“(The procedure) involves creating more and more cross-links between the collagen fibers in the cornea to strengthen it. You’ve got support struts, (and) you’re now putting cross beams to connect them.”
Lt. Col. (Dr.) Patrick Munson
Chief of refractive surgery, Madigan Army Medical Center
People tend to think youth brings the peak of physical health and as the body ages, that’s when conditions set in that deteriorate health.
Keratoconus flies in the face of this thinking, because it is most commonly found in teenagers and young adults.
“My vision with my left eye was rapidly declining. Every time I went to the eye doctor, it was a new prescription,” said Sean dela Pena, a high school senior whose mother, Maj. Ernestina dela Pena, is a nurse in the Primary Care Service Line at Madigan Army Medical Center.
The condition is a progressive thinning of the collagen fibers of the cornea — the flat surface of the eye.
“(The cornea) starts to warp and bow; it doesn’t hold its normal shape,” said Lt. Col. (Dr.) Patrick Munson, the chief of refractive surgery at Madigan.
Instead of a rounded dome, the surface of the eye becomes more of a rounded cone.
The result can be blurry or double vision, nearsightedness, astigmatism, increased light sensitivity and, in the worst cases, blindness. For dela Pena, the diagnosis was a bit scary.
“The doctor told me that if it does get worse, a transplant is required,” he said.
Corneal transplants are among Madigan’s more common types of transplants. Since keratoconus is a bar to enlistment, most of the patients seen for the condition are, like dela Pena, family members of active duty; some are retirees.
According to the National Eye Institute, keratoconus is the most common corneal dystrophy — degeneration of tissue of the cornea — in the U.S., affecting one in every 2,000 Americans.
In the past, there was no treatment for the disease. The symptoms were managed until corneal transplant was necessary to retain or restore vision.
“Now, with corneal cross-linking we have our first therapy to treat that disease rather than just the symptoms,” Munson said.
“(The procedure) involves creating more and more cross-links between the collagen fibers in the cornea to strengthen it,” Munson said. “You’ve got support struts, (and) you’re now putting cross beams to connect them.”
Approved by the U.S. Food and Drug Administration in April 2016, Fort Belvoir, the main eye research center in the Army, was the first Army site to start using this treatment. Madigan is the second.
The cross-linking procedure mimics what naturally occurs with aging by saturating the eye with riboflavin (vitamin B2) and exposing it to ultra-violet radiation — UVA light, also known as sunlight. This intensive dose of vitamin and UVA exposure spurs the formation of cross-linked fibers, strengthening the cornea.
Dela Pena was given a mild sedative before the procedure and some numbing drops. Col. (Dr.) Mark Torres, Madigan’s cornea specialist, removed the epithelium — the “skin” of the eye — and measured the cornea to determine if it was presenting the right conditions to proceed.
From there, Sol Epistola, an ophthalmic technician, kept constant watch over dela Pena, administering vitamin drops every two minutes for a 30-minute course.
“He made sure I was OK,” dela Pena said, adding that Epistola asked how he was feeling and if he needed more numbing drops throughout.
Following the course of drops, dela Pena had a 30-minute exposure to the UVA light. The final step of the
process involved Torres putting a contact bandage on the eye.
Dela Pena said he found the contact uncomfortable during recovery.
“The whole time it felt like something was in your eye and you just wanted to take it out,” he said.
Still, just weeks after the procedure, dela Pena said he notices improved vision in his left eye.
Munson said the success rate is 80 percent or higher. Some studies show rates above 90 percent. Success is defined as stabilization.
“Our goal is to grab the patient who can still wear the glasses or contacts and treat them then to stop the progression,” Munson said.
This is one reason to be seen early for evaluation. Madigan has many options for dealing with all sorts of eye conditions.
Now, unlike before this treatment, dela Pena will be able to wear contacts and even get LASIK surgery after he has his right eye treated and both eyes heal fully.
All of this is very good news for him. Dela Pena is going to college in the fall to study aerospace engineering.
“I’d love to build rockets and do what I can to contribute to the greater picture,” he said.
That is a goal that can take proper shape now.