Cornea Specialist at Hollingshead Eye Center
The cornea is the clear "window" that covers the iris and the pupil of the eye. For vision to be clear, the cornea must be clear. As a cornea sub-specialist, Hollingshead Eye Center eye surgeon Dr. Ryan Barrett has additional fellowship training and experience in evaluation of the cornea and the diagnosis and management of corneal eye disease.
Read on to learn about some of the most common corneal issues Dr. Barrett treats and how he treats them:
Keratoconus is a condition in which the typically round dome-shaped cornea progressively thins and weakens. This weakening allows the cornea to change shape, often bulging and becoming cone-like, which may result in blurry or distorted vision and increased light sensitivity.
Keratoconus is a part of a broader group of corneal-thinning conditions called corneal ectasia. Corneal ectasia conditions may be inherited, develop spontaneously, or be caused by repeated rubbing of the eyes.
Treatment options include:
- Rigid contact lenses: These are sometimes used to restore vision in people who cannot tolerate soft contact lenses.
- Corneal Intacs: These are rigid semi-circular rings that can be surgically implanted into the periphery of the cornea to help flatten the central cornea to better facilitate the ability to wear a contact lens.
- Corneal crosslinking: This procedure is the first therapeutic treatment that has been rigorously tested and approved for keratoconus and other forms of corneal ectasia. It is a minimally invasive procedure designed to stop the progression of this disease, so it is important to be evaluated for this early in the course of the disease, before the cornea has had irreversible changes or scarring. It involves applying drops of riboflavin solution (a form of vitamin-B2) to the cornea, followed by a small amount of UVA light. This process strengthens and stabilizes the weakened links bonding the corneal fibers together, helping preserve vision quality. While it can’t reverse the distortion of the cornea that has already happened, it locks the cornea into its current shape and helps prevent the disease from worsening.
- Cornea transplantation: This may be needed for advanced cases or for patients with significant corneal scarring who are not good candidates for corneal crosslinking, as well as for those who are not helped by or cannot tolerate contact lenses (see Endothelial Keratoplasty below for more information).
Endothelial Keratoplasty (DSEK & DMEK)
When the inner cell layer of the cornea stops working properly due to endothelial disorders (such as Fuchs’ dystrophy), endothelial keratoplasty (EK) is the preferred way to restore vision. This modern cornea transplant technique replaces only the diseased layer of the cornea, leaving healthy areas intact. Further advances in cornea transplant surgery have led to the development of several different kinds of EK procedures, including Descemet's Stripping Endothelial Keratoplasty (DSEK) and Descemet's Membrane Endothelial Keratoplasty (DMEK). These options have been shown to contribute to significantly better and faster visual recovery when compared to traditional corneal transplantation. Your doctor will determine which procedure is best for you and your unique condition.
Call to learn more about your corneal treatment options with Dr. Ryan Barrett.
Superficial keratectomy is designed to help correct vision for those struggling with cornea scarring or opacity involving the anterior layers (front part) of the cornea. This procedure is used to remove and smooth the corneal surface.
Anterior cornea diseases often cause:
- Irregular astigmatism
These symptoms can affect your ability to enjoy your daily life. Surgery may be the most appropriate treatment option for those whose vision is not improved by non-surgical methods, such as medications or lubrications.
Corneal scarring may be caused by injury to the cornea, including abrasion, laceration, burns, or disease. Based on the degree of the scarring, vision may become blurry or be significantly reduced.
Treatment for this condition may include Superficial Keratectomy, which is also used to treat a variety of other corneal issues. This procedure involves gently clearing away scar tissue. If the scarring is severe a corneal transplant may be necessary to restore your best vision.
Fuchs' dystrophy is a relatively common corneal dystrophy that affects the inner surface of the cornea, called the endothelium. When the endothelium is unhealthy, the cells die, do not regenerate, and leave dots called “guttata” on the inside of the cornea. These dots cause glare and decrease vision quality. Guttata are often the first sign of Fuchs' dystrophy.
If Fuchs' dystrophy progresses, the endothelial cells lose their ability to pump fluid out of the cornea, and the cornea swells. When fluid accumulates, the cornea can become thicker and hazy, like a steamy window, and can cause significant vision loss.
Treatment options include:
- Medications: These may help improve vision for early stage Fuchs' dystrophy.
- Cornea transplantation: This, among other surgical procedures to improve vision, may be needed for advanced cases (see Endothelial Keratoplasty above for more information).