I had the wonderful pleasure of speaking with Steve Zier a recent patient of Dr. Brian Boxer Wachler. Dr. Brian Boxer Wachler performs several Corrective surgeries in the Los Angeles area for patients around the world. This remarkable doctor is one of the kind. I am writing this week to share with you this patients experience at the Boxer Wachler Vision Institute.

Steve Zier was diagnosed with mild Keratoconus. In many states doctors feel it is difficult to work on patients with Keratoconus some don’t try, others do with complications. In Steve’s case it was difficult to locate a doctor that would attempt it due to his condition.

“None of the other surgeons would touch me with a 10 foot pole” He said sounding a bit frustrated.

Searching the Internet as so many of us do Steve happened upon Dr. Boxer Wachler’s website www.boxerwachler.com and decided to give it a try.

Steve was pleased with the incredible service that the Boxer Wachler Vision Institute had to offer.

“The service was great from the receptionist to the doctors” he said.

Steve Zier had a PRK treatment and C3-R directly afterwards. His total procedure time was less than one hour. Steve reports that he was a little sore afterwards but didn’t need any pain relievers. Additionally his vision was a bit blurry but cleared up within a week. Now he it is four weeks later and he is amazed at the results. Steve had 20/200 vision in the right eye- after treatment 20/20

Results:

Right eye- Before procedure 20/200

Right eye- After Procedure 20/20

Left eye-Before Procedure 20/60

Left eye- After Procedure 20/40

Steve says he only needs a soft contact in one eye now to help him see. His Keratoconus is currently stable and his new quality of vision is great “It was worth every penny!” he says.

Look for True Testimonials next week and hear the story of another patient…

Suffering from Keratoconus can be a difficult thing. Many people worry greatly about the progression of Keratoconus and although there is no definitive cure for Keratoconus there are treatments that can greatly improve your vision. Helping you have a much better quality of life. Laser surgery is not an options for individuals with Keratoconus, but Intacs may be a possibility. There are many benefits of using Intacs.

Below are a few reasons:

• Intacs are removable, which make it easier to adjust if you have visual changes later in life.
• No tissue is removed from your cornea when Intacs are used.
• If you decide to change the method you are using from Intacs to another the option is still open.
• Intacs are maintenance free. you can just enjoy your improved quality of vision instead.

When you have laser surgery they are changing the shape of your cornea by removing tissue with the laser. With Keratoconus this can cause problems, even making things progress and worsen quicker. With Intacs you can treat your disease with little complications.

The results of Intacs are much more exciting. The goal of INTACS is to help normalize the irregular cornea curvature, which has lead to decrease quality of vision. Over 90% of people with Intacs have an improved quality of vision with glasses or contact lenses. Additionally more than 50% of patients have better than 20/20 vision after the procedure with their glasses or contact lenses, which is a miracle for many who have had loss of vision over the years from this disease. Finally this can be a great choice for those with Keratoconus and mild nearsightedness. At times these people experience such a dramatic improvement they rarely need glasses or contacts.

Quite often we dream of good vision and for those of us who have been suffering with vision problems all our lives there is hope. The chance to finally have something that doesn’t require lots of maintenance or excessive checkups is a true blessing. Intacs can give it too you!

There are several things you can do if you feel you are suffering from Keratoconus. The professionals will help not only evaluate your physical status but also take a thorough examination of your medical history.

The Ophthalmologist or Optometrist will also give you tests to check your visual acuity. This means reading letters from an eye chart much like a general eye evaluation. It can also include measuring the curvature of the corneas using a topographer. Having an irregular curvature could mean possible Keratoconus.

One additional test that is often performed is a cornea ultrasound(Pachymetry). This will measure the cornea thickness. A thin cornea can be a sign of Keratoconus.

Another test examines your cornea with a slit lamp(Microscope). More advanced cases can be determined right away with this test, because of the yellow-brown or olive-green rings or a (Fleischer ring)

Fleischer Ring-

Seen in 50% of patients with Keratoconus. Also caused by Iron Oxide Hemosiderin that is deposited in the Corneal Epithelium.

Vogt’s Striae- These are fine lines or (stress lines) caused by stretching and can be seen on the front of the cornea.

Munson’s Sign- is another give away of Keratoconus. This is a V-shaped indentation and sometimes seen in the lower eyelid when the sufferer moves their line of sight in the downward direction. Most signs are detected before this stage and is seldom used for diagnosing keratoconus.

It is important to get a definitive diagnosis for keratoconus. Many times it requires several tests to make an absolute confirmation. There are numerous other conditions that have similar symptoms of keratoconus. Make sure you are being seen by a specialist in diagnosis of keratoconus and ask questions if you do not understand your diagnosis. After all it is your health at stake.

Though we have not walked a mile in your shoes there are certainly many who have. Meet Margret Puchjoe- Recently a patient at Boxer Wachler Vision Institute Margret has a real story to tell. Margret was treated with Lasik in 2002 on the East coast and experienced many complications. The surgeons treating her could not give her an accurate diagnosis and disturbingly enough would not answer her many questions.

She then followed up with 2 corrective procedures in the left eye and 1 in the right eye in a 6 month time span. After which her vision improved for some 4 years. Recently she has experienced some disturbing complications. She has had distorted vision- the inability to read comfortably or focus on an image. After exhausting all her possibilities on the East coast Margret found Dr. Brian Boxer Wachler.

*Quote-

Margret says: “ They got me in right away, I saw Dr. boxer Wachler on a Monday and he gave me options.”Margret has currently undergone C3R. Or Corneal Collagen Crosslinking with Riboflavin. This procedure involves the application of drops on the epithelium, The drops are then activated by exposure to UV lights for about 30 minutes. The procedure is virtually painless and can slow down or stop the progression of Keratoconus.

Margret is very pleased with her services and has hope for a great recovery. Although it will take a few months for the full effectiveness of the procedure to kick in she has a positive new light she didn’t have before. We will keep you updated on her progression.

Corneal Collagen Crosslinking with Riboflavin or (C3-R) is a relatively new treatment. In past decades surgeons would have to perform a corneal transplant to improve the vision of Keratoconus patients. Now they have developed a new treatment that helps strengthen the cornea and stop the damage that Keratoconus patients could suffer from this progressive disease.

The Treatment Application-

C3-R is directed under the epithelial cell layer. Located on the surface of the cornea. The surgeon will apply anesthesia drops on the surface of the eye. Then disrupt the epithelial cell layer. So the Riboflavin eye drops will penetrate the stromal portion of the cornea, which is the layer under the epithelium. The Riboflavin drops are then placed on the surface of the cornea.

A small UVA light is shone over the eye for about 30 minutes to activate the solution. The procedure is relatively comfortable if the epithelium layer is only disrupted rather than removed. Some surgeons removed the layer, which makes the first week of the procedure uncomfortable. Be sure to check with your doctor to see if they perform the epi-on or epi-off technique.

There are several benefits of Corneal Collagen Crosslinking below are a few:

Strengthens the cornea with less evasive procedures- The solution will improve the strength of the cornea over 3-6 months after treatment. It only requires a one time application. And there are less risks associated with C3-R as appose to corneal transplant.

Can be combined with INTACS to reverse damage to the cornea- C3-R treatment can be mixed with INTACS reduce the cone shape of the cornea. After the 3 year follow up doctors found that it stopped the increase of cornea curvature values and flattened the mean cone.

C3-R Stabilizes Progressive Ectasia- C3-R can give some relief from Progressive Ectasia. It has been proven to stabilize progressive Ectasia. While it is not a complete cure there are high hopes for further treatments of Ectasia.

The benefits of C3-R many. Surgeons are further studying and researching C3-R and INTACS. Without question medical sciences are growing rapidly. And each day we are improving the treatments for Keratoconus and other troubling diseases. There is no need to suffer with Keratoconus. Patients now have a wide array of treatments to help them with the progression of this condition.

We all have problems dealing with loss of vision and when we hear big words like “Keratoconus” we definitely struggle with questions. Looking for a way to get rid of it. We often struggle with questions like “What happens now?” “How will this effect my life” “Will I go blind?”

While those are all understandable questions first it is important that you understand what “Keratoconus” is and how it is treated. Keratoconus is a non-inflammatory eye condition which is often progressive. Keratoconus is a thinning of the cornea which causes many disturbances in the eyes creating vision changes.

Keratoconus affects each patient differently. About 2 out of every 100,000 patients suffer from Keratoconus. Treatment of Keratoconus depends on the stage the condition is in as well as the patient. Also it can affect one or both eyes. Your Eye doctor will help determine your stage and help you go over your treatment process. Many times Keratoconus can be treated with glasses and contacts.

Treatment Options for Keratoconus-

Keratoconus is treated many ways and just because you have been diagnosed doesn’t mean drastic measure need to be taken. Since it is progressive you should explore all options. This will keep you educated and you can ask any questions you have about them to your doctor.

RGP-

Rigid Gas Permeable lenses- or (RGP) are sometime used in the early to mild stages of Keratoconus. Quite often with Keratoconus soft contact lenses are not enough. The doctor can prescribe some hard prescription lenses to help you with your vision. However as the disease progresses you will need to change them or look into more options.

C3-R-

This is a 30 minute procedure performed in the doctors office. The procedure involves applying a special solution to the eye that is activated by a light. This procedure stops the disease from progressing so you can remain comfortable in your contact lenses or glasses.

INTACS-

Intrastromal Corneal Ring Segments- Referred to as (INTACS) are used quite frequently. They are an insertable contact that require less maintenance then RGP’s. INTACS also allow you to change your prescription as changes occur. They don’t create a lot of discomfort. The INTACS are placed behind the nerve so you don’t feel them. More people today are turning to INTACS as an option for treatment when they are no longer comfortable RGP’s or they have decreased quality of vision in their RGPS-

Corneal Transplants-

Corneal transplants are used for people with severe vision loss due to scarring. As well as progressive peripheral thinning. These conditions do occur in patients with Keratoconus but the doctor will discuss this option after all other options have been explored. As with all surgery there are risks of complications and rejection but modern medicine has improved. So it is much safer and done more routinely today.

The treatments for Keratoconus will be explained by your doctor and all you questions will be addressed. Learn, listen and if you are uncomfortable ask questions!

Many thousands of people have been receiving the simple outpatient surgery of Corneal implants. Though it is not a complex procedure you should still know how to prepare and what to expect after its over. After reading this overview you will have all the knowledge you need and know what to expect after the procedure has been completed.

Preparing-An eye examination is important to determine the health of your eyes. Not all candidates are suitable for the procedure. The doctor will let you know if he finds any problems. The doctor will also get a general medical history and take various ophthalmic tests. It can take up to two hours to complete the examination.

The Procedure-

When you are determined a good candidate for the procedure the doctor will set up you surgery date. You will have the opportunity then to ask him any questions you may have and he/she will explain the procedure to you.

The doctor will place some drops in your eye with anesthetic in them in order to numb your eye. They may implement a device to hold your eye open or have an assistant to help them with this. Your eye must remain open and you don’t blink during the procedure.

A small entry point will be placed on the surface of your cornea. Then they will prepare to place the Intacs implants. The doctor must stabilize your eye and align the eye, this could take 1-2 minutes. Use of additional delicate instruments will help them stabilize the eye.

The doctor will then create a small tunnel within the cornea which will hold the implants. However before he/she can make the tunnels he must determine the proper placing for the implants. There are many layers to the eye and it can take a minute to get the proper location. After the implants are placed, the doctor will close up the entry point. You will probably notice improved vision as soon as the next day for nearsighted patients and in two weeks for keratoconus patients.

Expectations after The Procedure-

There is little recovery time when having this procedure. After the procedure it is best to rest, however you probably will not feel any real discomfort, most people have no pain throughout the complete procedure. Most people don’t feel the Intacs because they are placed beneath the nerves in the cornea. Most people see improvement in their sight immediately however others can take a couple of weeks. The overall percentage of nearsighted patients experience “excellent” vision after this procedure without the need for glasses or contacts. Keratoconus patients notice a quality of improvement of vision with new glasses or contacts after this procedure.

Being diagnosed with Keratoconus is a hard thing. Learning what comes next in the process is most important. There are several tests that will be preformed on you to determine the condition of your cornea. This is one of the steps to determining how your doctor will treat your Keratoconus.

Slit-Lamp-

When you doctor is examining you he will want to look closer into you cornea. When he does this he will use a keratoscope. This device will help him see the surface of your cornea. It is not invasive and it will give him a better idea of the damage to your cornea.

Corneal Topography-

This instrument will give him more accurate details of the damaged area by looking at the cornea’s pattern. It analyzes the cornea’s topography and projects a digital image. The doctor can see the damage or scarring on the cornea and it can let the doctor see just how fast the disease is progressing.

Staging Keratoconus-

There are three levels of severity when it comes to Keratoconus. The doctor can use his topography and determine with close certainty how severe the disease is. Below are a few ways to tell:

Testing Steepness of greatest Curvature

40-45D is mild

52 D is considered advance

Above 52D is severe

Thickness of the Cornea

Mild- 506

Advanced- Less than 446

Morphology of the Cone-

If the cone is sagging it too is an indicator of the advancing of the disease.

Since the use of Corneal Topography we have not used the terms advanced and severe as we used to. However the image that they provide will help you doctor determine the next course of action. Making sure you ask questions and understand what is going on every step of the way will ensure a greater chance of full recovery. Trust your doctor and let him know you concerns I am sure he will listen!

Corneal Transplants are some of the most common transplants in the United States. There are annually over 40,000 transplants being preformed around the US. Over 90% of all transplants done are successful and after the procedure sight is restored. Corneal Transplants are known as Keratoplasty. There are many reasons why one would need a corneal transplant below are a few common ones:

• Keratoconus

• Fuchs Dystrophy

These can cause cloudiness in the cornea and it often alters the natural curvature of the cornea. They also reduce the quality of vision in the patient. Additionally these are a few other things to add to the need for corneal transplants:

•  Trauma

• Chemical Burns

• Bacteria

• Fungi and Protozoa

Many times use of local anesthesia is used. With local anesthesia the patient is numb around the area of the procedure however they are still away. Additionally one could also use general anesthesia and be unconscious during the procedure. Consult with your eye doctor to determine which way is best for you.

It is also very important that you speak with your physician on the risks of the corneal implant as well as the benefits. Many times if we hear enough good things and not the bad things we can convince ourselves that the procedure is right. However the decisions should be made only after knowing all the options and risks involved with the corneal implants. A few of the risks are:

•  Infections

• Cataract Formation

• Glaucoma

• Retinal detachment

• Rejection and need for another transplant

In rejection of the corneal transplants the immune systems fights off the donor tissue. Approximately 30% of corneal transplants result in rejections. Here are a few of the symptoms to look for after a corneal transplant to show the body maybe rejecting it:

•  Sensitivity to light

• Redness in eyes

• Change in vision

• Persistent or constant discomfort in the eyes

You should check with your eye doctor if you are having any of these symptoms or have any questions proceeding your corneal transplant. In the end the average corneal transplant is successful and a better quality of life is experienced because of it!