CORNEAL TRANSPLANT

By TRACEY D'ASTOLFO
VINDICATOR CORRESPONDENT
BOARDMAN -- Bob Spencer, Chaney High School's principal lived with barely passable vision for most of his life.
As a teen he developed a staph infection in his eyes while being treated in the hospital after going through the windshield in a car accident. The infection weakened the corneas of his eyes and caused them to cone, or protrude outward in a point, a condition called keratoconus, and his vision deteriorated.
For years Spencer, 59, wore rigid contact lenses to help correct his vision, but eventually the coning in his left eye reached the point where the contact would no longer stay put.
"The coning caused the lens to slip, like trying to put a plate on a stick. It was popping out and becoming more and more difficult," he said.
Big decision
After talking to Dr. Keith Wilson at Eye Care Associates Inc., Spencer decided to undergo corneal transplant surgery, something he'd been avoiding.
"I'd always been apprehensive about the surgery. Your eyesight is critical. I was afraid the knife might damage my vision," he said.
Dr. Wilson said keratoconus, which causes irregular astigmatism that cannot be corrected with glasses, is just one reason corneal transplants are performed.
"Corneal transplants are typically done because the cornea's lost its clarity for one reason or another. This could be because of a scar from an injury or from a bacterial infection, which can cause an ulcer and leave a scar," he said.
The most common reason for having the surgery, Dr. Wilson explained, is a worn-out corneal endothelium.
A critical function
The corneal endothelium is a critical layer of the cornea. It pumps water out of the cornea and keeps it clear. Usually because of age or a hereditary condition called Fuch's dystrophy, the corneal endothelium loses its ability to pump water out of the cornea to maintain its clarity. The cornea swells with fluid and loses its transparency.
"So instead of like looking through a clear window, you're looking through frosted glass. ... It starts to slowly become more blurry," he said.
Dr. Wilson said this happens in elderly people more frequently because the cells of the corneal endothelium don't replenish themselves and the cornea gradually thins with age.
"People actually outlive their corneas now," he said.
Spencer, of Boardman, had the surgery done Dec. 23 to coincide with the school's holiday break. He said his vision began to improve the day after the surgery.
"There was still swelling the next day, but I noticed my near vision was improved. I went from not seeing anything to seeing letters, and I could read up close," he said.
His vision now
After the surgery he went from 20/60 vision with corrective lenses to 20/25 with lenses.
Dr. Wilson said the procedure is done under general anesthesia and takes about an hour and 15 minutes. The corneal tissue is acquired from organ donors through an eye bank.
"A lot of people have the misconception that it's the whole eye that's used, when in fact it's just the cornea, which is that front membrane," said Dr. Wilson.
Dr. Wilson also notes that corneal transplantation is different from other organ transplants in that the tissue is not tissue-typed.
"The cornea's considered to be what we call a privileged site, where you don't have to do tissue [or blood] matching. The reason for that is because there's no circulation in the cornea, so therefore you can put the new cornea in place and the body isn't even aware that it's there," he said.
Corneas can be rejected, Dr. Wilson pointed out, but tissue typing generally doesn't make a difference. If the rejection is detected early, it can usually be treated and reversed with eyedrops, he said.
Rehabilitation after the surgery is lengthy, usually six months or longer, Dr. Wilson said. The stitches aren't removed for at least a year, because the cornea heals slowly.
Most of the advances in corneal transplant surgery over the past few years have been with the eye banks, said Dr. Wilson. Corneal tissue used to remain viable for a very short time, resulting in urgent, often late-night, surgeries when a cornea became available. The tissue can now survive a week in a newly developed preservation medium, allowing surgeries to be scheduled ahead of time.
Hospitals have also been better about asking for cornea donors, Dr. Wilson said, so there is a more regular supply of the tissue.
Driving difference
Spencer said he knew he needed the surgery when he realized he might have trouble getting his driver's license renewed. As he drove home from work shortly after the surgery, the difference it had made hit home.
"When I really first noticed it, I was driving, and suddenly I could read the license plates in front of me, and read street signs really easily. It was a big difference," he said.
Spencer said he now plans to have the surgery on the right eye because the contact lens is starting to slip.
"I always got through squinting and wearing reading glasses," he said. "I'm very pleased I did it and sorry I didn't do it sooner. It's been a wonderful experience and not as traumatic as I thought."
XNote: The Vindicator earlier profiled a woman who profited from cataract surgery. That surgery and corneal transplants are the two most common eye surgeries in the United States, but are often overlooked in favor of newer, high-tech procedures.