Northwest Health | SUMMER 2009 By KJ Fields

Ophthalmologist and nationally recognized corneal specialist Thomas D. Lindquist, MD, PhD, has been at the forefront of corneal transplantation for decades, and he's excited about recent developments in the field.

BACK TO: Northwest Health index

"In just the last few years, ground-breaking techniques are providing less invasive options for corneal transplantation," he says. "Incisions can be smaller, resulting in quicker healing and reduced risk of complications. Group Health medical centers offer the latest procedures, and we can direct patients to the one that's right for them."

Causes of Corneal Problems

The cornea is the window at the front of the eye that allows light to reach the retina, where images are received and transmitted to the brain. The inner layer of the cornea contains endothelial cells that pump fluid out of the cornea.

It's normal to lose half of our endothelial cells over a lifetime, so some people need corneal transplants later in life, usually in their 80s. Other reasons why a physician may recommend a corneal transplant include endothelial dystrophy (a hereditary disease where people are born with fewer endothelial cells); scarring from chemical injuries, accidents, and infections such as herpes; and corneal swelling after cataract surgery. Keratoconus is another damaging condition where the cornea becomes thin and cone-shaped, often occurring in people under age 25.

The Latest Treatment Options

"When the cornea becomes clouded, scarred, or misshapen," says Dr. Lindquist, "corneal transplantation from donor tissue returns clear vision to most patients. The procedure is often done on an outpatient basis, with a local anesthetic. The standard approach is full-thickness corneal transplant, but a new process developed in 2004 replaces only the endothelial cell layer."

Called DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty), this surgery requires only a tiny incision, which can reduce both healing time and risk of complications. Patients with endothelial dystrophy, corneal edema, and failed corneal transplants are good candidates for DSAEK.

Artificial corneas are now a possibility for people who have a high risk of transplant rejection. Because so few are done each year, our ophthalmic surgeons don't perform the procedure but can refer Group Health patients to specialists at the University of Washington.

If a doctor recommends a corneal transplant, call Customer Service to find out about your coverage.