At Pepose Vision Institute, we know that the best cornea patient is an informed cornea patient. Our patients are encouraged to carefully review the information provided below about the diagnosis and treatment of corneal conditions. For your convenience, we have developed a list of answers to questions most commonly asked by our patients. Please understand that it is your PVI cornea subspecialty trained surgeon who is ultimately responsible for deciding which treatment plan is right for you. We will not settle for anything less than preserving and protecting your vision to the highest degree possible.
We look forward to answering any additional questions you may have during your office visit or prior to your surgical procedure.
1. What is the cornea's function in helping me see? The cornea is the clear front of the eye that covers the colored iris and the round pupil. Light is focused onto the retina at the back of the eye by passing through the cornea. If the cornea is not clear or shaped properly, then this light will not be focused properly and vision problems will arise. In the extreme case, a badly damaged cornea can lead to blindness.
Back to Top2. How might my cornea become damaged? Your cornea may become hazy or damaged because of disease or injury. Corneal infections caused by inadequately cleaned contact lenses can lead to permanent corneal damage if not treated promptly. Trauma to the eye can likewise permanently injure the cornea, as can certain progressive diseases, such as keratoconus. When the cornea is damaged, it may become swollen or scarred, and its smoothness and clarity may be lost. The scars, swelling or resulting irregular shape cause the cornea to scatter or distort light, resulting in glare or blurred vision. Like a foggy window, light no longer passes through it well, so a blurred image forms in your eye.
Back to Top3. I've heard about corneal transplants. Is this a new procedure to address corneal problems?
Corneal transplants have been performed in this country for over 50 years. They account for the single largest number of transplant procedures in the U.S. each year. There have been exciting innovations in the way in which such transplants are performed, thereby increasing the success rate and reducing tissue rejection by recipients. Pepose Vision Institute's cornea subspecialty trained surgeons have contributed a great deal to the development of these new technologies, conducting clinical studies in order to bring the latest advances to their cornea patients.
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4. Are corneal transplants primarily for older patients?
We have had babies as young as 3 months old who have required corneal transplants because of congenital cornea defects. Through cornea transplants, we have saved the sight of young athletes who have suffered trauma to their corneas. We have performed corneal transplants on patients of all ages who have seriously impaired corneas.
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5. How do I know if I need a cornea transplant?
A corneal transplant is typically needed when:
- Vision cannot be corrected satisfactorily using other medical approaches
- Painful swelling cannot be relieved by medications or special contact lenses
- Corneal failure occurs after other eye surgery, such as cataract surgery
- Severe Keratoconus, a steep curving of the cornea, develops
- Hereditary corneal failure, such as Fuchs' dystrophy, exists
- Scarring after infections, especially after herpes, occurs
- Rejection occurs after first corneal transplant
- Scarring arises after injury
Only an experienced, cornea subspecialty trained surgeon can appropriately determine if and when a transplant will enhance the quality of your vision.
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6. How is a corneal transplant performed?
A cornea transplant is performed under local or general anesthesia at an outpatient surgery center. When we use local anesthesia, you may be able to hear what is going on, even though your eye and face will be numb and you may be groggy. Our cornea subspecialty trained surgeon will remove the hazy part of your cornea and a clear cornea from a donor will be put in its place. Tiny stitches, about 1/3 the diameter of a human hair, are used to hold this tissue in place. The procedure usually lasts for to two hours, depending on whether any additional procedures are done to remedy other vision problems in the eye.
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7. Is a corneal transplant painful?
The operation is virtually painless. Anesthesia is either local or general, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening, and will not have to worry about keeping your eye open or closed.
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8. Will my eye color change to the eye color of the donor?
No. The cornea is a clear tissue that is in the front of the eye and the iris, which gives your eyes their color.
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9. How safe is a corneal transplant in terms of the donated tissue?
Cornea tissue is subjected to a battery of laboratory tests prior to its release for transplant purposes. Pepose Vision Institute's Medical Director, Dr. Jay Pepose, is the Medical Director of MidAmerica Tissue Services, and has had decades of experience in validating the safety of corneal tissue. As an M.D. and Ph.D. with specialization in microbiology and infectious diseases, Dr. Pepose has conducted landmark medical research that has demonstrated that corneal tissue does not transmit the AIDS virus or many other viruses that are of concern in the organ transplant community. In addition to the numerous tests that are performed on donor corneal tissue, Dr. Pepose reviews a variety of donor characteristics before accepting tissue for a transplant.
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10. What are the chances that I will reject the cornea tissue that is used for my transplant?
After your corneal transplant, you will be given eye medications that will prevent infection and reduce the chances of tissue rejection, when used as directed. Usually, matching donor and recipient by age, gender, race, or any other characteristic does not reduce the possibility of rejection. Donor tissue is rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates. Most rejections, if treated promptly, can be stopped with minimal injury. Warning signs of rejection are: persistent discomfort; light sensitivity; redness; or change in vision. In the case where rejection does occur, a corneal transplant can be repeated, usually with good results. In some instances, matching the blood types of donor and recipient helps when there has been previous corneal tissue rejection. Still, the overall rejection rate for repeated transplants is higher than for the first time around, probably because of an underlying factor that causes a patient to be more prone to rejection.
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11. How long will it take for me to be able to see out of the eye that has had the transplant?
After a corneal transplant, your vision may continue to improve up to a year after surgery. Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision but can also be treated. Even if the surgery is successful, other eye conditions, such as macular degeneration (aging of the retina), glaucoma or diabetic damage may limit vision after surgery. Even in the face of such problems, corneal transplantation is still usually worthwhile in terms of vision outcomes.
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12. What will my post-operative care entail?
A successful corneal transplant requires meticulous care and attention on the part of both patient and doctor. Patients must adhere to their medication schedule and avoid any injury to the eye. Post-operative complications can arise, and are best treated if detected early by an experienced cornea surgeon. Therefore, it is imperative that your surgeon carefully supervises your post-operative care. At Pepose Vision Institute, we have a cornea surgeon on call 24/7 to respond to any concerns that our transplant patients may have post-operatively.
Corneal transplants typically require that sutures be used to hold the donated corneal tissue in place. These sutures are usually removed during an office visit several months after the initial surgery.
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13. Will I need a separate operation if I have additional problems that are affecting my vision, for example, a cataract?
We are often able to surgically resolve other vision problems - cataracts (cloudy lens) or retina damage in the same eye, during the corneal transplant.
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14. I've heard about Amniotic Membrane Transplants for cornea problems. What is this?
Amniotic Membrane Transplants may be used to repair corneas that are scarred or have thinned. This membrane is harvested after a baby is born: miraculously, birth can also give the gift of sight! Dr. Jay Pepose was the first eye surgeon in the bi-state region, and one of the first nationally, to perform an amniotic membrane transplant.
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15. Will my lifestyle be altered either in the short-run or long run due to the transplant?
The amount of time you will need to be absent from your job depends on how fast you recover and on what kind of work you do. Physical activity can increase gradually after transplant surgery and many patients are able to resume normal activities right after surgery. We do ask that our transplant patients refrain from swimming for several weeks, as well as the use of makeup. In general, we advise transplant patients to take it easy for approximately one month following surgery, and avoid heavy lifting, rubbing the eye, and contact sports for several months. Of course, the most important thing is to avoid a direct blow to the eye for several months, such as from a child's finger, a pet's paw or from falling on the eye.
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16. Are cornea transplants covered by my medical insurance?
A cornea transplant is considered major, functional surgery. It is covered by Medicare and virtually all private insurance plans. Our surgery schedulers will complete all pre-surgical authorizations required by your insurer, and will confirm any remaining patient obligation due to deductibles, co-payments, etc.
17. Will I need to wear contacts or glasses after my transplant?
Glasses or contact lenses are typically required to realize the full benefit of a corneal transplant. These will be fitted as soon as your vision stabilizes, which may be at three months or up to 12 months. The timing will depend on each patient's own rate of visual recovery. Typically, this will occur sooner for patients that have had DSAEK rather than a "full thickness" corneal transplant.
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