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Dr. Bo Huang checks the eyes of Harlon Graves Jr. of Tylertown after his endothelial cornea transplant surgery.

Advances in research and technology are allowing an aging population to hold onto good vision longer — and in some cases restore sight that’s nearly lost.

At University of Mississippi Medical Center, patients are referred from across the state for specialized procedures that can help the eyes keep up with an older-but-active body. Among those procedures, endothelial cornea transplant is allowing patients with age-related corneal dystrophy to experience clear vision again with a swifter healing time.

Dr. Bo Huang, assistant professor of ophthalmology, has performed the surgery on a couple hundred patients since introducing it in Mississippi about two years ago.

“It’s a great improvement over the old technique, and I think for the benefit of patients that’s what we’re trying to do,” he said.

UMC remains one of few places in the Southeast where patients can receive Descemet’s stripping with endothelial keratoplasty (DSEK) — transplantation of the back of the cornea. Before, the only option was to replace the entire cornea.

“In the past, we didn’t have a choice,” Huang said. “But by just replacing the damaged part, you can offer patients a much shorter recovery time. Instead of taking up to a year with total cornea transplant, the recovery is down to only a few weeks.”

For the procedure, Huang makes a custom cut or “strip” from an eye donor’s tissue to replace the damaged portion in his patient’s eye.

“You have to prepare it right,” he said. “When you do a partial transplant, it’s sort of like a custom treatment. You cut each one to suit the patient.”

After what he describes as a “steep learning curve” in mastering the challenging
technique, Huang today uses the partial-transplant approach with about half of his patients for cornea disease or injury.

“I do less and less of the total cornea transplant, because now we have a better technique,” he said. “Only if someone has a big scar do you have to replace the whole thing.”

In the case of age-related corneal dystrophy, patients are typically the victims of genetics. The disease, which occurs with the deterioration of endothelial cells, has been shown to occur more frequently in Caucasians, and more often in women than in men. It usually begins affecting vision in middle-age.

“It’s like any other age-related disease,” Huang said. “You cannot really do anything to prevent it.”

About 40,000 people in the United States undergo corneal transplants each year, according to the National Eye Institute.

In an even more common eye disease, those who suffer from age-related macular degeneration are also benefiting from recent advances that have produced the first truly effective forms of treatment.

Affecting an estimated 10 million to 15 million Americans, AMD is a leading cause of vision loss in those age 60 and older. It appears in two forms: “dry” and “wet.”

The former is characterized by a thinning of the retina and a gradual loss of central vision. In the latter, new blood vessels sprout in those areas of thinning — hemorrhaging, leaking and forming scar tissue which causes a further loss of central vision.

The primary treatment for the dry form of the disease remains a vitamin-supplement formula endorsed through the Age-Related Eye Disease Study (AREDS). For the wet form, ophthalmologists could offer their patients little effective treatment until the recent development of the drug Lucentis, generically named ranibizumab. Of those receiving the injections in clinical studies, the drug halted vision loss for 95 percent of patients, with as many as 40 percent experiencing significant improvement.

The drug was approved by the FDA just two years ago, and ophthalmologists are still observing patients to learn more about when the leakage associated with the wet form goes into a dormant phase.

“It’s not just the science but the art of medicine,” said Dr. Paul Sternberg Jr., chair of Ophthalmology and Vision Services at the Vanderbilt Eye Institute and a member of the AAO board of directors.

“But for those of us who have been doing this for several decades and never had anything to offer patients to improve their vision, to have some of those we are treating now at almost 20-20 is truly remarkable.”

In the years ahead, ophthalmologists hope for a form of AMD treatment that would be even easier for both doctors and patients, such as an eye drop or oral medication.



July 2008

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