Keratoconus Home Page - Keratoconus.com

Phone: 310.423.9640 | Email: rabinowitzy@cshs.org
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Welcome to the Keratoconus Center

'This website was designed to provide the latest information about treatment and research for patients with keratoconus and research about the disease keratoconus. For 15 years I have dedicated much of my professional life to studying keratoconus and treating patients with keratoconus. I am sharing what I have learned about keratoconus in the hope that those with keratoconus may benefit from my extensive clinical experience in treating patients with keratoconus.’

- Yaron S. Rabinowitz,M.D.
Clinical Professor of Ophthalmology, UCLA School of Medicine, Director of
Ophthalmology Research, Cedars-Sinai Medical Center, Principal Investigator, National Eye Institute (NEI) keratoconus research grant, entitled ‘Genetic Factors in Keratoconus'. This research grant on keratoconus, the largest grant of it's type in the world on keratoconus has been funded from 1993 to 2013.

Click here to view a videoclip of INTACS with Intralase for keratoconus, the very latest treatment for keratoconus patients who have clear corneas, but are contact lens intolerant.

Click here to an article about INTACS with the Intralase and why it is superior to the mechanical technique in patients with keratoconus.

Click here to learn about I.E.K.- corneal transplants with the laser for keratoconus- the biggest advance in corneal transplants in 30 years

Cornea Genetic Eye Institute - Southern California's Leading Cornea and Vision Correction Specialist

"Many patients with keratoconus feel their treatment options are limited, this is not correct. Two new treatments for keratoconus are INTACS with the Intralase and Corneal Transplants with the laser (I.E.K.) both provide a safe and effective means to obtain excellent vision in keratoconus patients who can no longer tolerate their contact lenses"

About Us

The Keratoconus Center is located in the penthouse of the Cedars-Sinai Mark Goodson Building and is one of the few centers in the world dedicated to both research and treatment of keratoconus.

Under the direction of Yaron S. Rabinowitz M.D., expert on keratoconus and cornea specialist, The Keratoconus Center offers consultation for the medical and surgical treatment of keratoconus. In addition, patients may volunteer to participate in a variety of clinical trials to treat and elucidate the underlying causes of keratoconus.

To schedule a consultation, discuss surgical options, or participate in a clinical trial please call 310-423-9640 to schedule an appointment.

The Keratoconus Center
Cedars-Sinai Mark Goodson Building
444 S. San Vicente Blvd. Suite 1102
Los Angeles, CA 90048
310-423-9640

What is Keratoconus

The cornea is the window of the eye. Light travels through the cornea past the lens to the retina and then the brain to form a visual image. The normal corneal surface is smooth and aspheric i.e. round in the center, flattening towards its outer edges. Light rays passing through it moves in an undistorted manner to the retina to project a clear image to the brain.

In patients with keratoconus the cornea is cone shaped (hence the name keratoconus, derived from the greek word for cornea (‘kerato’) and cone shaped (‘conus’). In patients with keratoconus the cornea is not only cone shaped but the surface is also irregular resulting in a distorted image being projected onto the brain.

Because the cornea is irregular and cone shaped, glasses do not adequately correct the vision in patients with keratoconus since they cannot conform to the shape of the eye. Patients with keratoconus see best with rigid contact lenses since these lenses provide a clear surface in front of the cornea allowing the light rays to be projected clearly to the retina. Hence the vast majority of patients are treated with rigid contact lenses. There are however some excellent new surgical options for patients with keratoconus who cannot tolerate these lenses, these options are discussed under treatments for keratoconus.

Many patients are initially unaware they have keratoconus and see their eye doctor because of increasing spectacle blur or progressive changes in their prescription. In many instances even a good refraction yields poor vision. Keratoconus is most often diagnosed by a cornea specialist who my see typical findings when examining the patient at the slit-lamp. In early forms of the disease there may be no obvious finding on slit-lamp evaluation and the diagnosis is made by computerized videokeratography only.

Keratoconus typically commences at puberty and progresses to the mid thirties at which time progression slows and often stops. Between age 12 and 35 it can arrest or progress at any time and there is now way to predict how fast it will progress or if it will progress at all. In general young patients with advanced disease are more likely to progress to the point where they may ultimately require some form of surgical intervention.

Keratoconus may occur in one eye only initially but most commonly affects both eyes with one eye being more severely affected than the other. Both males and females are equally affected and there is no ethnic predilection though in some parts of the world such as New Zealand and in certain parts of Finland there is a higher incidence due to genetic factors.

Despite millions of dollars being spent on keratoconus no one truly knows the cause of the disease. There have been many interesting theories but none of them have been proven conclusively neither have any of them consistently been reproduced by multiple research groups. For example one theory suggests that there is deficient collagen crosslinking caused by free radicals but there is no scientific reproducible evidence to support such a theory. Others suggest that eye rubbing causes the progression of keratoconus. The evidence for this is however anecdotal based on several case reports, but again there is no reproducible scientific evidence to support this.

Our research group was the first group to demonstrate that genetic factors play a major role in the development of keratoconus (Wang Y, Rabinowitz YS, Rotter J, Yang H. Genetic epidemiological study of keratoconus: evidence for a major gene determination. American Journal of Medical Genetics 93:403-409,2000). While our scientific based evidence supports a role for genetic factors this does not mean if you have a child with keratoconus they will necessarily develop keratoconus, since only 13-15% of keratoconus patients have a family history with keratoconus. It does mean however that genes play a role in its development and suggests that any proposed treatment for the disease will either be very temporary or short lived until the genes that contribute to its development are identified and either replaced or suppressed. This is the only potential hope for a permanent cure to stop progression and ensure the cornea will no longer continue to thin.

For a comprehensive scientific review on keratoconus click the link below to read a PDF version of the following article: (Rabinowitz YS. Keratoconus: update and new advances.(Major review). Survey of Ophthalmology. 1998: 42:4:297- 319.)

Our Director

Yaron S. Rabinowitz M.D. is a corneal surgeon and expert in the treatment and diagnosis of keratoconus. He has published more articles on the diagnosis and treatment of keratoconus than any other practicing eye surgeon in the world. He is Clinical Professor of Ophthalmology at U.C.L.A. School of Medicine and the Director of Eye Research at Cedars-Sinai Medical Center. His research on the early detection and genetics of keratoconus has received funding from the National Eye Institutes of Health and for the past 15 years.

His research has provided new insights into the understanding and treatment of keratoconus. Among the insights provided into the understanding of keratoconus are:

The first to describe that mild topographic abnormalities occur in family members of patients with keratoconus.
Authored one of the first text books on corneal topography.
The first to demonstrate through a research study that keratoconus has a genetic basis.
The first to demonstrate which keratoconus suspect patterns progress to ultimately develop keratoconus.
Most recently published the first article which demonstrates that the femtosecond laser is accurate and preferable for creating channels to insert INTACS a novel new treatment for patients with keratoconus.

He has been a recipient of multiple awards to acknowledge his contributions to keratoconus research, these include:

The American Academy of Ophthalmology Honor Award.
The Jules Stein/UCLA Research Alumni Award.
The 3rd American to be the honored guest of the French Eye Society.
The recipient of the International Society of Refractive Surgery and the American Academy of Ophthalmology– Kritzinger Memorial Research Award for contributions to refractive surgery research.

Dr. Rabinowitz sees patients in consultation at the Mark Goodson Building Cedars-Sinai Medical Center and performs surgery on patients with keratoconus at the Eye Surgery Center Beverly Hills. To contact Dr. Rabinowitz or to schedule an appointment call our office at 310-423-9640.

Keratoconus Genetics Research Program

Background:
The Keratoconus Genetics Research Program at Cedars-Sinai Medical Center is the largest research program on Keratoconus of its kind in the world. It has been funded by the National Eye Institutes of Health for the past 15 years and recently the Principal Investigator Yaron S. Rabinowitz M.D. was awarded a 3.5 million dollar grant from the National Eye Institutes to continue this research until 2013.

Research Goal:
The goal of the research project is to identify genes contributing to the development of Keratoconus and using this information to ultimately to devise a cure by for this disease by means of gene therapy.

For a complete abstract of this grant proposal click the link below
http://crisp.cit.nih.gov/crisp/CRISP_LIB.getdoc?textkey=7385160&p_grant_num=2R01EY009052-14A1&p_query=(rabinowitz+|+keratoconus)&ticket=71504892&p_audit_session_id=350386511&p_audit_score=29&p_audit_numfound=7&p_keywords=rabinowitz+keratoconus

For publications supported by this grant click the link below
http://scholar.google.com/scholar?q=rabinowitz+keratoconus&hl=en&lr=&btnG=Search

Recruitment and Eligibility
We are actively recruiting patients for this study. Any patient with Keratoconus is eligible and typically there is no out of pocket cost for any patient choosing to participate

Benefits of Participation
There are several benefits awaiting individuals who participate in the Keratoconus Genetic Research Program:

We will supply your eye doctor with a computerized map of your cornea so as to facilitate obtaining a far better fit for your contact lenses.
We will monitor the status and/or progression of your Keratoconus, on an annual basis.
We may be able to identify which of your family members (if any) are at risk for developing Keratoconus.
We can give you advice on the very latest treatments for Keratoconus currently available
You will be eligible to be placed on a waiting list for a trial for gene therapy if this comes to fruition

How to Participate
To schedule an appointment, please contact our research coordinator Martha Bucaram at (310) 423-9642. or email her at bucaramm@cshs.org.

For a maps and directions to our office click here

During your visit, which should take about 30 to 60 minutes, you will be asked to complete a questionnaire. An eye exam will be performed and computerized photos of your corneas will be taken. We may also request a blood sample from you which is optional and is not a requirement for participation in this study. You will be given a complete evaluation by a cornea specialist and an expert in Keratoconus.

Convenient validated parking is available in the Mark Goodson Building at Cedars-Sinai Medical Center.

Support
We can arrange for your to meet other patients with keratoconus who have had many contact lens changes or corneal transplants, so that you can discuss problems of common interest, share information, and better understand the treatment options that are available.

Keratoconus Research Overview
The Keratoconus Center is proud to offer more clinical trials for both treatment and understanding the basis of this disease than any other center in the world. Our clinical trials include:

The early treatment of keratoconus with INTACS and the Intralase laser.
Identifying genes in families with keratoconus.
PRK (photorefractive keratectomy) for keratoconus.
Treatment of mild to moderate keratoconus with INTACS and the Intralase laser.
Treatment of keratoconus with the Visian ICL.
Lamellar transplants in the treatment of keratoconus.
Developing a molecular genetic test to diagnose keratoconus.
Videokeratography indices for detecting early keratoconus.

To date our research has significant contribution to the medical understanding, advances, and treatment of keratoconus. Our achievements include:

Developed a computer software to early detect keratoconus.
Identified the first molecular defect in keratoconus.
The first group to demonstrate keratoconus has a genetic basis.
The first group to publish and demonstrate that inserting INTACS with the Intralase laser is safer and more accurate than the mechanical technique.
The first group in Los Angeles to offer the Intralase laser for corneal transplants in patients with keratoconus.

To participate in our clinical trials please contact our research coordinator Martha Bucaram at 310-423-9642 or bucaramm@cshs.org.

Clinical Research

Identifying Genes for Keratoconus
This is part of an ongoing study supported by the National Eye Institutes of Health over the past 15 years. In this study all patients with keratoconus and their family members under videokeratography (detailed topographic pictures of their cornea) and family pedigrees and data are entered into a database. Blood is also drawn from family members for molecular storage and molecular genetic analysis. We hope one day to identify a gene for keratoconus and find a means of retarding its progression early on in the disease. To date we have identified a gene locus on chromosome 5 in one large family with keratoconus (click here to view PDF of publication for details) and multiple other loci in sib pair analysis of keratoconus families. These loci may all contain genes providing clues to the underlying mechanism of the disease process in keratoconus. We are particularly interested in individuals who have a family history of keratoconus or at least one family member with keratoconus. All study related costs are free, however, if patients opt to have treatment, they will be charged a discount off normal costs.

Developing a Molecular Genetic Test for Keratoconus
By examining corneal transplant buttons on patients upon whom we performed corneal transplants we detected a molecular defect in patients with keratoconus – the absence of a water protein – Aquaporin 5 (AQP5). We hope to develop this into a molecular genetic test for ‘early’ detection of keratoconus. This will be particularly useful in family members of patients with keratoconus and patients with suspicious topography labeled ‘keratoconus suspect’. We ask all our patients upon whom we perform corneal transplants to donate their diseased corneas for molecular genetic analysis. If we perform your transplant and you agree to donate your cornea you will be making a critical contribution toward increasing our knowledge and understanding of keratoconus.

Videokeratography Indices for Detecting ‘Early’ Keratoconus
Our center is a large referral center for patients who are suspected for having keratoconus with either suspicious topography or clinical signs. We see approximately 20 such consults each week. We have developed computerized software with indices, which are critical in helping us make a decision as to whether it is safe to recommend patients proceed with laser refractive surgery. Development of this software has been dependant on developing a large database of normal patients and patients with suspected ‘early’ disease’ and following such patients longitudinally over time. Data from all patients who visit us for referral are entered into databases for ongoing evaluation and refinement of these indices.

If you are interested in participating in our clinical trials please contact our research coordinator Martha Bucaram at 310-423-9645 or bucaramm@cshs.org.

Treatment Options for Keratoconus

CONTACT LENSES

Patients with very mild disease may initially be corrected with glasses or soft contact lenses, however the vast majority of patients need rigid contact lenses for adequate vision correction. There are a variety of types of specialized rigid contact lenses and depending on the contact lens fitters experience or expertise they will describe the one best suited for you. The very latest contact lens for treating keratoconus is the “synergize hybrid contact lens” which is rigid in the middle and soft on the edges. This has the potential to give you the good quality vision of the rigid lens with some of the comforts of the soft lens. We don’t fit contact lenses, but we do work with several excellent optometrists who specialize in fitting lenses for keratoconus in the Los Angeles area and would be happy to refer you to one should you so desire. It is always a good idea to try several different contact lenses and fitters before giving up on them and embarking on surgery.

Many patients find their contact lenses uncomfortable and can only tolerate their contact lenses for a short period of time. The reason this happens is that the cornea steepens and rubs against the lens causing an abrasion and light sensitivity .  Another reason is patients with keratoconus often have very dry eye and as the eye dries out there is no lubricating barrier between the lens and the cornea contributing to the patient being uncomfortable. There are now many ways to treat dry eyes to improve contact lens tolerance. This includes the use of artificial tears, treating the lids for lid disease, Restasis– for increasing tear production and the use of punctal plugs to prevent tears from draining down your nasolacrimal ducts and keeping the eye moist.

Sometimes a little scar or nebulous appears on the tip of the cornea that constantly rubs against the lens making it difficult to tolerate contact lenses, this scar can be removed with a blade or with the Excimer laser to return patients to contact lens tolerance – this procedure is called phototherapeutic keratectomy(PTK) or nebulectomy.

INTACS

A method for flattening the cornea that is too steep and making a patient more contact lens tolerant is the insertion of INTACS into the cornea. This procedure is good for patients who are contact lens intolerant and who want to avoid a corneal transplant and whose K readings are not in excess of 58 Diopters. It is also useful for individuals with keratoconus who want to improve their present vision with or without contact lenses. This technique involves the insertion of two arc like plastic segments into the middle of the cornea to flatten the cornea. This procedure was pioneered 8 years ago in France, and is routinely being done by many cornea specialists in the United States. It is FDA approved under an HDE protocol and many insurances cover all or part of the cost. Our center pioneered the use of the Intralase laser for making the channels to insert the plastic segments this makes it a much safer and simpler technique for the patient compared to the mechanical technique which involves using metal blades, our finding have been confirmed by several other large research groups. We have now done several hundred of these procedures with the Intralase with excellent results. In many instances we have had to remove INTACS that were too superficially placed elsewhere using the mechanical technique only to get an excellent result when it is inserted with the safer and more accurate Intralase technique.

Click here to view a video clip of the INTACS with Intralase surgical procedure

Click the links below to read about the very latest advances in keratoconus treatment.

COLLAGEN CROSS LINKING (CXL)- to stop the progression of Keratoconus

A relatively new technology called collagen cross linking with UVA is currently being introduced into the United States under experimental protocols in Clinical Trials. This treatment which has been used in Europe for several years and is undergoing Phase 1 FDA clinical trials in the United States has been demonstrated to be safe if performed, with the epithelium removed, and has the potential to stop the progression of Keratoconus. This treatment is recommended for individuals with progressive Keratoconus or Ectasia following LASIK to stabilize the cornea. It can be performed with our without INTACS.

For a review of the literature on this procedure read this recent article by Dr. Rabinowitz. (http://www.ophmanagement.com/article.aspx?article=102563)

The procedure which is painless is as follows. The top layer of the cornea is removed under local anesthesia. Vitamin drops are soaked into the cornea until they penetrate the entire corneal and evidence of penetration into the anterior chamber of the eye is demonstrated by slit-lamp evaluation. Once this is confirmed the patient’s eye is put under a specialized lamp which emits UV light at a predetermined wavelength for approximately 30 minutes. During this process the cross links which link the fibers of the cornea are increased thereby stiffening the whole cornea. A bandage contact lens is then put on the eye and patients are given antibiotics and anti-inflammatory drops and follow up on a regular basis with their physicians for several months.

For a detailed explanation on how this procedure works view this video created by a group of Keratoconus experts in Bordeaux, France (courtesy of of Dr. David Toubol)
(http://www.eyetube.net/videos/default.asp?safire)

Why is it important to remove the epithelium in this treatment? The slide below which is an Electronmicograph of the cornea which has undergone the procedure clearly demonstrates that the epithelium acts as a barrier to cross linking. As you can see from this slide in the areas where the epithelium is missing, the stroma is compacted and cross-linking has occured, while in the areas where there is epithelium (blue layer) the corneal fibers below are widely spaced and no cross linking or compaction has occured (see slide below)

Clinical Trial to compare the effectiveness of Collagen Cross linking with or without INTACS to halt the progression of Keratoconus

We are pleased to announce that after studying this technology now for many years we are offering the only Clinical Trial in the United states under an FDA protocol approved by the Western Institutional Review Board(WIRB) which will determine whether it is more efficacious to combine INTACS with collagen cross linking or do cross linking alone to halt the progression of Keratoconus.

To qualify for participation in this study you need to be 21 years or older, and have progressive Keratoconus or Ectasia after LASIK. This study is not complementary neither are patients paid to participate in this study. There will be a fee for both the procedure and the tests involved in the pre-operative evaluation. For those who are interested in participating, please call 310-423-9640 and speak to Martha Bucaram the study coordinator.

CORNEAL TRANSPLANTS

Corneal Transplants are the only option for patients who have scarring in the center of the cornea or who are contact lens intolerant because their corneas are too steep. The results of corneal transplants are excellent in keratoconus patients with an over 97% success rate. Patients can have LASIK or PRK on their transplants and become relatively independent of glasses or contact lenses – many of our patients achieve 20/30 or better vision with this combination of procedures.

Recently the Femtosecond Laser was approved for performing Corneal Transplants (also known as I.E.K or Intralase Enabled Keratoplasty). This is one of the biggest advances in Corneal Surgery in the past 30 years. The result is a quicker procedure, quicker recovery and less astigmatism with better vision. The Keratoconus Center is one of the few centers in the world that now uses this groundbreaking technology.

To learn more about the Femtosecond Laser/I.E.K click here

Sometimes patients who have had a successful transplant with a clear cornea still do not see well and cannot tolerate contact lenses. The reason for this is that they have large amounts of astigmatism following their transplant surgery. This can be corrected with Astigmatic Keratotomy (AK) and followed if necessary by Excimer Laser PRK. In most instances patients then become either contact lens tolerant and can see better with glasses or contact lenses.

LAMELLAR CORNEAL TRANSPLANTS

Treatments that are less commonly performed and are in part investigational include Lamellar corneal transplants, Excimer PRK (photorefractive keratectomy) and phakic intraocular lenses for keratoconus patients who are extremely nearsighted. In lamellar corneal transplant only a part of the cornea is removed and is replaced. This is slightly safer than a full thickness transplant however patients do not have the same quality of vision as patients who have undergone full thickness transplants. We are actively doing research at our center to improve the outcomes of lamellar transplants with the Intralase Laser.

PRK FOR ‘EARLY’ KERATOCONUS

Though eye care professionals recommend against Excimer laser PRK in patients with keratoconus because it thins the cornea even further, we are actively researching this area. Our experience has shown that in patients who are over age 40 whose vision is stable and whose corneas are thick enough they get similar results with the Excimer PRK as they would get with glasses. Patients who elect to undergo this treatment will be done under an experimental protocol and need to understand that they are at increased risk of scarring with the potential for needing a corneal transplant.

PHAKIC INTRAOCULAR LENSES

Patients who are extremely nearsighted more than -10D might benefit from phakic intraocular lenses. Currently there are two type of these lenses approved by the FDA –the Verisyse and the Visian ICL. These are implantable contact lens has been approved by the FDA for up to -20Diopters. We are one of few centers performing a research study on the use of these intraocular lenses in keratoconus eyes, This will be an exciting new opportunity for a select number of patients with keratoconus who could potentially improve their vision without the need for laser surgery.

All the procedures outlined above are routinely done by Dr. Rabinowitz himself who is a cornea specialist and an expert in the treatment of keratoconus.

Click here to view a video of the INTACS with Intralase surgical procedure

We have now done several hundred of these procedures with the Intralase with excellent results. In many instances we have had to remove INTACS that were too superficially placed elsewhere using the mechanical technique only to get an excellent result when it is inserted with the safer and more accurate Intralase technique.

Click the links below to read about the very latest advances in keratoconus treatment.

Corneal Transplant Q & A

Ophthalmologists (medical eye doctors) perform over 40,000 corneal transplants each year in the United States. Of all transplant surgery done today, including hearts, lungs and kidneys, corneal transplants are by far the most common and successful.

What Is The Cornea?
The cornea is the clear front of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea so we can see. To stay clear the cornea must be healthy.

How Can An Unhealthy Cornea Affect Vision?
If the cornea is damaged it may become swollen or scarred. In either case, its smoothness and clarity may be lost. The scars, swelling or an irregular shape cause the cornea to scatter or distort light, resulting in glare or blurred vision.

A corneal transplant is needed if:

Vision cannot be corrected satisfactorily.
Painful swelling cannot be relieved by medications or special contact lenses.

What Conditions May Require Corneal Transplants?
Corneal failure after other eye surgery, such as cataract surgery;

Keratoconus, a steep curving of the cornea
Hereditary corneal failure, such as Fuch's cornea
Scarring after infections, especially after herpes
Rejection after first corneal transplant
Scarring after injury
Complications from LASIK (lamellar transplants)

What Happens If You Decide To Have A Corneal Transplant?
Before Surgery
Once you and your ophthalmologist decide you need a corneal transplant, your name is put on a list at the local eye bank. Usually the wait is short.
Before a cornea is released for transplant, the eye bank tests the human donor for the viruses that cause hepatitis and AIDS. The cornea is carefully checked for clarity.
Your ophthalmologist may request that you have a physical examination and other special tests. If you usually take medications, ask your ophthalmologist if you should continue them.
The Day of Surgery
Surgery is often done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Once you arrive for surgery, you will be given eye drops and sometimes medications to help you relax.
The operation is painless. Anesthesia is either local or general, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening, and will not have to worry about keeping your eye open or closed.
The Operation
The eyelids are gently opened. Looking through a surgical microscope, the ophthalmologist measures the eye for the size for the corneal transplant.
The diseased or injured cornea is carefully removed from the eye. Any necessary additional work within the eye, such as removal of a cataract, is completed. Then the clear donor cornea is sewn into place.
When the operation is over, the ophthalmologist will usually place a shield over your eye.
After Surgery
If you are an outpatient, you may go home after a short stay in the recovery area. You should plan to have someone else drive you home. An examination at the doctor's office will be scheduled for the following day.
You will need to:

Use the eye drops as prescribed
Be careful not to rub or press on your eye
Use over-the-counter pain medicine, if necessary
Continue normal daily activities except exercise
Ask your doctor when you can begin driving
Wear eyeglasses or an eye shield as advised by your doctor
Your ophthalmologist will decide when to remove the stitches, depending upon the health of the eye and rate of healing.

Usually, it will be several months, at least, before stitches are removed.

What Can I Expect After Corneal Transplant Surgery?
Cornea Transplants are done on an outpatient basis. The procedure itself takes 45 minutes to 75 minutes depending on the complexity of the situation. You should expect to spend the whole morning at the outpatient surgery center however.
When you leave the hospital you will wear a patch and a shield. This will be removed the next day at your follow up visit at the doctor's office. After that you will be wearing dark glasses during the day and a protective shield at night only. Your vision will be blurry for approximately 3 - 6 months.
At 3 months you will start having your sutures removed and they should all be removed by the end of 6 months a little longer if you are older. At the end of 6 months you will be fitted with glasses or contact lenses. During the whole 6-month period you will take anti -rejection drops and antibiotic drops approximately 4 times a day.
For the first 6 weeks heavy exercise and lifting of heavy objects will be prohibited, but otherwise you can live a normal life. Most people return to work 3 to 7 days after their surgery depending on the type of work they do.
Corneal transplants are rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates.

Can I Get Rid Of Contacts Or Glasses After Transplant Surgery?
Yes it is possible to be free of contact lenses or glasses after transplant surgery. This will however require additional procedures such as astigmatic keratotomy or LASIK. The fees for these procedures are not included in the cost of the original procedure and may not be covered by traditional insurance, though under certain circumstances they may be covered.
After all the sutures are removed most patients are left with a certain amount of nearsightedness and astigmatism. This can be corrected either with Rigid contact lenses or glasses.
If the astigmatism is large this can be corrected with astigmatic keratotomy to bring the patient to less than 4D of astigmatism. Patients with less than 4D of astigmatism and less than 8D of myopia can then have their vision corrected with LASIK.
We have many patients who have successfully undergone these procedures and some of them would be happy to talk to you about their experiences.

Who Is Best Qualified To Do A Cornea Transplant?
The person most qualified to do a cornea transplant is an ophthalmologist fellowship trained in cornea transplant surgery. Transplant surgeons who have an academic interest in the advancement of knowledge on cornea transplantation are also members of the Castroviejo Cornea Society. For further information on Yaron S. Rabinowitz M.D, fellowship trained cornea transplant surgeon and member of the Castroviejo cornea society for the past 10 years. Click here to learn more about Dr. Rabinowitz

What Complications Can Occur?
Corneal transplants are rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates.
Most rejections, if treated promptly, can be stopped with minimal injury. Warning signs of rejection are:

Persistent discomfort
Light sensitivity
Redness
Change in vision

Any of these symptoms should be reported to your ophthalmologist promptly.
Other possible complications include:

Infection
Bleeding
Swelling or detachment of the retina
Glaucoma

All of these complications can be treated.
A corneal transplant can be repeated, usually with good results, but the overall rejection rates for repeated transplants are higher than for the first time around.
Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision but can also be treated. Vision may continue to improve up to a year after surgery.
Even if the surgery is successful, other eye conditions, such as macular degeneration (aging of the retina), glaucoma or diabetic damage may limit vision after surgery. Even with such problems, corneal transplantation may still be worthwhile.

A successful corneal transplant requires care and attention on the part of both patient and physician. However, no other surgery has so much to offer when the cornea is deeply scarred or swollen. The vast majority of people who undergo corneal transplants are happy with their improved vision.

Of course, corneal transplant surgery would not be possible without the hundreds of thousands of generous donors and their families who have donated corneal tissue so that others may see.

If you are a candidate for a corneal transplant and would like to receive a more detailed booklet about corneal transplants please mail us a $20 donation made out to the Eye Defects Research Foundation with your return address.

Click here to learn more about the Eye Defects Research Foundation and how you can support groundbreaking vision research.

Published Scientific Manuscripts on Keratoconus

Below is a list of over 50 manuscripts and books on Keratoconus and related issues written by Dr. Rabinowitz. Click the blue links below to download and read the available PDF’s.

National Eye Institute DNA Library/NEIBANK
Human Cornea (Keratoconus) cDNA Library

Scientific Manuscripts

INTACS for Keratoconus
Current Opinion In Ophthalmology, 2007

INTACS for Keratoconus
International Ophthalmology Clinics, 2006

INTACS Inserts Using the Femtosecond Laser Compared to the Mechanical Spreader in the Treatment of Keratoconus
Journal of Refractive Surgery, 2006

No VSX1 Gene Mutations Associated with Keratoconus
Investigative Ophthalmology & Visual Sciences, 2006

Keratoconus and Corneal Ectasia after LASIK
Journal of Cataract and Refractive Surgery, 2005

Genome Linkage Scan in a Multigenerational Caucasian Pedigree Identifies a Novel Locus for Keratoconus on Chromosome 5q14.30q21.1
Genetics in Medicine, 2005

Gene Expression Profile Studies of Human Keratoconus Cornea for
NEIBank: A Novel Cornea-Expressed Gene and the Absence of
Transcripts for Aquaporin 5
Investigative Ophthalmology and Visual Sciences, 2005

Longitudinal Study of the Normal Eyes in Unilateral Keratoconus Patients
Ophthalmology, 2004

Genetics of Keratoconus
Ophthalmology Clinic North America, 2003

Pellucid Marginal Degeneration: Spotting the Rare but Significant Hazard
for Refractive Surgeons
Refractive Eye Care, 2003

Pellucid Marginal Degeneration. An Unsuspecting Trap for the
Refractive Surgeon
Refractive Eye Care, 2002

Surgical Treatment of Advanced Pellucid Marginal Degeneration
Ophthalmology, 2000

Genetic Epidemiological Study of Keratoconus: Evidence for a
Major Gene Determination
American Journal of Medical Genetics, 2000

Keratocyte Apoptosis Associated with Keratoconus
Experimental Eye Research, 1999

KISA% Index: A quantitative Videokeratography Algorithm Embodying
Minimal Topographic Criteria for Diagnosing Keratoconus
Journal of Cataract and Refractive Surgery, 1999

Inter and Intra-Observer Reliability of a Classification Scheme for
Corneal Topographic Patterns
British Journal of Ophthalmology, 1998

Accuracy of Ultrasonic Pachymetry and Videokeratography in
Detecting Keratoconus
Journal of Cataract and Refractive Surgery, 1998

Keratoconus: Update and New Advances (Major Review)
Survey Of Ophthalmology, 1998

The Influence of Contact Lens Wear on the Topography of Keratoconus
CLAO Journal,1996

Corneal Dystrophies and Keratoconus.
Current Opinion in Ophthalmology, 1996

Tangential Vs Saggital Videokeratographs in the
'Early' Detection of Keratoconus
American Journal of Ophthalmology, 1996

Videokeratography Database of Normal Human Corneas
British Journal of Ophthalmology, 1996

Videokeratography of Keratoconus in Monozygotic Twins
Journal of Refractive Surgery, 1996

Videokeratography Indices to Aid in Screening for Keratoconus
Refractive and Corneal Surgery,1995

Corneal Topography 1994
Current Opinions in Ophthalmology Current Science,1995

Keratoconus in Photorefractive Keratectomy Candidates Detected by Computer-Assisted Videokeratography
Refractive and Corneal Surgery, 1995

Corneal Topography: Comanagement / Management of Corneal Astigmatism
Optometry Today,1994

Corneal Topography: Diagnosis and Management of Corneal Disease
Optometry Today, 1994

Detection of Keratoconus Before Refractive Surgery
Ophthalmology,1994

Nomenclature for Keratoconus Suspects, Opinions
Refractive and Corneal Surgery, 1993

Corneal Topography (Review Article)
Current Opinions in Ophthalmology Current Science,1993

Detection of Keratoconus Before Keratorefractive Surgery
Ophthalmology, 1993

Videokeratography of the Fellow Eye in Unilateral Keratoconus
Ophthalmology, 1993

Keratoconus and Bilateral Lattice-Granular Corneal Dystrophies
Cornea,1992

Molecular Genetics in Autosomal Dominant Keratoconus
Cornea,1992

Videokeratography, Keratoconus, and Refractive Surgery Opinions
Refractive and Corneal Surgery,1992

Contact Lens Selection for Keratoconus Using a Computer-Assisted Videophotokeratoscope
CLAO J, 1991

Computer-Assisted Corneal Topography in Family Members of
Patients with Keratoconus
Archives of Ophthalmology,1990

Corneal Topography of Early Keratoconus.
American Journal of Ophthalmology, 1989

Keratoconus, Granular and Lattice Dystrophies in the Same Eye
American Journal of Ophthalmology, 1989

Computerized Corneal Topography in Keratoconus
Refractive and Corneal Surgery, 1989

Wavefront Analysis in the Early Detection of Keratoconus
Refractive and Corneal Surgery, (In Press)

Two Stage Genome Wide Linkage Analysis of Keratoconus Families
Invest Ophthalmology and Vis Sci, (In Press)

Intacs for Keratoconus
International Ophthalmology Clinics, (In Press)

Ectasia after Lasik
Current Opinion in Ophthalmology, (In Press)

A Molecular Maker for Keratoconus with Potential for Detecting
Subclinical Disease
Refractive and Corneal Surgery, (In Review)

Longitudinal Study of Familial Influences of Keratoconus
Invest Ophthalmology and Vis Sci, (In Review)

BOOKS (Top of Page)

A Color Atlas of Corneal Topography: Interpreting
Rabinowitz YS,Wilson SE, Klyce SD editors Videokeratography.
Igaku-Shoin Medical Publishers
(New York -Tokyo) 1993.

BOOK CHAPTERS (Top of Page)

Intracorneal Ring Segments and Alternative Treatments for Corneal Ectatic Diseases. Diagnosis of Keratoconus and Other Ectatic Diseases
Colin, J. Ertam, A. (Editors), Kudret Eye Hospital (Pulbisher)
Chapter 1: Pages 9 - 35, 2007

Corneal Topography and its Optics.In, Duane's
Clinical Ophthalmology. Duane T,Jaeger ED (Editors)
Volume 1;Chapter 65:pages 1-15,1996.

Keratoconus.
In, Genetic Diseases of the Eye. Traboulsi E(Editor).
Oxford University Press. Chapter 13: 267-284

Pellucid Marginal Degeneration.
In: Current Ocular Therapy 5. Fraunfelder F(Editor)
2002 Section 20. Cornea. Pages 371-373

Corneal Topography: Corneal Curvature and Optics, Clinical Applications, and
Wavefront Analysis.
In Bennet E.S and Weissman B.A. Clinical Contact Lens Practice. Lippincot, Williams and Wilkins. Pages 215 – 232.

Ectatic Disorders of the Cornea. In
Smolin and Thoft’s The Cornea. Scientific Foundations and Clinical Practice.
Fourth Edition. Foster C.S., Azar D.T. and Dohlman
C.H.(Editors) Lippincot Williams and Wilkins Pages 889-911.

Definition, Etiology, and Diagnosis of Keratoconus. In Treating Irregular Astigmatism and Keratoconus. Alio J.L. and Belda J.I. (Editors).
Highlights of Ophthalmology. Pages 241-260.

Corneal Topography and Wavefront Analysis. Optics and Clinical applications. Clinical
Ophthalmology. Duane T,Jaeger E(Editors) 2006(In Press)

Pellucid Marginal Degeneration. In: Current Ocular Therapy 9
Fraunfelder F(Editor) 6 Section 20

Patient Testimonials

"I am an ophthalmologist with keratoconus and had the INTACS with Intralase procedure performed by Dr. Rabinowitz in October 2006. Speaking from the perspective of both a keratoconus patient and an eye doctor, I must say that I am truly impressed with the procedure. It was amazing- my astigmatism was reduced by 50% and my vision imporved by 3 lines on the vision test chart.

This procedure allowed me to improve the quality of my work and my personal life. I always thought that I would need a cornea transplant some day, but this procedure has allowed me to defer the need for a transplant at this time. The procedure was fast, easy, and painless. I would do it again in a heartbeat without hesitation or reservation.

As each patient is different, expectations are key to the success of this procedure. The purpose of the procedure is not to make your vision perfect, it is to improve the astigmatism and thus lessen distortion. You still will have keratoconus after INTACS, however you will hopefuklly have better vision with glasses, contact lenses, or both.

I feel this procedure has given me a new lease on my future.
Thank you Dr. Rabinowitz and staff for your expertise and excellent work!
- Steven Ofner, M.D.
Eugene, Oregon