Hargrave Eye Center | Corneal Transplantation

A Pocket-Sized Revolution in Eye Care

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A pocket-sized device made with spare parts of phones and computers ordered online for under $200 could hold the future of eye care.

According to a recently published article in NBCNews, the device acts essentially as a retina camera with the ability to take images of the inside of an eye.

A pair of the researchers responsible for this advancement, Dr. Shizuo Mukai and Dr. Bailey Shen, are claiming that this technology can hopefully soon replace eyecare practices of late where patients are subjected to strong eye drops to dilate the eye in order for an ophthalmologist to be able to properly examine the health of the eyes. The new device will cut the eye drops from current practice and simply use infrared light focused on the back of the eye to snap an image of the entire eye without the pupil constricting.

However, before excitement takes hold that this product may soon be on the market, there is still a lot of work to be done. In fact, Dr. Mukai, an ophthalmology professor at Harvard, and Dr. Shen, an ophthalmologist with UIC College of Medicine, are making the prototype available to tech experts and doctors for further testing and design insight. By doing this, the researchers behind this new device hope to gain more sophisticated software to improve the images taken by the retina camera, which will ultimately lead to stronger diagnoses.

The most exciting aspect of this device is the possibilities it brings. For one, the prototype cost only $185, and was constructed from a combination of cellphone parts, LED lights, and pieces from a computer kit. Once a scalable model is created, prospects are high that this device could be mass produced at a low rate, making it more accessible globally as well. Aside from relieving the pain and inconvenience of eyedrops, Dr. Rahul Khurana, the clinical spokesperson for the American Academy of Ophthalmology, has hopes that this technology can be used in poorer countries where access to healthcare is not as prevalent.

Because the device doesn’t require the eye to be dilated, patients who are unable to have their eyes dilated will be able to be screened for eye health concerns that were not able to be examined before. As Dr. Shen stated in a Harvard Medical School article on the findings, “…As residents seeing patients in the hospital, there are often times when we are not allowed to dilate patients–neurosurgery patients for example.” With its convenient and portable size, Dr. Shen hopes the device can be used to cut down on the amount of time it can take to give an eye exam, especially in hospitals, stating, “…there are times when we find something abnormal in the back of the eye, but it is not practical to wheel the patient all the way over to the outpatient eye clinic just for a photograph.”

By making eyecare more accessible, the possibilities of mastering eye health throughout the world become more attainable. While this prototype is not the first to make a breakthrough on retina camera technology, it does offer a wider spectrum of vision in the lense for clearer and more precise imaging. The development of these discoveries can only grow from here, giving researchers in ophthalmology something very special to look forward to–soon, they hope, with perfect vision.

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Could 3-D Retina Transplants Put a Stop to Degenerative Blindness?

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More than two million Americans suffer from age-related macular degeneration (AMD). While AMD does not result in total blindness, it is the leading cause of vision loss among Americans age 50 and above, and it causes sufferers to slowly lose central vision and interferes with an individual’s ability to drive, read, write, recognize faces, and more. There is no cure for AMD, although doctors can prescribe treatments in an effort to slow its progression.

AMD is only one of several degenerative eye conditions that lead to vision loss for which there has been no cure since it is caused by the actual decay of structures within the eye. However, this may soon change thanks to a groundbreaking advance in medicine: the development of transplantable 3-D retinas.

A team of researchers at California-based AIVITA Biomedical led by CEO Hans Keirstead, PhD have successfully used human embryonic stem cells (hESCs) to develop a 3-D “retinal organoid” made of laminated retinal progenitor cells and retinal pigment epithelium (RPE). In preclinical studies, the researchers showed that, when injected into the eye, the organoid was able to form synaptic connections with existing tissue and thus restore vision.

“The cause for hope for transplanting a 3-D retina has never been greater,” Keirstead told Modern Retina. “We have been on a relatively long journey, but are now at a point where we will be walking along a well-articulated path that will lead us to the beginning of our first in-human study.”

Keirstead, who suspects that a clinical research phase for the 3-D retinas may be as soon as two years away, explained that AIVITA’s target population is patients with degenerative disease of the outer retina, like AMD or retinitis pigmentosa. The 3-D retinas can be transplanted in the patient’s eye to replace the diseased or non-functional photoreceptors and RPE and establish new, functional connections with the inner retina and restore lost vision.

Of course, there are still a number of challenges ahead of the researchers, and the retinas are still years away from becoming commercially available for patients. But the possibility that 3-D retinas could be viable for use in patients opens the door for millions of patients, potentially, to get their sight back.

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Are Eye Transplants on the Horizon?

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The human body is incredibly resilient, and even after parts of it have been destroyed, it can accept foreign tissue via transplants–in certain circumstances–and continue to function as if nothing ever happened. Doctors today can transplant organs such as hearts, lungs, kidneys, and others from one person to another; there’s even a doctor who wants to perform a head transplant by next year. One organ that still cannot be transplanted is the eye, but thanks to a team of doctors and researchers in Pittsburgh, Pennsylvania, that may not be the case for very long.

Dr. Kia Washington, a plastic surgeon at the University of Pittsburgh Medical Center, is leading a research team with the goal of performing the first successful human eye transplant. She hopes that the procedure will be ready within the next 10 years.

In the United States, over one million people have vision impairments as a result of injuries. In fact, traumatic eye injuries are the fourth most common cause of combat injuries for American soldiers, which is why the Department of Defense is sponsoring Washington’s research: If she discovers a procedure for eye transplants, then it will go a long way toward treating soldiers, as well as the thousands of civilians who have impaired vision or no vision at all due to injuries.

Of course, this is all much easier said than done. A successful eye transplant would require, for one, a way of keeping the optic nerve alive during the procedure and reattaching it to the new host’s brain. Normally, upon removal, the cells in the optic nerve die immediately, thus rendering the eye useless; even if they didn’t, the new optic nerve would need to grow from the eye all the way back to the brain, which is no small feat.

However, one of Washington’s colleagues recently published a paper indicating that a cocktail of drugs, including the multiple sclerosis drug 4-AP, could help blind mice regrow their optic nerves and regain their sight after injury. This procedure, if replicable in humans, could lead to successful eye transplants. Although it is a “moonshot,” transplanting eyes in the next 10 years would be an incredible achievement that would help to treat cases of injury-related vision loss.

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Pokemon Go and Eye Health

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There are risks that go along with playing Pokemon GO nonstop.  That expanded time spent gazing at screens can have long-haul consequences for eye and vision wellbeing. Remember that computerized wireless screens transmit blue light radiation called High Energy Visible Blue Light, which can throw off your rest and, over time, might damage photoreceptors in the eyes.

With too much mobile screen time, there’s also a potential for digital eye strain brought on by an excessive amount of blue light radiation. This exposure can cause tiredness and alter sleeping patterns, not to mention causing hazy or unfocused vision, and dry eyes, sensitivity to light, headaches, and even myopia as children age.

Here’s an excerpt from a recent story, “Two Unexpected Ways Pokemon GO Can Affect Eye Health,” in Parent Herald: 

With users spending an average of 26 minutes a day using the app, Dr. Mark Jacquot, Clinical Director, LensCrafters, explains, “people, and parents of young children and adolescents in particular, should be aware of their overall screen time. In order to continue enjoying the game while minimizing the impact of mobile phones on vision, be aware of how much time you or your children are spending in front of screens each day and take regular breaks using the 20-20-20 rule by taking a break every 20 minutes to look 20 feet away for about 20 seconds. Perhaps check out each PokeStop or Pokemon GO gym for a few minutes to give your eyes a break and take in some new scenery before continuing on in pursuit of a Dragonite.”

Continue to make your eye health a priority, even in gaming season and as you’re chasing Pokemon characters with your friends. It’s August, which means children’s eye health and safety month so it’s especially important for kids to practice safe screen time and make sure that they’re being wise about how they interact with electronics.

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3 Eye Signs You Shouldn’t Ignore

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As I often say, your eyesight is one of your most precious resources. It’s imperative to be vigilant about protecting your eyes and getting regular checkups. In between checkups, you still want to keep an eye on your eyes. Today.com published a useful roundup of “5 eye symptoms you should never ignore.” Here are the three of the symptoms that were mentioned and why they’re important to pay attention to.

    1. When You See Floaters Accompanied by Flashes of Light Generally speaking, eye floaters aren’t indicative of anything wrong with your eyes. You know eye floaters when you see them, WebMD describes them as “small moving spots that appear in your field of vision…[that are] especially noticeable when you look at something bright, such as white paper or a blue sky.” But if you see floaters while also seeing what appears to be a lightning streak in your peripheral vision, then see your ophthalmologist. It might be that you’re experiencing posterior vitreous detachment (PVD), which is typically a benign condition. The National Eye Institute says, “Although a vitreous detachment does not threaten sight, once in awhile some of the vitreous fibers pull so hard on the retina that they create a macular hole to or lead to aretinal detachment. Both of these conditions are sight-threatening and should be treated immediately.” The good news is that your eye doctor can diagnose the cause of the problem–and, if necessary, begin early treatment–with a comprehensive dilated eye examination.
    2. When Contact Wearers Have Red, Teary Eyes An eye infection of the cornea known as keratitis can cause redness, pain, inflammation and discharge in the eye. This condition is common with contact wearers who sleep in their contacts–which you should never do, even if they’re labeled extended wear.
    3. When One of Your Pupils Looks Larger Than the Other The condition of having unequal pupils, which is called anisocoria, can be purely physiological or it can be a sign of a neurological issue (i.e. aneurysm, tumor, a brain infection or a sign of a stroke). If the difference in pupil size is something you’ve never noticed before, and you haven’t recently used eye drops which could be causing your pupils to react, then call your doctor.

 

 

 

 

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Keratoconus and New Stem Cell Research

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Did you know the cornea is the only living tissue that has no direct or indirect connection to blood vessels to obtain the oxygen and nutrients it needs to remain healthy? Instead, it absorbs oxygen from the outside air (diffused through the tears) and it gains nutrients from the inside using the aqueous humor (fluid that fills the chamber behind it).

According to WebMD, we see through the cornea, which can be described as the clear outer lens or “windshield” of the eye. Normally, the cornea has a dome shape, like a ball. Sometimes, however, the structure of the cornea is just not strong enough to hold this round shape and the cornea bulges outward like a cone. This condition is called keratoconus.

Keratoconus is a progressive non-inflammatory disorder that causes a characteristic thinning and cone-like steepening of the cornea. According to WebMD, it is caused by a decrease in protective antioxidants in the cornea. The cornea cells produce damaging by-products, like exhaust from a car. Normally, antioxidants get rid of them and protect the collagen fibers. If antioxidants levels are low, the collagen weakens and the cornea bulges out.

How is Keratoconus treated?

Treatment usually starts with new eyeglasses. If eyeglasses don’t provide adequate vision, then contact lenses, usually rigid gas permeable contact lenses, may be recommended. With mild cases, new eyeglasses can usually make vision clear again. Eventually, though, it will probably be necessary to use contact lenses or seek other treatments to strengthen the cornea and improve vision.

However, most recently, researchers in Japan and Wales found that human cells reprogrammed to become stem cells were able to form cornea tissue in lab dishes. This was reported on March 9th in the Science and Medicine publication, Nature. The stem cell tissue was used to repair the damaged outer layer of the cornea in rabbits. In a separate study also published March 9 in Nature, researchers in China and the United States coaxed stem cells in the eyes of a dozen babies born with cataracts to regrow clear lenses.

The researchers also studied 37 babies who were born with cataracts. Regular cataract surgery, which involves removing the cloudy lens and replacing it with a plastic one, was done for 25 of the babies. In the remaining 12 babies, doctors made a small incision in the side of the sack containing the lens and extracted the cataract, but didn’t replace the lens. Stem cells in the sack generated a new lens within about three months of surgery.

While both studies are technically proficient and provide new approaches to treating cataracts or corneal injuries, neither will soon be ready for widespread use in the clinic, says Henry Klassen, an ophthalmologist at the University of California, Irvine School of Medicine.

Sources:

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4 Signs of Graft Rejection

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corneal_transplant Hargrave Eye Center BlogA cornea transplant is most often used to restore vision to a person who has a damaged cornea. A cornea transplant may also relieve pain or other signs and symptoms associated with diseases of the cornea.

In corneal transplant surgery the scarred or damaged cornea is removed and replaced by a human donor cornea called a graft. Corneal transplant surgery also is called penetrating keratoplasty or corneal grafting. Your eye is the recipient eye because it receives the graft. The other person’s cornea is the donor cornea or donor tissue because the cornea is being donated or given to you.

There always is a possibility that the body will reject the graft. This is like an “allergic” reaction of the body against the donor cornea. It can occur any time after the surgery. There is a good chance this can be treated successfully if you act immediately. There are four danger signs you must know, according to the University of Michigan Kellogg Eye Center in Ann Arbor.  If any of these occur and last for more than 12 hours, you should call your ophthalmologist – even if it is a weekend or a holiday.

To remember the signs of graft rejection, remember the letters: R S V P:

Redness – For a few weeks after surgery, your eye may be red. If at any time your eye begins to get redder, you should call your ophthalmologist. You easily can check the redness of your eye by looking into a mirror and pulling down the lower lid. Look carefully at the white part of the eye, especially in the area next to the cornea.

Sensitivity to light – Bright lights may seem irritating to your eye after surgery. This, too, slowly should get better. If you notice your eye becoming so sensitive to light that you feel like covering it, you should call your ophthalmologist.

Vision changes – Your vision most likely will improve gradually after your surgery. Make a habit of checking your vision every day. Check it at about the same time and in the same light. Pick an object in your house that has some pattern or detail to it. Look at the object with your operated eye while covering the other eye with your hand. If your vision seems to be getting worse, you should call your ophthalmologist.

Pain – It is normal to have occasional small twinges of pain in your eye. If your eye develops constant pain or dull aching that lasts several hours, call your ophthalmologist.

Make a habit of checking your eye every day. Check your vision at about the same time and in the same lighting each day, perhaps at the same time you do another routine activity, such as brushing your teeth.

Source: Mayo Clinic WebsiteUniversity of Michigan Kellogg Eye Center 

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