Articles

New Technique in Cornea Transplants

August 17, 2011
By Deborah J. Botti
For The Times Herald-Record

The eye's cornea, too, is sharing the new-technology spotlight with the retina.

Mary E. Davidian, M.D., a fellowship-trained cornea specialist, refractive surgeon and medical director of Highland Ophthalmology Associates in New Windsor, explains.

Just a few weeks ago, Davidian saw a patient with a disease called Fuch's corneal dystrophy. Fuch's dystrophy, in which the cornea's endothelial, or fluid-pumping, cells are damaged, is the reason for about 80 percent of all corneal transplants. It is an inherited disease.

The job of the endothelial cells, which make up the posterior layer of the cornea, is to pump excess fluid out, thereby keeping the cornea tissue clear. When they are not working properly, the overhydrated cells cloud vision.

"Sometimes, especially if there is already some damage to endothelial cells, the cornea can decompensate further when a patient has cataract surgery, which in and of itself is a form of trauma to the eye," Davidian says.

This is what happened to a patient of hers; he was told by his general ophthalmologist that there was nothing that could be done to improve his cloudy vision.

'It's amazing'

"He is now seeing 20/40," says Davidian - thanks to a new procedure called DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty) that, as one of the few cornea specialists in the region, she is performing.

"It's not magic, and it doesn't always work," she says. "But when it does, it's amazing."

When the corneal cells become swollen and cloudy because the pumping cells are not functioning properly, the only previous option was a full-thickness cornea transplant, Davidian says. A mini-circular cookie cutter of sorts, called a trephine, is used to excise 80 percent of the cornea. A similar-size graft is taken from the donor. Fine sutures are used to stitch the donated cornea into place.

"There's a long healing period (with full-thickness corneal transplants); in older patients, sometimes longer than a year," says Davidian.

Stitches cannot be removed until scar tissue starts to form, which also can result in significant astigmatism, or an irregular curvature of the cornea.

'Clearer vision faster'

With state-of-the-art DSAEK, however, a tiny incision is used to allow the selective removal of the back (endothelial) cells of the diseased cornea. Similarly, the same selective cells are removed from the healthy donor, folded in half and slipped into the tiny incision.

"Air is injected to float the donor button up and make it stick," says Davidian. "There are, on average, three stitches placed peripherally that typically do not induce astigmatism. The wound is stronger and, therefore, resistant to future trauma. Most importantly to the patient, there is clearer vision faster."

Because air, and not stitches, is used to make the transplant adhere, the donor cornea might not stick and Davidian says, despite the refinements in the procedure since 1998, researchers still don't understand why.

"We may have to inject another air bubble or repeat the procedure, and it may work the second time," she says.

However, there are virtually no suture-related complications, such as the risk of infection or popping and loosening a stitch, even in a repeat procedure.

Davidian says she's doing this surgery more and more frequently - on about 20 patients so far - and she sees about two patients a week with Fuch's dystrophy.

In patients who have had success with a full-cornea transplant, DSAEK can be used if the endothelial cells slack off the down the road.

For more information please call us at (845) 562-0138.

Q&A With Dr. Mary Davidian: Taking a clear look at treatable cataracts

August 19, 2009
By Deborah J. Botti
For The Times Herald-Record

"Cataracts are the leading cause of visual loss in Americans 65 and older," says Mary Davidian, M.D., founder and medical director of Highland Ophthalmology Associates in New Windsor.

But there's good news: Cataracts are very treatable.

To increase awareness, Highland Ophthalmology is offering free cataract screenings in its new, full-service vision center during August, which is Cataract Awareness Month.

GO Healthy asked Davidian for an overview on symptoms, causes and treatments.

Q. What is a cataract?

A. A cataract, like a wrinkle, is part of the natural aging process. If we live long enough, we'll have both wrinkles and cataracts.

Some people begin to wrinkle earlier than others, based on factors such as smoking, unprotected sun exposure and genetics.

It's the same with the many types of cataracts. Genetics play a role in how quickly they'll develop. The sun can also hasten their development, as can the use of certain medications such as prednisone, or eye injury or surgery. There are congenital cataracts as well, meaning the person is born with them, although this condition is not common.

Q. Can anything be done to prevent cataracts?

A. Wearing sunglasses with ultraviolet light protection when outdoors, eating a healthy diet rich in antioxidants and avoiding smoking might help stave off the development of cataracts. Regular visits to your eye-care professional will help detect cataracts early in their development.

Q. What are the symptoms of cataracts?

A. Decreased, cloudy or blurry vision is a common complaint. Colors don't seem as bright, and there might be double vision. Eyeglass and contact lens prescriptions might be changed frequently. People also might notice that they need more illumination to perform daily tasks such as reading, and there can be more sensitivity to light in general.

Many people are unable to drive at night because the glare of headlights is unbearable. That is because cataracts are typically not homogenous or a uniform level of clouding across the lens; rather, there are usually spokes of opacification that disburse the light in patterns.

Q. What is the treatment for cataracts?

A. Right now, there is no medication to prevent cataracts or to decrease their density. When the decrease in vision is such that daily activities are limited, then surgery is the only course of action available. Contrary to popular belief, lasers are not used to remove cataracts. The most modern method available utilizes ultrasound, and is called phacoemulsification.

Q. How is the surgery performed?

A. The technology has really advanced in the last decade or so to minimize side effects and maximize results.

Small, approximately 3mm self-healing incisions are made. The small probe of the phacoemulsification machine is inserted into the eye, which breaks up the lens into tiny pieces that are essentially vacuumed up while irrigating the fluid-filled anterior chamber of the eye.

Next, a foldable lens is inserted through that small incision and implanted. The implant opens and is positioned on the lens capsule.

Q. What type of lens is implanted?

A. Each patient is measured to determine the appropriate lens power for his eye. The goal is to get the patient as close to 20/20 vision as possible. Most patients who wore distance glasses before cataract surgery may not need to wear any distance correction after cataract surgery. This is because much of their previous eyeglass power can be incorporated into the implant that goes in their eye. If a monofocal lens implant is used, glasses will generally still be required for reading.

If the patient desires minimal to no dependence on glasses at all, then new generation multifocal lenses may be considered. These lenses have rings of different powers for distance, near and intermediate ranges. The brain learns to focus on the proper ring for each range to bring objects into focus. It's similar to having a progressive lens in the eye.

Barring any unforeseen complications, many patients return for follow-up care the next day with outstanding vision.

Q. What are the potential side effects?

A. All surgical procedures carry the potential for risks. Because there is an incision, however small, there is always a risk for infection or bleeding.

If there is underlying pathology, such as glaucoma or macular degeneration, because the cataract is superimposed on those conditions, the patient might not get optimum results. However, there is generally a noted improvement in vision, despite these conditions, when the cataract is removed.

Q. Who can perform cataract surgery?

A. While an optometrist, or eye doctor, will frequently make the diagnosis, only an ophthalmologist, who is also a surgeon, can perform the surgery. Cataract surgery is not an in-office procedure; it must be done at an ambulatory surgical facility or hospital, but is generally conducted on an outpatient basis, with the patient returning home shortly after the procedure. The cost of surgery is covered by major medical insurances.

For more information please call us at (845) 562-0138.

High-Tech Eye Care Right Here At Home

By Deborah J. Botti, Mid-Hudson Senior Gazette
Printed Weeks March 5th and 12th, 2007

Did you know that fair-skinned people are at higher risk for macular degeneration, and that cataracts will affect everyone if they live long enough? It's impossible for even the most educated consumer to keep abreast of every new revelation or advance in technology. That's why there are specialists.

And Dr. Mary E. Davidian, who founded Highland Ophthalmology Associates in Newburgh a decade ago, wants it known that a patient needn't travel to Manhattan to ensure state-of-the-art care and cutting-edge technology. Davidian and her staff bring Manhattan to Mid-Hudson.

Davidian is a board-certified medical doctor and fellowship trained cornea specialist and refractive surgeon. She's on staff at the New York Eye and Ear Infirmary in Manhattan, where she also teaches residents. That affiliation, coupled with her participation in ophthalmologic societies, connects her with those in the vanguard.

Dr. Thien (Tim) Huynh, joined the group last July. He received his fellowship training in glaucoma at the Mount Sinai School of Medicine in New York City and specializes in the early detection and treatment of that disease.

Add to the mix two optometrists qualified in primary eye care and an optician, who crafts glasses and cuts lenses, and the result is an all-care practice that can diagnose and treat just about every visual/eye abnormality. "We offer the full spectrum of eye care right here at home," Davidian says.

And here's an eye on what you need to know.

Cataracts are a clouding of the natural lens, resulting in blurry vision. "They're a normal part of the aging process," Davidian says, putting anyone age 60 or older at risk. Steroid use, eye trauma and diabetes can also increase their likelihood.

Years ago, the complication rate from cataract surgery was high, Davidian says, so doctors often held off surgery until the cataract was "ripe", meaning the patient was legally blind. "Today, an ultrasound probe is inserted through a tiny self-healing incision and used to break the cataract into small pieces, allowing for a quicker recovery time," she says. "A lens is then implanted."

Single power and newer multifocal lenses are available, meaning they have multiple powers to address distance and near vision - and everything in between.

Glaucoma, or high pressure in the eye, results when the normal eye fluid does not drain properly. Left untreated, blindness results. "A person can have perfect blood pressure and abnomal eye pressure," says Huynh. "There are no symptoms, no pain or discomfort." Once diagnosed, the disease cannot be reversed. The treatment goal is to prevent progression. Oftentimes the new breed of eye drops are successful. If not, Huynh might perform delicate microsurgery called a trabeculectomy, which allows fluid to drain through a microscopic hole. Another option is the insertion of a tiny filtering tube between the cornea and the iris.

Macular degeneration is the degeneration of the macula, or the central part of the retina. Those with that lack of pigment - in the skin and in the eyes - are more susceptible. Studies indicate that wearing sunglasses and taking antioxidants are helpful.

Macular degeneration can be categorized "wet" or "dry". Wet means blood vessels are leaking, causing a dramatic decrease in vision. There has been success with injections that cause the regression of the vessels. "In this case, we make the diagnosis and set the patient up with one of our retina colleagues," Davidian says.

The cornea is the clear front that covers the iris and pupil. Scars or swelling can cause the cornea to distort light, resulting in glare or blurred vision. Inherited dystrophies, trauma and infections (sometimes caused by sleeping in contact lenses) can affect the cornea. A corneal transplant is considered when vision or swelling cannot be corrected, giving patients the chance of improved sight.

For optimum eye health, annual exams are crucial, the doctors say.

Our office is within an easy commute from the following areas in the Hudson Valley and Orange County and Dutchess County: New Windsor, Cornwall, Fishkill, Middletown, Florida, Warwick, Monroe, Harriman, Fort Montgomery, Highland Falls, Marlboro, Walden, Wallkill, Pine Bush, Vails Gate, Goshen, Salisbury Mills, Washingtonville, Campbell Hall, Montgomery, West Point, Modena, New Paltz, Highland, Beacon, Castle Point, Wappingers Falls, Poughkeepsie, NY.

With this, Highland Ophthalmology has become New Windsor's leading specialty eye care center. Call (845) 562-0138 today for your first consultation.