Keratoconus is a type of corneal ectasia, which refers to a group of diseases in which the cornea is thinned and weakened. The name is derived from the Greek word for “horn” (keratos) and “cone” (konos) – “I have a horn-cone on my eye” (said no one, ever). As the corneal tissue thins, the pressure inside the eyeball may push outward and distort the cornea into a cone shape, leading to distorted vision. Think of a balloon with a weakness in one particular spot – this area will bulge outwards more than the rest of the balloon. While keratoconus does not cause total blindness, vision impairment may progress to the point of causing legal blindness. In the US, legal blindness is defined as a visual acuity of less than 20/200, or a visual field of 20 degrees or less.
Research & Publications
In the eye care world, there is a mixed variety of reactions a doctor might encounter from a patient after announcing that he or she has signs of a cataract.
“Cataract? Is it bad? But I’m only 65 years old!”
“Ah yes, cataract. It runs in the family so I knew I was going to get It. All my grandparents and also my parents got cataracts.”
“What’s a cataract? Is that the same as macular degeneration?”
I’d like to venture into the human component of what I do. A little story that reminds me of the true essence of what I do for a living. At the end of the day, it’s not about the money. It’s all about affecting people’s lives and how much I’m affected by affecting those lives.
We spend a lot of time trying to provide useful research to our website visitors especially in the fields of LASIK/LASEK and Pterygium. I think there are times, though, when a good old fashioned story is called for.
What words come to mind when you think of a bright and sunny holiday destination such as California? Beach, white sand, water? Surfing, sun, sunburn, awkwardly-located tan lines? How about Pterygium?
Pterygia, or its singular form, pterygium, is a benign overgrowth of conjunctival tissue on the eye and has a worldwide prevalence of about 10.2%1. The first part of the word, ptery, is derived from the Greek meaning “wing” (think of the winged pterodactyl), as the typical shape of a pterygium is a triangle. The conjunctiva is a membrane that sits over the whites of the eye, and if it grows over the cornea, the clear bubble over the coloured part of the eye, we get what we call a pterygium. Its little cousin, a pingueculum, is also an overgrowth of conjunctival tissue that presents as a little white or off-white yellowish bump on the sclera but doesn’t encroach onto the cornea.
Yes, you read that right. I love LASEK. I fully admit it. When done properly it is a great procedure.
Quick story: I recently had a Navy veteran in for a Laser Vision Correction consult. He told me that the Navy requires LASEK to be performed on all of its pilots. So if you are going to land a plane on a ship, you have to go with LASEK (or equivalent) instead of LASIK. Who would not want the same LASEK technique used on them as the Navy demands for its pilots?
Imagine this. The zombie apocalypse has finally arrived, you’re running for your life from the undead when suddenly your glasses slide off your nose – and you hear a crunch under your feet. What do you do now? Is that a hungry zombie over yonder or just a human dragging his feet?
A great way to prepare for this impending event (and to not need glasses) is to consider laser eye surgery.
In 2015, 596,000 people in the USA underwent a laser eye surgery procedure known as LASIK. This year, in 2017, an estimated 638,000 people in the USA will have LASIK performed. Also known as laser assisted in situ keratomileusis, LASIK is just one of several refractive surgery options alongside another relatively newer procedure known as LASEK (laser assisted sub-epithelial keratomileusis). Both are surgical techniques with the aim to address what is called refractive error – basically, the need for correction with spectacles or contact lenses.
I had a weird consultation this week. The case wasn’t weird but the dynamics were. A young person came in for a Pterygium surgery evaluation. He was in his early 20s and was a great candidate for surgery with a significant growth that was plaguing him. He had gone down to Big University eye hospital in Los Angeles the last few years and every time he went in he was told to wait for surgery as his case was high risk. Then he comes to visit little old me in Ventura County and I turned his world upside down when I said he would do great.
He was accompanied by a relative who was clearly stressed out that I would dare contradict the so-called ‘best of the best’ at Big U. The fact that I saw no good reason to make this silently tortured young man wait blew this persons mind. In fact, they were so flustered I was waiting for this person’s head to explode during the visit! They simply refused to believe that better options were available.
Last summer, we embarked on a trial program with the goals of providing great vision at a reasonable price point while reducing the fear that is inherent to eye surgery. Part of my goal was to make eye surgery more accessible to patients in their 20s and 30s as they tend to have nearsighted eyes that respond beautifully to treatment.
Wavefront Lasik surgery typically costs $5,000 and up. It is worth every penny but most people don’t have $5,000 to spend on a luxury surgery. Couple this with the reservations that any sane person would have about having surgery on their otherwise healthy eyes and it is no wonder that only a small percentage of the US population has had Laser Vision Correction.
Our website brings inquiries and questions from all over the world. Recently a woman in Florida sent a desperate plea for help. Her husband had been diagnosed with Keratoconus and was told that he would inevitably go blind over time. The poor guy was living his life thinking that nothing could be done and he was destined to a life with a seeing-eye dog and a cane. Meanwhile, he could see well enough to work on a computer at his work, so he still had functional vision.
Like many Cornea Specialists, I have a thriving general Ophthalmology practice. I am always amazed when I see patients that had Laser Vision Correction done elsewhere when they were over the age of 40 and had both eyes corrected for distance vision only. This effectively wiped out their near vision and made them completely dependent on reading glasses to see up close. They basically traded one shortcoming for another.