Fuchs Corneal Dystrophy, Keratoconus, Lattice & Fingerprint at The Eye Care & Surgery Center in New Jersey
About Corneal Dystrophy
As a Corneal Specialist, Joel Confino, M.D. provides consultation, diagnosis, and treatment for the full range of medical and surgical conditions affecting the anterior segment of the eye including corneal dystrophies such as Fuchs Dystrophy, Map-Dot-Fingerprint Dystrophy, Lattice Dystrophy and Keratoconus.
Fuchs Dystrophy is a slowly progressive disease of the cornea that can develop in both eyes and is slightly more common in women than men. While it is possible to observe Fuchs Dystrophy in people in their 30’s and 40’s, it usually does not compromise vision until people are in their 50’s or 60’s. The innermost layer of cells in the cornea, called the endothelium, is a single layer of non-regenerating cells. The endothelial cells are responsible for pumping water out of the cornea and helping to maintain corneal transparency. While the reason is poorly understood, in Fuchs Dystrophy, endothelial cells die, causing the remaining endothelium to shoulder the burden of pumping water, with reduced efficiency. This results in corneal swelling and distorting vision. In its later phases, Fuchs Dystrophy is often associated with considerable pain as the epithelium “blisters” by forming “bullae”, which begin to burst.
Early in the course of Fuchs Dystrophy patients will wake up with blurry vision that gets progressively clearer as the day passes. This phenomenon occurs because the cornea normally takes on water and swells during sleep. A healthy endothelial pump is necessary in order to restore the cornea to a normal thickness. In Fuchs Dystrophy, the endothelium removes fluid from the cornea less efficiently. As the Fuchs Dystrophy disease worsens, the vision does not clear Dr. Confino will attempt to help reduce the corneal swelling each day with eye drops and ointments. However, when these measures fail to provide comfort and clear vision, it may be necessary to have a Corneal Transplant.
For some patients, there may be the option of a procedure, called DSEK (Descemet’s Stripping Endothelial Keratoplasty) that Dr. Confino has been performing, to transplant endothelial cells, which may help certain Fuchs Dystrophy patients overcome their discomfort and vision problem.
The outermost layer of the cornea, called the epithelium, is attached or anchored to an underlying basement membrane, called Bowman’s Membrane, in order to remain healthy. Sometimes the epithelial basement membrane develops abnormally making it difficult or impossible for the epithelium to adhere properly to the basement membrane. If the epithelium does not adhere properly, Recurrent Corneal Erosions will occur. Recurrent Corneal Erosions are painful and cause the corneal surface to become irregular resulting in intermittent blurry vision along with the discomfort and foreign body sensation. Map-Dot-Fingerprint Dystrophy is also known as Epithelial Basement Membrane Dystrophy because it is caused by a lack of the healthy formation of the Basement Membrane. It affects adults between the ages of 40-70 and can sometimes begin earlier. As the name implies, its appearance is of a map of gray areas, which may also be accompanied by opaque dots, and fingerprint like whirls or lines.
Dr. Confino will often detect Map-Dot-Fingerprint Dystrophy during a routine eye examination in patients who are asymptomatic. If treatment is required to control the pain for those patients who are symptomatic, Dr. Confino may prescribe lubricating eye drops, patch the eye, apply a soft bandage contact lens or in more severe cases, scrape the cornea to attempt to achieve better adhesion of the epithelium. In some cases, Dr. Confino may suggest that the best results can be achieved using Excimer Laser Phototherapeutic Keratectomy (PTK) to smooth the surface of the cornea.
Lattice Dystrophy occurs as a result of the accumulation of abnormal protein fibers, or amyloid deposits in the middle cornea layer called the corneal stroma. If these deposits become dense enough they will become opaque and affect the corneal transparency so that vision is reduced. If these deposits occur under the outermost layer, the epithelium, they can cause recurrent erosions of the cornea, which can be painful and disturb the normal corneal curvature, effecting vision.
In instances where there are recurrent corneal erosions and pain, Dr. Confino may prescribe eye drops, ointments and occasionally an eye patch or bandage soft contact lens. Early Lattice Dystrophy seems to respond well to Excimer Laser Phototherapeutic Keratectomy (PTK) whereas more serious cases may require a Corneal Transplant.
Keratoconus is disorder of the cornea characterized by a progressive thinning of the tissue, and instability of the cornea. The cornea begins to bulge outward and become cone like. It is the most common corneal dystrophy found in the in the United States. As the cornea begins to bulge it causes considerable changes in the refractive power of the eye producing nearsightedness and astigmatism. Keratoconus usually affects both eyes. At first it may be possible to correct your vision with contact lenses. Unfortunately, for about 20% of patients, contact lens intolerance develops making a corneal transplant necessary. For some patients, Dr. Confino may recommend Intacs® Corneal Implants for Keratoconus as an intermediate treatment between contact lenses and a Corneal Transplant. Intacs® prescription inserts are an option between contacts and a Corneal Transplant that may help to stabilize the cornea and improve vision. Intacs® prescription inserts are indicated for use in the correction of nearsightedness and astigmatism for patients with Keratoconus, where contact lenses and glasses are no longer suitable.
If you are in need of Intacs® Corneal Implants or a Corneal Transplant for Keratoconus, Dr. Confino will take all the time necessary to explain the risks, benefits and likelihood of success in your particular situation. Please be assured that all of your questions will be answered so that you can make an educated and informed decision about your treatment options at The Eye Care & Surgery Center.