Modern Day options beyond Corneal Transplants
The cornea is the front clear window of the eye and comprises of 5 layers. The shape of this cornea determines the visual error (glasses prescription) for each individual person.
Therefore eyes with very curved (steep) corneas are myopic (nearsighted), those with flat corneas are hyperopic (farsighted), and football-shaped corneas are astigmatic.
A healthy cornea is clear and transparent. This is essential for good vision and therefore any loss of transparency from minimal haze to scarring can decrease the vision in that eye.
Corneal scars can occur from various causes including contact lens related infections, trauma, LASIK complication, previous Radial keratotomy, PRK surgery and even dry eyes.
The way to correct a corneal scar has traditionally been replacing the cornea with a donor cornea (cadaver eye cornea) by a surgery called corneal transplant.
Corneal transplant is one of the most successful transplant surgeries in the entire field of medicine but is inherently interventional and in most cases results in high astigmatism (since it is stitched by hand) despite a clear cornea and hence leaves the patient with less than perfect vision, chance of rejection of this tissue and a potential weakness in the ocular anatomy in case of future accidents or trauma.
In these moderate times with heightened expectations for excellent vision and a desire for minimalistic, elegant interventions, the same laser used for LASIK surgery can be used to address most of the anterior corneal scars to help people see once again.
Using the knowledge mentioned above that the shape of the cornea decides vision and adding this to the concept of optics according to which the front curvature of a lens is more important than the back impurities; the LASIK laser can be used to shape the cornea (Simply put, most Laser Vision Surgeries including Lasik re- shape the cornea) despite its anterior scar to result in vision in most cases even without glasses.
Think of this concept as a carpenter’s plane shaping a piece of wood where while shaping that piece of wood, the shavings that come off are the scar. So the focus of the surgery is not so much the scar but actually the shape and the scar coming off is actually a welcome side effect.
This modern they elegant and minimalistic approach of Corneoplastique ™ to address anterior corneal scars in a three-minute surgery using numbing drops only and resulting directly in vision in most cases even without glasses is the future direction.
Corneal transplants can always be a backup surgery and finally find its place in what it was originally meant to be ----- a last resort.