Seeing Eye To Eye

An Alternative to Corneal Transplant: Intacs

Written By: Pepose Vision | November 28, 2011

As a corneal specialist, I am often referred patients with a corneal disease called keratoconus, where the front window of the eye – the cornea – becomes thinner and begins to bulge outward.  In advanced cases, the cornea will have a cone shape instead of being round like a baseball.  The irregular shape of the cornea causes light to enter the eye in a distorted fashion.  Many keratoconus patients are legally blind without glasses or contacts.  They often require special rigid or hard contact lenses to see well.  However, these contacts can be uncomfortable and cannot be worn on a regular basis.  Some patients are then faced with the difficult choice of functioning with blurry vision with glasses or attempting to improve their vision with corneal transplant surgery.  In corneal transplant surgery, the patient’s cornea is removed and a donated cornea is stitched in place.  While the new cornea would have a more round shape, there is a lifetime risk of rejection and other significant risks with the surgery.  The recovery from corneal transplant surgery can take up to a year in some cases.

An alternative treatment, with no risk of rejection and much lower risks from surgery, is Intacs.  Intacs were first used to treat nearsightedness, so they have a track record of about 20 years.  They are a semi-circular ring that is inserted into the deeper layer of the cornea in order to add strength and support to the weakened keratoconic cornea and, more importantly, to reshape it.  A laser is used to create tunnels in the cornea and then the Intacs segments are inserted in the operating room.  This outpatient procedure allows patients to return to their normal routine within a few days and resume contact lens wear in a couple of weeks.  Most patients notice an improvement in vision without glasses, improved vision with glasses, and greater ease in wearing contact lenses, including soft contacts.  All intacs patients at Pepose Vision Institute have been able to avoid corneal transplantation.

Patients are candidates for Intacs if they have keratoconus or an irregular cornea, have poor vision with glasses or contacts, cannot wear contact lens on a regular basis, or have been advised to consider corneal transplantation.

Help for Keratoconus – a true case story.

Written By: Carrie Gaines | March 25, 2011

William is a very intelligent and pleasant 34-year-old gentleman.  He has had known keratoconus since 2006.  The keratoconus was more severe in his right eye.  With glasses his best vision was 20/150 in his right eye and was 20/25 in his left eye.  Keratoconus interfered with his life.  Images were multiple, distorted and blurred.  His work suffered because he had difficulty using the computer and reading.  He experienced glare and haloes around lights which made it difficult to drive both at night and in bright sunlight.  William tried multiple contact lenses to manage his keratoconus.  And although he could see reasonably well with contact lenses, they became intolerable after 4 to 5 hours.

Intacs corneal implants were recommended for William to restore his visual function.  Intacs are micro thin.  They work by flattening the steep part of the cornea resulting in improved vision and reduced vision distortions.  Prior to Intacs, the steepest part of his cornea was 9.25 diopters in his right eye.  Following Intacs, the steepest part of his cornea was 5.25 diopters and his vision improved from 20/150 to 20/30!  Lastly, he was fit with a custom scleral contact lens to fine tune the vision in his right eye.  He comfortably wears the scleral lens all day long and has the best vision that he can remember.  Although William still has keratoconus, it is no longer a source of stress and no longer interferes with driving or work.  Best of all, he is able to clearly see his new baby girl!