Blind World


Keratoconus.
Plastic cones can restore failing eyesight.





December 23, 2004.
Seattle Post Intelligencer.




For more than a year, Lance Palmer noticed his vision failing.


Under dim restaurant light, menus were a blur. He could no longer enjoy an evening with a good book. At work, the Seattle trial lawyer relied on a magnifying glass to get through documents at his desk.


Finally, he couldn't pick his son out in a pack of three 5-year-olds playing next door.


"It just hit home more and more how precious my eyesight was," said Palmer, 43.


Legally blind in his left eye and rapidly losing sight in the other, Palmer has a condition called keratoconus, in which the cornea loses its rounded shape. It was fuzzing the sharp angles Palmer used to see, leaving behind only light and color.


Yet, three days before he was scheduled for a cornea transplant, the most common treatment for advanced keratoconus, Palmer got nervous.


Although cornea transplants are among the most successful transplant procedures, there's still a risk of rejection. It's still major surgery.


Never mind, Palmer's doctor told him. There's another option.


That alternative involves two half-moon shaped plastic cones inserted into the cornea to stop the progressive vision loss. The inserts provide a support structure that stretches the thinned cornea back in place around the eye.


Palmer would be Dr. Audrey Talley-Rostov's second patient to receive the Intacs inserts, a procedure that was approved by the Food and Drug Administration this summer for patients with keratoconus.


Contact lenses can correct the vision loss caused by keratoconus at first, but eventually the cornea becomes so distorted it's difficult to fit a lens over the conelike protrusion.


About 1 in 1,000 Americans have keratoconus or some form of corneal thinning, which typically strikes young people between their late teens and early 40s, according to Talley-Rostov.


A cornea specialist at Northwest Eye Surgeons, Talley-Rostov is one of two doctors in the state certified by Addition Technology Inc., the company that makes the Intacs inserts, to perform the procedure.


Since October, she's implanted the inserts for a dozen patients.


About a quarter of patients with keratoconus will eventually need corneal transplants, according to the National Keratoconus Foundation.


"These were all people destined for organ transplantation," said Talley-Rostov. "To be able to provide an alternative surgery for them that's less invasive is probably one of the most exciting things that's happened in cornea (medicine) in at least 10 years."


The inserts can also be used for thinning of the cornea caused by complications from laser eye surgery, said Talley-Rostov, who in September went to practice with a surgeon in Mexico, where the procedure was approved earlier.


Patients are awake during the operation, which takes about 20 minutes per eye. Drops numb the eye and one stitch seals the incision.


Palmer had his left eye done on Oct. 13 and the right last week. His vision is improving so quickly he can't keep his glasses up to date.


"Now I can read depositions without having to take my big magnifying glass out," Palmer said. "I've got thousands of books to read yet and I had always looked forward to retiring and reading."


The inserts were approved for use in 1999 in near-sighted patients, but never caught on because there were so many other options, including laser surgery, according to Dr. Ernest Kornmehl, a Boston eye surgeon and spokesman for the American Academy of Ophthalmology.


"For keratoconus, it's a godsend," Kornmehl said.


Keratoconus patients who have too much scarring on their cornea, often caused by ill-fitting contact lenses, will still need transplants, according to Talley-Rostov.


FOR MORE INFORMATION


For more information about keratoconus, go to the National Keratoconus Foundation's Web site at www.nkcf.org or call 800-521-2524.


P-I reporter Julie Davidow can be reached at 206-448-8180 or juliedavidow@seattlepi.com.



Source URL: http://seattlepi.nwsource.com/local/204933_hcenter23.html.




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