Blurry vision can occur in adults for a variety of reasons. As we age, our prescription changes, cataracts develop and other age related eye diseases like macular degeneration, glaucoma and dry eye can become a reality. Fortunately, advanced technology has provided significant improvements in treatment modalities for all these conditions. One condition that may not be as well known to the general public is a corneal disease called Fuch’s Endothelial Dystrophy. In moderate to advanced cases of Fuch’s traditional surgical treatment was a corneal transplant. Today, Fuch’s dystrophy can be surgically treated with technology that has resulted in far less post-operative healing and an incredibly rapid visual recovery compared to previous methods.
Fuchs’ dystrophy is an inherited condition that affects the inner most layer of the cornea. The cornea is the clear layer of tissue directly in front of the colored part of the eye also known as the iris. The cornea has often been referred to as the window of the eye. It has five layers the innermost called the endothelium. The endothelial layer functions as a pump mechanism that constantly removes fluid from the cornea to maintain its clarity. Patients with Fuch’s gradually lose functional endothelial cells as the dystrophy progresses. Once these cells stop working they become large and abnormal pushing functional cells aside. The cornea is unable to repair itself and replace the abnormal cells resulting in the pump system failing to work efficiently causing the cornea to swell, scar, and eventually reduce vision. Fuchs’ cannot be cured; however, with certain medications, blurred vision resulting from the corneal swelling can be treated. Salt solutions such as sodium chloride drops are often prescribed to draw fluid from the cornea and reduce swelling. This is also available in an ointment form for night time use while sleeping. Eventually topical treatment is not enough to maintain clear vision and surgery is necessary.
Fuchs’ is detected by examining the cornea with a slit lamp microscope that magnifies the cornea 40 times its size. The health of the endothelium can also be evaluated and monitored with two additional technologies. Corneal pachymetry measures the corneal thickness with ultrasound allowing observation of small amounts of swelling through thickness measurement changes over time. Specular microscopy allows the evaluation of individual endothelial cells on the back surface of the cornea. Their number, size and shape can be determined and compared to normals.
Fuchs’ affects both eyes and is slightly more common among women than men. It generally begins at 30-40 years of age and gradually progresses. Traditionally, if the vision became significantly impaired, a corneal transplant would be performed to provide new healthy tissue to allow clear vision. Although usually successful, post-operative recovery is slow, requires much attention, six months to a year to fully recover, and typically results in a high prescription with significant astigmatism.
In the last decade surgical techniques have dramatically improved, providing a much faster and more comfortable recovery as well as a reduction in the degree of high prescriptions post-operatively. Even in the last 3-5 years the technique has improved. The new and improved methods of treatment are called DSEK and DMEK. Although very similar, DMEK requires more skill on the surgeon’s part. DSEK stands for Descemet’s Stripping Endothelial Keratoplasty and DMEK, stands for Descemet’s Membrane Endothelial Keratoplasty. These surgeries replace only the diseased layer of the cornea, unlike a corneal transplant, which replaces the entire cornea. Therefore, the procedure is far less invasive and there is less healing involved. DSEK and DMEK take about 30-40 minutes to perform and the surgeries are usually done as an outpatient procedure at a hospital or surgery center. Visual recovery is fast and although glasses are required after surgery, prescriptions are usually mild.
If you have a family history of Fuch’s Corneal Dystrophy and would like to be evaluated for the condition, please contact us at our Stillwater office @ 405-372-1715 or Pawnee @ 918-762-2573. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!