Cornea

The cornea is the transparent "window" covering the iris and the pupil of the eye. For vision to be clear, the cornea must be clear. Mattax Neu Prater Eye Center provides a comprehensive range of medical and surgical cornea care. Our team—including cornea subspecialist Jacob Thomas, MD, who is fellowship trained in the evaluation, diagnosis, and management of corneal eye disease—is trained in the following:

  • Surgical alternatives, such as partial-thickness cornea transplants (DMEK and DSAEK)

  • Corneal topographical analysis

  • Complicated contact lens fitting

  • Dry eye

Using this expertise, some of the most common conditions treated by our cornea team include:

  • Various corneal dystrophies, such as Fuchs' dystrophy

  • Keratoconus

  • Corneal scars and infections

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Corneal Transplant: Overview

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DSEK: Overview

Fuchs' Dystrophy

What is Fuchs’ dystrophy?

Fuchs' dystrophy is a relatively common corneal dystrophy.

The cornea has three layers. The bulk of the cornea is called the stroma. The outer surface of the stroma is covered by the epithelium layer, which is several cells thick. A layer of endothelium lines the inner surface of the cornea.

The endothelium of the cornea is the primary area of pathology in Fuchs' corneal dystrophy. When the endothelium is unhealthy, the cells die, do not regenerate and they leave dots called “guttata” on the inside of the cornea. Guttata are often the first sign of Fuchs' dystrophy. Guttata cause glare and reduce quality of the vision.

In late stages of Fuchs' dystrophy, the corneal endothelial cells lose their ability to perform their primary duty, which is pumping fluid from the stroma. The stroma then accumulates fluid, causing corneal stromal edema, which makes the cornea become thicker. It also becomes more hazy, like a steamy window, and can cause a significant decrease in vision.

How is Fuchs’ dystrophy treated?

When corneal stromal edema develops in the early stages of Fuch’s dystrophy, medications can be used to improve vision. If this does not work, then cornea transplantation procedures are sometimes necessary to restore vision.

In the past a penetrating keratoplasty was performed. This procedure involved a full thickness transplantation with a prolonged recovery lasting often over 1 year. The surgeons at Mattax Neu Prater are now offering the latest corneal transplantation procedures, DMEK and DSAEK. These partial thickness corneal transplants replace the endothelium (inner portion of the cornea) rather than the full thickness of the cornea as in standard corneal transplants. By replacing only the specifically diseased layer, patients can have a more rapid and safer recovery.

Dry Eye

What is dry eye?

To be comfortable, your eyes need to be lubricated with tears. Normally, there is always a “film” of tears on the surface of your eyes, but if your eyes do not produce enough tears or the quality of your tears is poor, the surface may become irritated. This is known as “dry eye disease.” Symptoms include gritty, scratchy, or burning eyes; a feeling of something in the eyes; excess tearing; and blurred vision.

What causes dry eye?

Many things can cause your eyes to become dry. These include:

  • Blocked meibomian (tear) glands
  • Aging
  • Heaters and air conditioners
  • Wind, smoke, or dry weather
  • Allergies such as hay fever
  • Medications
  • Eyelid problems, injuries to the eye, or diseases like rheumatoid arthritis

How is dry eye diagnosed?

To diagnose dry eye, your eye doctor will thoroughly examine your eyes. He or she may examine the tear film, test for any dry spots, and measure the amount of tears your eyes produce.

Be sure to tell your doctor about:

  • Medical conditions you have
  • Medications you use, such as eyedrops or antihistamines
  • Any contact lenses you wear

Keratoconus

What is Keratoconus?

The cornea is made up of millions of fibers that link together to maintain the cornea’s shape. Keratoconus is caused by a weakening of the links between these fibers. It is an abnormality in which the cornea becomes progressively thin centrally and bulges forward in a pointed fashion. It sometimes can lead to corneal scarring that can also compromise vision. It usually occurs in both eyes, but sometimes affects one eye more than the other.

How is Keratoconus treated?

It creates irregular astigmatism, which sometimes cannot be corrected with eyeglasses. Rigid contact lenses are then attempted to restore vision in people who cannot tolerate contact lenses.

Surgical intervention is sometimes recommended in patients with significant corneal scarring who are not helped by or cannot tolerate contact lenses. Traditionally, this involved a corneal transplant. However, technology in this field is rapidly evolving and many new surgical treatments may soon be available.