begin to go into exact details (this blog is for everyone, not technical scientists!), but the general process is easy to explain.  Your ophthalmologist will apply riboflavin to the eye (after they prepare your cornea to improve penetration of the liquid riboflavin into the deeper layers of the eye).  Then your eye is exposed to UV light for around 30 minutes, which causes the chemical "strengthening" reaction between collagen fibers.  Studies have shown that this procedure increases the corneal "rigidity" by 328%!  You will be conscious the entire time of the procedure and should experience no pain.

Cross-linking procedure.  Riboflavin has been applied, and now UV light is being shone on the eye. Photo via clspectrum.com

Benefits
Of all studies so far completed (about 691 eyes worldwide have been done), an impressive 92% of patients saw NO progression of their keratoconus 1 year after the procedure.  55% (up to 81% in some studies!) of people saw their vision improve by 1 line or more.  In summary: with this procedure, your eyes should stabilize, and may even improve a little.

Vision is usually worse right after the procedure, and for as long as 6 weeks afterward.  Improvement in vision will begin to be evident by 3-6 months after the surgery date.

Potential Risks
In rare cases (8% from the recent research), the cornea can develop a permanent haze.  To avoid this risk, the cornea needs to be over 400 microns thick (this is a measurement that the surgeon will take prior to performing the procedure).

Who is a candidate?
Corneal cross-linking is ideal for patients with keratoconus who are under 35.  It can also be considered in older patients if their keratoconus is progressing.  You will still need glasses or contact lenses after the procedure, and your prescription may change afterwards.

Cost?
Because it is not yet FDA approved, the procedure is not covered by medical insurance.  Costs across the nation are $3-6,000.

In North Carolina, Dr. Patrick Laber is now offering the procedure.  (Most information provided in this post is courtesy of his detailed explanations!)

Photo via J CREW

With back to school ads littering the airways, it's time to start thinking about another change in seasons.  New trends for Fall 2012 seem to be focusing on a neutral color palate, letting the style lines of your glasses speak instead of the colors.  Thicker frames are still on point, so expect the "geek chic" trend to continue.  Gray, bone, tans -- all are making a major comeback from the days Michelle Pfeiffer was sporting them poolside in Scarface (below).

1983 is new again; Michelle Pfeiffer's classic look would be right on trend for fall 2012

   





Depending on your skin tone, a bone or light gray colored frame can be difficult to wear, so it is always best to try the frames on your face.  Darker browns seem to be more universally flattering.  As a general rule, darker skin tones can aim more towards the pale frame colors, while really pale skin tones will likely look too washed out in these lighter colors.

Readers from Anthropologie

Yves Saint Laurent priced at $295

Major 80's throwback via Cutler and Gross

Anne Hathaway at BBC Radio interview, wearing neutral plastic frames.  The darker  temples and dark brown tint help keep the lighter plastic from completely washing out her face.  This neutral color palate transitions as a perfect compliment to your fall wardrobe of darker colors, layered looks, and tweeds.

Everyday I see patients who are coming to the eye doctor for the first time in years because they noticed they just weren't seeing as well as they used to.  Well imagine what it feels like when the doctor looks at your screening tests and performs the refraction, and then tells you that you have a medical condition that will prevent you from seeing better, even with glasses!  Keratoconus is a condition that affects less than 1% of the American population, but it causes major visual issues that sometimes require intensive surgery like corneal transplants to treat.  It typically affects people between their late teens to late 30s, and usually progressively worsens as the eye continues to change with age up until our 40s, when the condition appears to stabilize.  In that period of 20 years where the cornea is susceptible to progression, people often end up needing surgery or at least speciatly contact lenses to achieve their best vision.

Have you ever been on a roller coaster where you experienced gradual dimming of your vision?  This phenomenon actually has a name:  the greyout.  While many people find this visual experience to cause nausea and severe discomfort, there are a large group of thrillseekers out there just looking for their next greyout experience.  Let's breakdown what the greyout really is:

King's Dominion Intimidator

Greyout Symptoms

• gradual dimming of vision
• color vision changes
• possible peripheral vision loss
• transient -- symptoms only last a few seconds and then return to normal

CENTRAL RETINAL ARTERY OCCLUSION

A new longitudinal study out of Bristol University continues to support other recent correlational data that time outdoors playing seems to be related to a decreased risk for poor distance vision.  Near-sightedness or myopia is a refractive condition where the person sees well up close, but very poorly in the distance.  Click here for more details.  In the past, data has supported that more time reading as a child is associated with myopia, but in this new study, time indoors (not specifically reading) also appears to have a link.

Colleague Dr. Joy Ellenberger and a young patient Photo Via Smith Eye Care

14,000 children were followed from age 8 to 9 until age 15 during Avon Longitudinal Study.  Children were grouped into 2 categories based on survey information provided by their parents:
High Time Outdoors = 3 or more hours in summer, 1 or more in winter
Low Time Outdoors = anything less
Those children spending "high time" outdoors were much more likely to have normal vision.

In the past, myopia development has been theoretically linked to near strain, like long hours reading.  New research however is showing that bright light may be essential in the developing eye.  Bright outdoor light stimulates the release of dopamine, a neurotransmitter, in the brain.  Research on baby chicks has shown that higher levels of dopamine in the brain and retinal cells is correlated with less risk of myopia.

Other research out of the University of Alabama at Birmingham (also home to an optometry school!) has shown that bright light exposure in tree shrews appears to minimize the risk for myopia.  Researchers with this study purport that their findings in future may supports increasing lighting intensity at schools to help prevents or slow myopia development

There is still much to understand in the relationship between sun exposure and vision development, and we can't forget about the risk of UV damage to the skin and eyes with prolonged times outdoors.  I do recommend bright lighting conditions for reading in all of my young patients, and encourage outdoor sport participation for those with a high genetic risk for myopia or children starting to show myopia at a young age.   And don't forget that sunglasses are still highly recommended to protect the eye from damaging UV rays!

The summer Olympics is perpetually one of my favorite sporting events, but this year I have had the extra dorky distraction of paying heed to all of the great glasses on display!  Olympians have access to the best equipment on the market, and their sports glasses are no exception.  Remember, for FDA regulations, glasses for sports must meet specific safety standards in material thickness and resistance to shatter.  Safety glasses are a great idea for anyone competing in sports with a high danger of eye injury (think small balls or projectiles flying towards the face).  For an athlete at high risk for a retinal detachment due to eye injury, safety goggles become essential in protecting the eye from possible blindness.  Numerous athletes competing are protecting their eyes with these glasses:

Tony Parker: Basketball Player for France
He is wearing protective glasses due to an eye injury suffered prior to the Olympics.  Apparently shattered glass penetrated his left eye.  Due to the sensitivity of the cornea to injury, protecting the eye from stray fingernails while playing basketball is of utmost importance.


Foluke Akinradewo: USA Indoor Volleyball

photo via washingtonpost.com

Durant (right) with fellow NBA players via

A new survey published by Bausch and Lomb polled 11,000 customers in 26 countries revealed some startling results.  Eyesight perpetually ranks as one of the senses people are least willing to lose, and the survey results continued this trend with over 67% of participants saying they would rather a limb or lose 10 years of their life than go blind!  Surprisingly enough, protecting their ocular health wasn't quite as important as those survey answers would have us believe.  Only 21% of survey responders had gotten a comprehensive eye exam in the past 5 years.

NORMAL RETINAL FUNDUS: via topcon-medical.eu