What is Keratoconus?

Keratoconus is an eye condition that affects 1 out of every 2,000 people according to the National Keratoconus Foundation. It is a non-inflammatory condition of the cornea in which there is progressive thinning of the cornea changing it from dome-shaped to cone-shaped. The cornea is the clear windshield of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities of the cornea can greatly affect the way we see the world.

Keratoconus is not a blinding disorder, but does result in increasing near-sightedness (things far away are out of focus) and irregular astigmatism (things look tilted) that can significantly distort your vision. It is almost always bilateral (affecting both eyes). It is a slowly progressive disorder, taking years to develop, and may halt at any stage from mild to severe.

Signs and Symptoms

During the early stages, the symptoms of keratoconus may be similar to having the need for glasses or contacts. As the disease progresses, the vision deteriorates. Keratoconus will often progress slowly for 10 to 20 years and then suddenly stop. As the condition progresses, the most common symptoms include: 

• Increased blurring and distortion of your vision
• Sensitivity to light
• Increased nearsightedness or astigmatism
• Frequent eyeglass prescription changes
• Inability to wear contact lenses

Treatments

Keratoconus treatment often depends on the severity of the kerataconus symptoms. Contact lenses are the most popular nonsurgical treatment for symptoms related to keratoconus. Contact lenses can provide good vision in early to mid stages of keratoconus by correcting the refractive error, but lens tolerance and good quality vision can be difficult to maintain as the condition progresses.

Intacs

Keratoconus can also be treated with Intacs, which are small curved implantable corneal inserts that reshape the cornea and add structural integrity to the cornea. This unique attribute make Intacs an ideal treatment for keratoconus.

The placement of Intacs inserts remodel and reinforce the cornea, eliminating some or all of the irregularities caused by keratoconus. The procedure takes approximately 15 minutes per eye and is performed in office as an outpatient procedure. Follow up visits will be required to monitor the healing process and to evaluate the visual outcomes.

The goal of the Intacs procedure is to provide the keratoconic patient with the ability to achieve improved functional vision with contact lenses or glasses, and, in some cases, without them. They can provide an effective option prior to considering a cornea transplant.

Intacs were originally designed and FDA approved to correct mild nearsightedness, and now Intacs have emerged as a new therapy for treating patients with keratoconus.

Corneal Collagen Crosslinking

Another treatment option for keratoconus is corneal collagen cross-linking (CXL). Corneal collagen cross-linking is a new treatment that uses a special UV light and eye drops to promote “cross-linking” or strengthening of the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming irregular. It is the most advanced non-surgical treatment available that is proven to prevent the progression of keratoconus, and it may even be able to reverse the condition to some extent.

The 30-minute treatment is performed in the doctor's office. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light. This amazingly simple process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea. In published European studies, such treatments were proven safe and effective in patients.

Corneal collagen crosslinking treatments can be combined with Intacs to flatten the keratoconus cone even more than with Intacs alone. In these cases, corneal crosslinking treatments stabilize keratoconus from getting worse as well as help the Intacs reverse the keratoconus steepening that had already occurred.

Corneal Transplant

"Dr. Jackson and his staff have been part of my life and my family's life since 2008. Dr. Jackson has performed both of my Cornea transplants. I thank God not only for Dr. Jackson’s knowledge on the subject but also for his kind and warm spirit. He greets you and makes you feel comfortable with every visit. My vision is great due to his care. This excellent service was given to me before and after surgery. I have been blessed to be in the care of such a wonderful doctor and know I couldn’t do better if I tried."

-LaTara Lane

When good vision is no longer possible with other treatments, a corneal transplant may be recommended. Corneal transplants are the most commonly performed tissue transplant in the world, with some 48,000 procedures performed in the U.S. every year. The surgery restores eyesight for people who have a damaged cornea from keratoconus, injury, infection or inherited corneal disease.

A corneal transplant is an outpatient procedure that usually takes less than one hour. The diseased cornea is removed and replaced by the donor cornea with an instrument that acts like a cookie cutter (trephine) by making a precise circular cut. The donor cornea, cut to fit, is placed in the opening. Dr Jackson then uses a fine thread to stitch the new cornea into place. The stitches may be removed at a later visit. After the surgery, you will be required to place a plastic shield over your eye to protect it from being inadvertently rubbed or bumped.

While a corneal transplant will relieve the symptoms of keratoconus, it may not provide you with flawless vision. Even after a successful cornea transplant, most keratoconic patients still need glasses or contact lenses for clear vision.

The primary function of the ocular surface is to provide clear vision when the eye is open.   Dry eye syndrome is caused when the eye does not produce enough tears.  Other times, the tears that the eye produces are not "healthy." This change of the tear film results in irritation and changes on the eye surface that lead to characteristic symptoms, such as a sandy or burning sensation, discomfort, blurred vision, and redness of the eye.

Decreased tear production associated with dry eye may be caused by any condition that damages the tear glands.  The most common cause of gland damage is Sjögren’s syndrome, a chronic inflammatory disease in which mucous membranes, especially those in the eyes and the mouth, become extremely dry.  Sjögren’s occurs alone or is often accompanied by other autoimmune disorders such as lupus or rheumatoid arthritis.

Treatment

The selection of treatment depends largely on the severity of the disease. Mild cases of dry eye syndrome will require no more than use of artificial tear solutions and hot compresses with eyelid massage with ophthalmic ointments. If the condition is not managed with artificial tears, the use of sustained-release eye lubricant or prescription eye drops may be recommended. Therapy for dry eye syndrome also might include punctal plug (small devices, no bigger than a grain of rice, that are inserted into the tear ducts to block unnecessary drainage.)

Most people associate allergies with runny noses, sinus congestion and sneezing, but in fact allergies can affect various organs, including the eyes. Because the eyes are often a significant component of your allergies, they deserve specific attention and treatment. Many who have ocular allergies experience itching as the primary source of discomfort, though some people have no itchiness but instead experience a burning sensation that causes them to rub their eyes. Other common symptoms include redness, lid swelling, tearing, light sensitivity, "grittiness" and swollen eye.

Treatment

If you have ocular allergies the most effective treatment is prevention. Try to avoid the allergens that trigger symptoms. This is not always an easy task, especially if your triggers are airborne, such as pollen. When ocular allergies can’t be controlled, there are several medications that may help to relieve symptoms. Most of these treatments are topical, such as eye drops or ointment. Dr. Jackson develops for his patients, a sound ocular allergy treatment protocol that will help you more effectively manage allergy-related complaints and symptoms.

Lid margin disease or blepharitis is a common and frequently chronic, ongoing inflammation of the eyelids. The hallmark symptoms are burning, especially in the morning; thick, red eyelids; eyelids matted together in the morning and red eyes. This condition frequently occurs in people who tend to have oily skin, dandruff, rosacea or dry eyes. With proper diagnosis, LID Margin Disease can be managed through medications, good hygiene and cleaning of the eye lid and lashes.

Descemet’s Stripping Automated Endothelial Keratoplasty or DSAEK is a procedure used to correct corneal edema. The cornea is the back portion of the eye which contains cells that allow for fluid to pass in and out of the cornea. When these cells are damaged, fluid can build up and cause corneal edema or swelling of the cornea. These cells will not heal themselves and have to be replaced.

 DSAEK 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 cornea heals much faster and stronger and the patient's visual recovery is better.   Because this technique leaves a smoother surface and significantly improves the visual results, it has become a preferred method for treatment for Fuchs' Dystrophy and pseudophakic bullous keratopathy.

With a DSAEK 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 placed 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 DSAEK 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.

Advantages of DSAEK:

• The eye is left much stronger and more resistant to injury
• There is minimal change in refractive error because the patient's cornea is essentially intact
• Suture-related problems can be eliminated
• Lower transplant rejection rate compared to full corneal transplant
• Visual recovery is significantly faster and better
• Less downtime from work and normal activities of daily living compared to corneal transplant

The most popular refractive procedures are PRK or LASIK. Both procedures reshape the surface of the cornea. However, not everybody is a candidate. Implantable contact lenses, or ICLs, offer an alternative for people who are not candidates for PRK or LASIK. ICLs correct vision in the same manner as regular contact lenses. The difference is that ICLs are permanent. The lenses used for this procedure are similar to small contact lenses that, instead of sitting on the surface of the eye, are placed inside the eye. These lenses are composed of a collamer material which mimics the natural tissue of the eye and provides excellent optical clarity. Once in place, the lenses are undetectable, cannot be seen by the naked eye and require no maintenance other than a routine, annual visit to your eye doctor.  ICLs offer a life without dependence on glasses or contact lenses.

This simple procedure is performed on an outpatient basis. Dr. Jackson makes a small incision in the cornea and inserts the foldable lens between the iris and the natural lens. The procedure takes only 15 to 30 minutes for each eye and only requires topical anesthesia (numbing eye drops). Typically, patients can see clearly within a few hours after the procedure. Candidates for ICLs are between 21 and 45 years old and have moderate to severe myopia (nearsightedness). Your vision must be stable for at least six months prior to surgery. Advantages of an ICL

• The implantable contact lens provides exceptional quality of vision with predictable and stable results.
• Once implanted by your surgeon no maintenance is required.
• The procedure is proven to be safe with exceptionally high success rates.
• How much does it cost?

Lens implant surgery is a sophisticated procedure that your surgeon has recommended because it’s in your best interest medically. Due to the cost of the lenses and staffing requirements, implantable contact lens procedures are customarily more expensive than other laser vision correction options. Therefore, we are pleased to offer many payment and financing options in order to make your procedure affordable.

Experience you can trust

Mitchell Jackson MD is among the most experienced and well-trained surgeons in the world with over 20 years of experience with an emphasis on patient safety and satisfaction. Dr. Jackson has performed thousands of surgical and laser vision correction procedures and continues to lead the way.

If you are not a candidate for laser vision correction and would like to find out more about Implantable Contact Lenses, call 847.356.0700 to schedule a free consultation.

March 1, 2010. In a historic moment for the United States bobsled team, Steven Holcomb piloted bobsled USA-1 to the Olympic gold medal in the four-man event, ending a 62-year Olympic medal drought for the American. Holcomb’s heroic mastery of the treacherous track is made even more significant by the fact that not long ago, he had 20/500 vision -- "profound visual impairment" caused by keratoconus-- that very nearly ended his bobsledding career. Contact lenses could no longer provide the level of visual acuity required for Holcomb to compete. Finally, with the help of U.S. bobsled coach Brian Shimer, he was deemed a good candidate for the Visian ICL. Holcomb said. "I couldn't wear contacts the day of the surgery, so they literally had to walk me around the room. And then they did it, I got up, and just like that, I was 20/20. It's incredible. I call it an eye-opening experience."

What is a Pterygium?

A pterygium is a raised, wedge-shaped growth that invades the cornea.  It is an abnormal process in which the conjunctiva (a membrane that covers the white of the eye) grows into the cornea.  

Symptoms

• Redness
• Irritation 
• Light Sensitivity
• Inflammation 
• Tearing
• Foreign body sensation

Treatment

Although there are no known causes of pterygium, this condition occurs more often in people that have more exposure to outdoor elements such as wind or sunlight, specifically people who work in windy or sunny conditions.

Pterygium is usually not treated unless the condition irritates the patient or vision becomes impaired from the growth spreading over the cornea. Then surgery is recommended.

Dr. Jackson performs a procedure called Amniotic Membrane Transplantation (AMT) with fibrin glue (no stitches).  The result of using amniotic membrane for pterygium surgery offers aesthetic improvement with decrease pain, dryness, and discomfort.  The technique also helps the eye rehabilitate quickly and appear whiter,  reducing the chance of the  pterygium growing back. 

Pterygia can have up to a 50% recurrence rate even after surgery. The use of sunglasses and hats are recommended for patients to try to prevent return.

The symptoms described above may not necessarily mean that you have pterygium.  However, if you experience one or more of these symptoms, contact our office to schedule a complete exam with Dr. Jackson.

Our office can now fill your eyecare prescriptions!

Convenience.Safety.Savings

How It Works

• You doctor will offer in-office dispensing for your eye care, or you can ask about it
• The office staff will request your insurance card and basic information
• In less than one minute, your insurance is approved, your co-pay is determined and your label with instructions is
  printed
• Our office staff affixes the label to the prescription, confirms accuracy and collects your co-pay

It’s that easy and that quick!

Refills

• Seven to Ten days before your refill is due, we will contact you by phone or email to determine your needs. Of course,
  you can also contact us
• Your refill is processed with your insurance and your co pay is collected upon pickup

It’s that easy and that quick!

Benefits

What are the benefits of filling my prescription at my doctor's office?

Convenience

• No more driving to the pharmacy
• No more waiting for your prescription to be filled
• No more personal questions in public
• Quicker onset of therapy

Safety

• Substantially lowers prescription error
• FDA-approved medications
• 88 quality control checks on all medicine
• A-Rated brand and generic medications
• Government-approved storage and dispensing

Savings

• In most cases, the prescription costs will be the same or less than in a retail pharmacy
• Spend less time filling prescriptions and more time feeling better
• Less driving means lower fuel bills

Privacy

• Consultations and questions about your medication will be answered in a privacy of our office

All medication arrives in safety sealed bottles
Pre-packaged offsite under the supervision of a licensed pharmacist.

If you are an Ophthalmologist and would like information on how you can offer Eyescripts Dispensing for your patients, contact Pamela Willis at 561-376-8781 or email pamela@eyescriptsdispensing.com