Cornea Transplant: Scott, 37

August 17, 1999
Web posted at: 11:44 a.m. EDT (1544 GMT)

Name: Scott

Age: 37

Residence: Fort Lauderdale, Florida

Procedure: Cornea Transplant

Which eyes: Right eye

Cost: The procedure costs $5,000 to $7,000 and was covered by insurance.

When done: April 1999

Why did you do it?

He decided to have it done when his vision was affecting his happiness and ability to function.

Scott has a disorder called kerataconus, which causes the cornea to steepen. It results in reduced sight to the point that it cannot be corrected with glasses or contacts.

Scott said he had no family history of kerataconus. Doctors do not know for certain what causes the disorder, but research suggests a link with a protein deficiency.

As the cornea becomes steeper and the eye more distorted, contact lenses and even blinking scar the cornea.

Scott had severe astigmatism in his right eye. He wore a piggyback contact lens: a soft contact with a hard lens over it. His optometrist, Dr. William Wiengar, did calculations to figure out how the two lenses would work together. "It becomes a real artistic as well as scientific procedure," Scott said.

He had used the piggyback technique for years with "remarkable success." He always knew he would eventually need a cornea transplant but was advised by doctors to wait as long as possible. They told him technology and procedures would advance as he waited.

But as his cornea became steeper and steeper, the contacts became difficult to use. And with this condition, glasses are not able to correct vision.

Eventually the piggyback technique did not work for his right eye. The best it could be corrected to was 20/80. "It become intolerable," he said. Vision in his left eye, in which he still uses the piggyback technique, was 20/30. The difference in vision from one eye to the other gave him dizzy spells.

As his cornea steepened in his right eye, the contact lenses started popping out. Doctors tried to make it better by making steeper lenses, but after awhile they were not able to make lenses steep enough to help his right eye. The lenses he was using would pop out up to 15 times a day.

Scott is a trial lawyer and lives a very active personal life. He said he has had contact lenses pop out just about everywhere, and usually at the most inopportune times. They fell out in trial summations, acting on stage, and in theaters.

Would you call it successful?

"Yes, absolutely. As of right now I have not had a rejection. I can see better, and I am relatively pain-free, and it is nothing compared to what I had before."

He will never have uncorrected 20/20 vision. Cornea transplant is not like other refractive surgeries. He now wears a -8 lens in his right eye, which he says is "nothing." "It is the first off-the-shelf lens I've worn in 20 years."

What was your vision before the procedure?

His right eye was a -24. His overall corrected vision was 20/35, but that was due to his left eye, which is dominant.

His left eye, with corrected vision, is 20/30. Without correction, he approximated, his left eye is 20/400.

His right eye, with lens correction, was never above 20/70.

After:

Following the procedure he is now -8 in his right eye. His overall corrected vision is 20/30. He says that for him, "That is paradise."

Did this procedure meet your expectations?

"Yes." Scott was made aware ahead of time that he would never see without corrective lenses. He is pleased with the outcome thus far.

Cornea transplant is a substantial procedure. He still has 11 stitches in his eye, though the surgery was in April. He has a stitch taken out about every three or four weeks. The stitching technique, which is called interrupted suture, allows the doctor to adjust the cornea so that it heals as perfectly as possible on the patient's eye.

Would you do it again?

"I am going to have to do it in my left eye," he said. But he said he isn't going to do it until he has to. He reads a great deal for work and has some fears about having two eyes that are surgically worked on.

"The procedure is very important to me. If I have to patch my eye for April, May and June, I have no sight in that eye, because a contact can't be put on for some time."

Any pain?

"Yes, there was pain."

Scott said after the first week or so he had less pain and then just general discomfort. "I would not consider it remarkably debilitating from a pain standpoint," he said.

The biggest discomfort came from the sensation that something was in his eye. He had 14 microthin interrupted stitches. He said they were half the thickness of a fingernail.

How would you describe the experience?

Because he has had the condition for so long, Scott had been on the waiting list for a cornea transplant for 10 years. He let people jump ahead of him on the list until he was ready for the procedure.

From the time he indicated he was ready, he waited about eight weeks until a cornea was available. He said he believes most people wait three to four months for a transplant.

It was a two-hour procedure under general anesthetic. He said it was pretty much like any surgery.

He chose to have a general anesthetic, but many doctors do not want their patients totally asleep because they want them to be aware a procedure is happening.

What risks were you made aware of ahead of time?

The biggest risk he was told about, and faces still, is rejection. He is taking steroid drops, which help prevent the body from rejecting the new organ.

The problem with long-term use of steroid drops, he said, is cataracts. He has been told he runs an extraordinarily high risk of developing them. Doctors assure him it will be easy to deal with them, but it will mean a cataract removal procedure.

Scott was told there are two primary times a body usually rejects an implanted cornea. The first is a couple of weeks to a month after the surgery, and the second is five to eight months after. At five to eight months, as the cornea is finally settling in and becoming part of your body, the immune system makes one last attempt to reject what it thinks is a foreign body.

Did you seek out the treatment, or was it suggested to you by a doctor?

Scott's doctors recommended he put off the procedure, which he did for 10 years.

He was extremely impressed with how conservative the doctors were about this. They suggested he wait until he absolutely had to have the transplant. Their reasoning, he said, was that procedures would get better.

He didn't do it until the vision problem with his right eye affected his quality of life.

He said his decision on when to have a cornea transplant for the left eye will be based on the same criteria. "But hopefully I won't have to have it done for a long time, or maybe there will be a new procedure," he said, "one that maybe provides for less steepening or less sutures."

He said he isn't excited at the prospect of another surgery, but he isn't frightened either.

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