Until a few years ago, we only had corneal transplants for people with keratoconus when glasses or contact lenses were not sufficient to give them good vision for as long as they needed to wear them to do their daily tasks. Now we have many new modalities. The new modalities are: 1. Collagen Corneal Cross linking, 2. Intacs, 3. ICL’s and 4. PRK, 5. DALK with the IntraLase. Cross linking will stop the progression of keratoconus in most cases. This can be combined with Intacs and these will help to reshape the cornea and improve the quality of the vision in about 80% of patients. Later, a small amount of cornea can be removed with the excimer laser and this often results in further improvement in vision. If the person still has a lot of near-sightedness or astigmatism, an ICL can be inserted. If however, the keratoconus is too far advanced, we can do a deep lamellar keratoplasty, to remove the thin part of the cornea and replace it with a normal donor.
While there are many more choices availble, we at YELC are able to offer the full range of treatments that are available for our keratoconus patients.

The IntraLase is a most amazing device for refractive and corneal surgery. Not only is Yonge Eglinton laser the centre with the most experience with this technology, we are also using it to modify astigmatism after corneal transplants. Normally, astigmatism is very common occurrence. This describes the oval shape of the cornea that occurs when the transplant is healed. This can be treated with glasses, but these cause a lot of distortion. Contact lenses of the hard variety can also correct the problem. But this doesn’t fix the problem, only masks it, and gives relatively good vision. To permanently change the astigmatism, something must be done to the cornea. We see the challenge of rehabilitation after a new cornea is to have the person achieve good vision with glasses or even without any correction at all. When corneal transplants began over 100 years ago, just getting a clear new transplant was a miraculous thing. We have moved ahead a lot in the past 3 decades, yet still patients after a corneal transplant cannot see, due to high astigmatism. We believe that the time has come to move beyond just a clear transplant and obtain good vision for the patient. How do we do this? First, if there is a very high astigmatism, we use the IntraLase to make very precise curved incisions in the cornea. these incisions can be done to incredible precision and with a perfect curve, resulting in a marked decrease in the amount of astigmatism. This may not correct all the astigmatism though. We then use the Excimer laser (Visx Star S4) to do a custom reshaping of the cornea. Many of our patients can now see well with a thin glasses prescription or even without glasses. This is a much more advanced and better goal for somewhat undergoing a transplant for Keratoconus or other problem.

We are the first center in Ontario, and one of only a few in Canada to be offering Intacs corneal ring segments for treatment of Keratoconus.  These rings help to make the cornea more regular in people that have this problem.  Yesterday, we implanted the “SK” variety of Intacs.  These are a modification of the usual Intacs and are good for the higher degrees of keratoconus.  We are the first center in Canada and the US to do this procedure with the SK implants, and are very excited to be there and watch our patients improve and benefit from the Intacs, where formerly, a corneal transplant may have been the only option.
We now have almost 2 years followup on our patients with the SK segments and have many people who have achieved a very good outcome with these modalities

 Getting back to the IntraLase, it is used for making the LASIK flap, but it doesn’t stop there.  The company behind this machine has now made it possible to use the laser for therapeutic applications.  This means that my patients with cornea problems that are fixable with a corneal transplant can now be operated on with a laser.  The cornea is a very thin curved tissue on the front of the eye.  It functions like a lens, and that is why we can reshape it with the laser and correct for the need to wear glasses.   But, there are many unfortunate people out there with problems with the cornea that cannot be corrected with the laser.  For these patients, a corneal transplant may correct their problem by putting a new clear window in place.  This is great, but has its down side too.  The healing is prolonged, and often there is much astigmatism after.  This is where the IntraLase comes in and can help.  The laser is so precise, that it can cut a perfect circle, give us alignment marks and even shape the edge, much as a carpenter does to shape a tongue-in-grove joint.   This makes the cornea heal better and quicker.  Truly science fiction.  And we at Yonge Eglinton Laser Eye Centre, are the first in Canada, in fact one of the few places in the world to be able to offer this type of transplant.  It is very exciting to be part of this revolution and can’t wait to see the further developments.

 Are these for everyone?  Not really.  Though they were developed first for the correction of near-sightedness, they didn’t pan out for this group of patients.  However, a doctor in France suspected they might be good for patients with a condition called keratoconus.  You will remember that the cornea is the clear dome on the front of the eye and functions as the major lens of the eye. This allows us to use our lasers to correct near-sightedness, farsightedness and astigmatism.  If you have keratoconus, your cornea is distorted, and vision is blurry.  This is often correctable with hard contact lenses, but often, the lenses are uncomfortable and don’t correct the vision all that well.  That is where Intacs can help.  Intacs are small, clear half ring segments that are imbedded in the cornea; they reshape the cornea, and generally improve the quality of vision and make it possible for many patients to see with glasses or contact lenses.  Unfortunately, they don’t work in all patients with Keratoconus, but they do help in many, many people with this condition.We make a special little channel in the cornea using the IntraLase.  (You are probably starting to notice that we use the IntraLase for many different purposes, it is true, we do!)  At any rate, we then can insert these little ring segments (Intacs) into the channels.  The procedure is painless, done with numbing the eye with drops only.  It takes about 20 minutes, and most people are feeling fine by the next day.  The first night there is some scratchy discomfort, but this quickly passes.  Most people with Keratoconus notice some immediate improvement in quality of vision, but it can take up to 6 months to fully stabilize.  They don’t always work though, and in some people they can be uncomfortable.  The good news is, that if they don’t work, they can be removed.   These Intac implants are a good alternative.  Until recently, all we had was a corneal transplant for patients with keratoconus.  Now we can treat some people and avoid a more major surgery, though when needed, a transplant is a very good operation for patients with keratoconus, with an excellent outcome and long track record.  We have been doing corneal transplants for more than 50 years, and thousands of people world wide undergo this sight restoring operation for many different conditions.