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Dr. Jacob Thomas, Mattax Neu Prater’s cornea subspecialist, provides comprehensive and surgical cornea care.
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. As a cornea subspecialist, Dr. Thomas has additional fellowship training and experience in evaluation of the cornea and the diagnosis and management of corneal eye disease. This training includes (but is not limited to):
Dr. Thomas provides treatment for the following:
He also performs the following procedures:
The first successful transplant was performed in 1906. Techniques have been refined since then to allow the transplantation of the specific corneal layers affected by different diseases. Currently, more than 45,000 cornea transplants are performed each year. However, corneal treatment technology and techniques continue to evolve. Thanks to these innovations, Mattax Neu Prater now offers corneal crosslinking as a less invasive treatment option.
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.
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 in which only the diseased layer of the cornea is removed and replaced with a transplant. This technique is call endothelial keratoplasty or “DSAEK”. By replacing only the specifically diseased layer, patients can have a more rapid and safer recovery.
Do your eyes sting, burn, or feel scratchy? 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, the surface gets irritated. This is known as “dry eyes.”
Each time you blink, another kind of tears, called lubricating tears, spread over the surface of your eyes. These tears keep the eyes moist and comfortable. Without them your eyes become dry and start to burn or sting and feel scratchy. They may also water in order to lubricate the surface of the eye.
Many things can cause your eyes to become dry. These include:
Your eye doctor looks at your eyes through a special microscope called a slit lamp. This allows him or her to examine the tear film. Your eye doctor may also use eyedrops with dye to help show any dry spots.
Testing Your Tear Production: Your eye doctor also measures the amount of tears your eyes produce. First, your eyes may be numbed with anesthetic drops. Then, your doctor folds filter paper over your lower lids. You’re asked to sit with your eyes closed for about 5 minutes. The paper absorbs the tear film. The amount of fluid in the paper tells your eye doctor the amount of tears your eyes produce.
Be sure to tell your doctor about:
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.
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.
Another minimally invasive treatment option is corneal crosslinking. The aim of corneal crosslinking is to stop the progression of keratoconus and similar conditions. While it can’t reverse the distortion of the cornea, it can prevent it from worsening to the point where a corneal transplant is needed. In this procedure, drops of riboflavin solution (a form of vitamin-B2) are applied to the cornea followed by a small amount of UVA light to activate the riboflavin which strengthens and stabilizes the weakened links bonding the corneal fibers together.
Surgical intervention is sometimes recommended in patients with significant corneal scarring who are not good candidates for corneal crosslinking or 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.