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News from the First Global Parent's Story: Fight Keratoconus in the First Round
Top Left: Dina's Son Top Right: Family fun Bottom Left: Following the family tradition in the Army (2nd to the last of the soldiers) Bottom Right: Dina's Son I can't even begin to tell you how much this International Organization helped us when we first found out that my son has KC. Almost 5 years ago my son was diagnosed with Kerataconus. The doctors here (Israel) pretty much just said: see you in a year. I found out about cross-linking, we flew him out to LA, where he (at the age of 14) had it done at Dr. Boxer-Wachler's office and every 6 months he gets his check ups. So far, his eyes have remained absolutely the same. Which is a minor miracle since his eyes had begun to deteriorate rapidly when he was first diagnosed. We went the route of trying different kinds of contacts, but he felt pain in his eyes when he used them and he gave up on them. He has glasses now which corrects one eye. The other eye has just a clear lens since it can not be corrected. In one month he will be 19, and this year he is doing a year's service for the country before enlisting in the IDF (Israel Defence Force). The year's service includes working with the youth movement in small villages, plus working with autistic children. He has grown up a lot these last few months, learning how to budget money with a small group of volunteers who all live together in a common house. They buy their food, use the money for travelling and whatever else they need. It's a good lesson for life in general. As for the army, he got a low profile because of his Kerataconus which means he can't be in a combat unit. So who says Kerataconus is all negative? (don't tell him I said that). He has been accepted into an officer's training unit after his year's service is over, and hopefully he'll acquire skills there that he can use after his service. Both his sister and brother are officers in the army too. So is his Dad. That's what happens when a country is so tiny. Everyone helps out. And I've learned all sorts of healing methods from Reiki, Rising Star, Matrix Energetics, Reconnective Healing. I have used them all on my son (in vain!). I'm still waiting for him to say: hey! I can see in both eyes! I did help him when he had the flu. So I guess I can't complain...
The Human Factor: Another Members Keratoconus Escapology Jamie and Kristin from AZ, United States Time - line Date: 15 Dec 09
10,000 days since recorded Vision Loss
"My optometrist at the time (at the age of 12) never really caught my Keratoconus because he didn't have sophisticated equipment to screen for it. The minute I went somewhere high tech...They
found it." - Kristin
4595 days since Diagnosis
"Keratoconus was diagnosed when I was age 20" - Kristin 4553 days since my specialist advised me to put my name down on the list for a corneal transplant
“This was advised to me as the only option I have, but from my
research in to this I have not needed to go that route" - Kristin
4320 days since getting maximum vision with maxium comfort I have ever had with contact lenses.
“This was by finding a new optometrist purely by
chance from a recommendation, and from which a little known contact lens fitting
methodology was tried that works to this day” - Kristin
2541 days since an unheard of change for the better in my Keratoconus
“This coincided with the fitting methodology used and/or when I changed to eating a more healthier diet and I started to take up more exercise. Over time, new contact lenses was being prescribed flatter and flatter, due my corneal topography each time getting flatter also, until the flattest possible contact lens available to my optometrist was prescibed for me, which is still the same prescription that is worn by me till this day” - Kristin
San Francisco 2009: American Academy of Ophthalmology Vision-Related Quality of Life in Keratoconus Patients Treated for Corneal Collagen Crosslinking Location: San Francisco 2009 AAO, Moscone Center, Room: South 238. Presenting Author: Ricardo Gomes dos Reis MD. Co-Authors: Adalmir M Dantas MD, Haroldo V Moraes Jr MD, Ricardo Lamy MD, Mariana G Pecego MD, Camila F Netto MD, Bruno P Procopio Da Silva, MD, Lorena Vianna. Purpose: Evaluate the vision-related quality of life in keratoconus patients treated with riboflavin and ultraviolet radiation for Corneal Collagen Cross-linking (CXL). Methods: The National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) was applied in twenty-one patients with progressive keratoconus treated by CXL. The questionnaire was applied before and after the procedure, with ranges of 3, 6 and 12 months.Results: The NEI-VFQ-25 composite score increased 5,3 points after 3 months (P<0,05); 4,2 points after 6 months (P<0,05) and 5,4 points after 12 months (P<0,05). Conclusion: The vision-related quality of life had a general improvement after cross-linking treatment. Effects of Corneal Collagen Crosslinking on Visual Acuity and Contrast Sensitivity Location: San Francisco 2009 AAO, Moscone Center, Room: South 238
Presenting Author: Ricardo Lamy MD. Co-Authors: Adalmir M Dantas MD, Haroldo V Moraes Jr MD, Mariana G Pecego MD, Camila F Netto MD, Ricardo Gomes dos Reis MD, Bruno P Procopio Da Silva, MD, Lorena Vianna. Purpose: Assess the effects of corneal collagen crosslinking (CXL) on visual acuity and contrast sensitivity. Methods: Sixty two eyes of 31 patients were enrolled. One eye was treated and the fellow served as control. Pelli-Robson contrast sensitivity test (PR) and best corrected visual acuity (BCVA) were compared preoperatively and 40, 90, 180 and 365 days after cross-linking. Results: In the treated group, BCVA (logMAR) improved (P<0,05) after 40 days (-0,08); 90 days (-0,14); 180 days (-016); 365 days (-0,18) and PR decreased -0,13 points (P=0,34) after 40 days and increased +1,23, +1,81 and +2,35 points after respectively 90, 180 and 365 days (P<0,05). Conclusion: CXL was efficacious in improving visual acuity and contrast sensitivity. American Academy of Ophthalmology 2009
The Influence of High-dose Cortisol on the Biomechanics of the Cornea Eberhard Spoerl, PhD; Viktoria Zubaty, MSc; Naim Terai, MD; Lutz E. Pillunat, MD;
Frederik Raiskup, MD, PhD Purpose: To investigate the change in biomechanical properties of the cornea induced by high-dose hydrocortisone.
Methods: The influence of hydrocortisone was investigated in 12 fresh porcine corneas incubated in culture medium of 2.5 μM of hydrocortisone for 7 days. Twelve additional porcine corneas incubated in culture medium without hydrocortisone for the same time served as the control group. Strips of cornea were cut and the stress–strain relationship was measured in a biomaterial tester. Young’s modulus was calculated.
Results: After incubation, the thickness of the cornea was 11206130 μm in the control group and 1320690 μm in the hydrocortisone group. The hydrocortisonetreated corneas were 18% thicker compared to the control corneas. However, the difference in the biomechanical stress value at 10% strain was significantly larger. In the control group, the stress value measured 122640
kPa, and in the hydrocortisone group, it measured 77619 kPa (P=.003), representing a reduction of the corneal stiffness by 37% due to hydrocortisone treatment. Young’s modulus was reduced by 42.8% from 2.9061.10 MPa in the control group to 1.6660.49 in the hydrocortisone group.
Conclusions: Hydrocortisone is a modulating factor of the biomechanical properties of the cornea. The significance of the cortisol status of the patient and its influence on the biomechanical stability of the cornea should be considered in the development of keratectasia in keratoconus or after refractive surgery. [J Refract Surg. 2009;xx:xxx-xxx.] doi:10.3928/1081597X-2009
In the Line of Sight: News in the Pentacam Software During the ASCRS in Chicago Oculus has presented two unique software features of the Pentacam: - Belin/Ambrosio Enhanced Ectasia Screening, developed by Prof. Michael Belin, MD, Albany/New York and Renato Ambrosio, MD, Rio de Janeiro/Brazil,
- 3D lens densitometry with the Pentacam Nucleus Staging called “PNS”, developed by Donald Nixon, MD, Ontario/Canada.
“The goal of the Belin/Ambrosio Enhanced Ectasia Display is, to combine elevation based mapping and pachymetry corneal evaluation in an all inclusive display”, says Prof. Michael Belin one of the clinical investigators.
A new method is used to fit the sphere to the cornea called the enhanced BFS. It offers two main advantages:
- A cone in an early stage of Ectasia or Keratoconus is more pronounced
- A elevation map of normal eyes (eg. an astigmatism) looks same with the common BFS and the enhanced BFS. Only irregularities like early Ectasia are more pronounced.
The pachymetry progression analysis is already included in the Pentacam software and well known. Together with the enhanced BFS it completes this display. “We found that Keratoconus patients have thinner corneas and faster and more abrupt increase of corneal thickness progression than normal corneas. These findings were in agreement with previous reports in the literature pioneered by Mandell and Polse. Interestingly, these new parameters are effective in detecting abnormalities in the majority of eyes with normal anterior curvature maps in patients with keratoconus in the contra-lateral eye. Thus, these parameters increase our sensitivity to detect Ectasia and its susceptibility. However, the enhanced display has increased our specificity to detect not ecstatic cases with inferior steepening” says Dr. Renato Ambrosio the second clinical investigator. More than 800 eyes were examined in Rio de Janeiro/Brazil, Ankara/Turkey and Albany/USA to define the borderline numbers.
The investigation and interpretation of the display is intuitive:
- If the corneal thickness progression shows an average index higher 1.1 the increase of thickness progression is clinically significant and the red curve is not parallel to the black broken lines but steeper and...
- If the difference map between the BFS and the enhanced BFS elevation map shows a red center it is clinically significant as well.
The evaluation of the crystalline lens conditions in terms of opacifications is clinical routine. There are lens opacification systems like the LOCS grading but it still subjective and open to interpretation. Another question is: what are the most efficient Phaco settings. The Pentacam measures the lens density in an objective, reproducible and accurate. “The new software measures a 3D template volume and optical density to generate a nuclear cataract grade”, says Dr. Donald Nixon the clinical investigator of this project. More than 300 patients were included into the clinical studies in Ontario/Canada which were done with the AMO Signature Phaco System linked to the Pentacam Nucleus grading system. The results are very promising, because: - Significant less EPT and BSS was used with Pentacam guided settings
- The needle time significantly less in grade 4-5 cataracts.
These results were confirmed and presented during the ASCRS in Chicago by T.M.Rabsilber, MD member of the refractive group leaded by Prof. G.U. Auffarth, MD at the University of Heidelberg, and Prof. Ekkehard Fabian, MD, AugenCentrum Rosenheim.
 PENTACAM® HR 2.94 MB PDF
PENTACAM® Basic 1.59 MB PDF |
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