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Cornea transplants offer new hope

Cornea transplants offer new hope

 

Innovative method improves results and drastically reduces recovery time

 
By Chris Zdeb, The Edmonton Journal Comments (3)
 
 

Jane Popow, 62, left, had her vision restored with a corneal transplant after being diagnosed with Fuchs’ dystrophy.

Photograph by: Shaughn Butts, Canwest News Service

When blurry vision prompted Jane Popow to visit her eye doctor, all she expected to get was a new pair of glasses. Instead, she was diagnosed with a condition the optometrist said would eventually make her blind.

The first thing a shaken Popow, 62, did when she got home that day was Google Fuchs’ dystrophy.

She found out Fuchs’ (pronounced fewks or fooks), is a condition of the cornea, the clear dome over the eye. Over time, the inner lining — or endothelium — of the cornea slowly loses the cells that pump impurities and fluids out of the eye.

This changes its structure and function, resulting in swelling, pain and eventual loss of vision.

Fuchs’ affects one in 1,000 people, mostly women, and has a hereditary component. Patients, many of whom mistakenly believe they have cataracts, are usually diagnosed after age 50.

Popow was relieved to read that with a corneal transplant, the condition can be cured.

Unfortunately, there’s a shortage of donated corneas, and some patients can wait as long as five years for a transplant. Worse yet, the traditional transplant method can leave them significantly visually impaired for a year afterwards.

“Your risk of falls goes way up, so hip fractures and things like that go way up,” says ophthalmologist Dr. David Climenhaga. “Managing your diabetes becomes difficult if you can’t see the insulin in your syringe properly. All those health issues kick in when you can’t see, so there’s a big quality-of-life issue.”

For the past year, Climenhaga has been doing a relatively new type of laser corneal-transplant surgery known as Descemet’s Stripping Automated Endothelial Keratoplasty or DSAEK, following the lead of doctors in Toronto and Brandon, Man.

The procedure, which involves splitting a patient’s cornea in preparation for the graft of a donor cornea, is done with a modified version of the machine used in Lasik vision-correction surgery, and requires few or no stitches.

It’s virtually painless, the potential for infection is reduced because the surgeon makes a shallower incision, and because of the angle of the cut, the patient has less astigmatism afterward, Climenhaga says.

“Two weeks later, people are often back behind the wheel with driving-functional vision,” he adds. “It’s a dramatic change in recovery time.”

The wait for donated corneas, however, hasn’t changed.

Popow was on the waiting list for almost a year before her first transplant in 2007. The wait for her second was about the same.

“It was really terrifying before the first transplant because I couldn’t really do anything,” she says. Her vision continued to deteriorate until it was like looking through glasses smeared with petroleum jelly.

“I couldn’t drive, I couldn’t read. I’d get lost in a store if my husband wasn’t with me. I couldn’t go up and down escalators because I had no depth perception, so I fell a lot. I fell up steps all the time.

“I felt really, really helpless and isolated.”

Life was better after the first transplant, but it was only after surgery on her other eye that it became more normal, she says.

Popow is still not driving, but she can read again — large print because it’s less tiring.

Between 420 and 430 people are on the Edmonton waiting list for a corneal transplant, Climenhaga says. About 75 transplants are done each year, though numbers can fluctuate from a low of 15 to 20, to a high of 90.

“It’s a shame that there just are not corneas available when you can open up the obituaries page in the newspaper any day of the week and see more than enough corneas to satisfy the weekly need and they are not being donated.”

Popow has always been an advocate of organ and tissue donation.

“I understand and respect people who aren’t (donating) because of their religious or moral convictions. … But people who would donate their eyes, but don’t get around to it (signing a donor card), or people who don’t even think about it, those are the people that bother me because it’s that important.

“I’m just so grateful to the unselfish people who went out of their way to donate their eyes for me. They really did give me my life back.”

For more information about Fuchs’ dystrophy and its treatment, visit www.fuchsdystrophy.com and www.corneatransplant.org

czdeb@thejournal.canwest.com

© Copyright (c) Postmedia News

Stem Cells Cure Blindness

Stem Cells Cure Blindness

Simone Biow's picture

Submitted by Simone Biow on Mon, 11/20/2006 – 8:11pm

The Controversy

Earlier this November, scientists from the University College London Institutes of Ophthalmology and Child Health and Moorfields Eye Hospital were able to restore vision to blind lab mice. This scientific breakthrough signifies that millions of people with optical conditions such as macular degeneration (loss of sight experienced by the elderly), diabetic retinopathy, and a variety of other forms of blindness could be able to regain sight through a remarkably simple procedure. However, the fact that the procedure requires stem cells from foetuses—currently viewed as a highly controversial method by many politicians—has prevented this procedure from becoming more publicized in the U.S. (1).

The Breakthrough

Researchers have identified certain cells on the margin of adult retinas that are similar to stem cells. Additionally, retinal cell replacement may be the most effective method of “cell transplant therapy because photoreceptor loss initially leaves the rest of the wiring to the brain intact” (1). In other words, major surgical reconstruction is not necessary. Any surgical procedure would only involve the superficial layer of the retina and not the particularly sensitive optic nerve wiring at the back of the eye. However, in order to attain human retinal cells at the necessary stage of development, stem cells would need to be extracted from a foetus during the second trimester of pregnancy (1). Because stem cells are able to proliferate and develop into many other types of cells within the human body, they can be extracted from any part of the foetus. However, the timing is imperative if the procedure is to work.

Three Blind Mice… See How the Procedure Works...

1. Early stage retinal stem cells were extracted from a 3 to 5 day old newborn mouse (1).

2. The retinal cells were transplanted onto the retinal surface of a blind mouse whose condition was genetically programmed to resemble the gradual loss of sight characteristic to the human disease retinitis pigmentosa or age-related macular degeneration (1).

3. The cells embed themselves and connected with other cells on the retina of blind mouse. Within 30 minutes the photoreceptors from the retinal stem cells implanted themselves and fused electrical connections with the animals’ existing retinal nerve cells (3). As a result, the formerly blind mice’s pupils began to respond to light and there was activity in the optic nerve (indicating that the eye was transmitting signals to the brain) (1).

Anatomy & Physiology of the Eye: Photoreceptors

The retina (around 0.5 mm thick) lines the back of the eye. It is lined with a network vascular blood vessels and neurons that gradually channel towards the optic nerve which contains the ganglion cell axons that connect the ganglion cells to the brain. The ganglion cells—the neurons of the retina that transmit images to the brain—are located in the innermost region of the retina and extend toward the lens, or anterior portion of the eye (2). The photoreceptors—the rod and cone shaped cells—are situated toward the outermost portion of the retina and are closer to the back of the eye (5). As a result, light must penetrate the nerve cells within the retina before reaching and activating the rods and cones. Once reached, the rods and cones absorb photons through their visual pigments and translate the photons into a biochemical message and then into an electrical message that stimulates all of the succeeding neurons of the retina. Consequently, “the retinal message concerning the photic input and some preliminary organization of the visual image into several forms of sensation are transmitted to the brain [by] the spiking discharge pattern of the ganglion cells” (2). From then on the brain is responsible for identifying, processing and interpreting the visual image (2).

Candidates for retinal cell replacement surgery must have some retinal cone and rod photoreceptors intact (1) . The retinal cell replacement surgery primarily serves to repair the nerve synapses in the retina, the macula lutea, and the fovea. The surgery cannot generate new photoreceptors.

The surgery mainly repairs the macula and the fovea. The macula functions as a short wavelength filter while the fovea, characterized by a dark circular area towards the back of the eye, is considered to be the most vital portion of the retina. Like the lens, it functions as “a protective mechanisms for avoiding bright light and especially ultraviolet irradiation damage” (2). The fovea is entirely composed of a mosaic cone photoreceptors that are arranged in a hexagonal structure. Outside of the foveal pit, the density of cone photoreceptors becomes increasingly more balanced with that of rod photoreceptors. There is a peak in the density of rod photoreceptors at about 4.5mm (or 18 degrees) from the foveal pit where the rod photoreceptors arrange themselves in a ring around the fovea (5). (Naturally, the optic nerve (the blindspot) is entirely free of photoreceptors) (5). If the macula or fovea cones are damaged (as happens gradually over many years), instant blindness results (2). However, macular degeneration could be easily remedied since stem cells take only about half an hour to develop into photoreceptors.

Repairing the Cornea

In August of 2003, Mike May, a Californian man who had been left blind for 40 years as the result of an accident that happened when he was three years old had his vision restored. Though the vision in his left eye was permanently lost, he could still sense light with his right eye. Researchers implanted corneal and limbal stem cells into his right eye. Five months after the surgery, May was able to sense movements and recognize simple shapes. After two years, he was able to see forms, color, and motion nearly accurately. His 3D perception and face and object recognition remained impaired, though his ability to sense motion was the best restored visual faculty (4).

Like photoreceptors, the cornea is responsible for channelling light through the eye’s surface. The corneal surface refracts to provide 2/3 of the eye’s focusing power. he corneal surface is entirely transparent and not lined with blood vessels, so the uniformity of cells may contribute to its ability to regenerate more rapidly than other cells in the human body. On the other hand, it is extremely sensitive. There are more nerve endings on the cornea than anywhere else on the human body (6). The cells that compose the layers of the cornea are found to regenerate at a rapid pace, though less rapid than photoreceptor cells. Again, a simple surgical procedure, most of which is processed by human mechanisms, could restore sight to millions of people if only the procedure were to be legalized.

Anatomy of the Eye

courtesy of U.S. National Library of Medicine


(1) “Cell transplants ‘restore sight.'” BBC International News Online. (http://news.bbc.co.uk/2/hi/health/6120664.stm)

(2) Simple Anatomy of the Retina. (http://webvision.med.utah.edu/sretina.html)

(3) “Cell Transplants Restore Vision in Mice.” Live Science. (http://www.livescience.com/healthday/535968.html)

(4) “Cell Transplant Restores Vision.” BBC International News Online. (http://news.bbc.co.uk/2/hi/health/3171993.stm)

(5) Photoreceptors. (http://webvision.med.utah.edu/photo1.html)

(6) “Cornea.” Eye Anatomy. (http://www.stlukeseye.com/anatomy/Cornea.asp)

»

Serendip Visitor's picture

Stem Cells

Submitted by Mr. T (not verified) on Sun, 06/13/2010 – 3:35pm.

This woman was at the hospital at the same time as Frank.
I want to send you all my e mail adress but It wont work here because we should not advertise
 

Hello guys,

Well, has it really been 3 months and 1 week since we came home, WOW WOW WOW and WOW! Well, I am doing pretty well. I had my tests the other day in Dublin and I have my visual fields and visual acuity check this wednesday so I will update when I get results.

Since my last post my left and right eye are now at around 5 meters!! Big difference from 1 meter??!! I notice a lot more little things like I could see the goal posts at a match last week and every day things. My improvements have slowed down a lot, maybe its because when i first cam home i was seeing everything for the first time! But I am still thrilled as I have gained 4 meters of sight this year, something I thought would never happen.

Other then that I am keeping really well, still smiling and enjoying watching the world cup!! Its strange watching soccer properly!! the players all have legs and all 🙂

Anyway, I will be sure to let ye know how my results go and please keep me in yere thoughts and prayers! There working!!

Lots of love and enjoy the world cup 2010!!

Lots of irish hugs and kisses

Valerie

Add comment June 14th, 2010
1 Month home….

Hi there,

I cant believe we are home 4 weeks already. The time flew. It feels almost like a dream that we were even there!! Everything is going really well. I have noticed a few improvements since my last post. Little things really, like shopping, I can make out clothes sizes, on certain items, my finger counting has improved amazingly!! I watched a hurling match on my tv and I could actually make out the 2 different teams!! I even knew no 15 jersey!! Its almost as if my little jigsaw pieces are fewer.

I know I have a long way to go but hopefully I will get there. I am continuing my accupuncture, herbs etc and I really hope they help. Someday I WILL drive…..

Thanks for helping me through the past few months.

 

Thank you http://serendip.brynmawr.edu/exchange/node/50

Cheers

Tags, , ,

Improve without Glasses!

Want to improve your vision without glasses or contact lenses? Coming from someone who had to wear glasses and contacts from the age of 13, I feel your frustration. Although I was fortunate enough to have improved my eyesight naturally, I want you to know that you can do the same. If you want to say good bye to glasses and contacts lenses for good without expensive and risky eye surgery this article is for you.

One of the first things you need to ask yourself is how often do you perform eye strengthening and eye relaxation exercises. If the answer is never like almost all those who have vision problems, it might surprise you that improving your eyesight naturally is indeed possible.

Like any other muscle in the body your eyes must perform exercises to not only strengthen but to reduce the deterioration over time due to age. Unfortunately we can not reverse the aging process but we can do things to help our eyes naturally, let’s look at how you can improve your vision without glasses or contact lenses.

Due to the changes in our everyday lives both with work and play there are many reasons why our eyes weaken a lot faster than what mother nature would dictate. Activities such as computer use and watching television causes not only strain on our eyes, weakening of our eye muscles but also other health issues. No doubt you have experienced eye strain, head aches, migraines and other debilitating conditions when your glasses or contact lens are not in reach.

Wearing glasses and contact lens is only a temporary fix that leads to your eyes getting weaker and lazier overtime. This is why you will often see yourself buying a new set of glasses and a strong lens prescription year after year, this is the last thing you want.

Although you should do everything in your power to help strengthen your eyes such as having a balanced diet rich in vitamins and minerals and exercising, you must also relax them. If you experience blurry vision, headaches or burning sensations while using a computer or watching television your eyes are strained and should be rested.

One of the most popular methods used today to improve your vision without glasses or contact lenses is the Bates method. Originally created in 1880 by Dr William H Bates and perfected over time, The Bates Method is based on a series of eye exercises and relaxation techniques performed daily.

Although there are some vision problems that can not be corrected naturally, the vast majority of vision problems such as being short sighted, far sighted or both can be cured using the Bates Method.

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January 8th, 2011.