Corneal Services
Cornea Overview
Issues with your corneas are best trusted to eye doctors with the most extensive experience. We have one of the most advanced facilities for eye health, vision correction, and refractive surgery in the area, and we have invested in the latest eye care technologies to bring you state-of-the-art eye surgery procedures.
We invite you to visit our Boulder, Lafayette or Longmont offices to access these services and state-of-the-art eye care.
Our Corneal Specialist: Aimee Verner, M.D.
Corneal FAQ's
Do you treat corneal disorders?
At the Eye Care Center of Northern Colorado we offer the best specialized eye care for your cornea and laser vision correction needs. Not only do we provide traditional solutions for existing or chronic corneal problems, but our patients experience innovative corneal care and treatments with less-invasive solutions that increase safety, or end-stage solutions when traditional treatments have failed.
What types of corneal disorders do you treat?
Keratoconus, Pterygium, and External & Infectious Eye Disease
What is keratoconus?
Keratoconus is an uncommon condition that causes a progressive thinning and bulging of the cornea (the clear front portion of the eye). As this condition progresses, the cornea develops a cone-like bulge, altering the shape and distorting vision. Keratoconus usually affects both eyes, however the progression and symptoms may differ in each eye. Blindness rarely occurs as a result of keratoconus although vision may become significantly impaired. The cause of keratoconus is unknown but some researchers believe there may be a genetic link since an estimated 10% of patients with keratoconus have a family member with the disease.
Generally glasses are used to correct vision in patients with keratoconus. Rigid Gas Permeable (RGP) contact lenses may be used if good vision cannot be achieved with glasses. RGPs are contoured to address the cone-like shape of the cornea, thereby improving vision. A proper fitting lens is vital in providing a comfortable fit and adequate vision.
A relatively new option for patients with keratoconus is placing crescent-shaped acrylic inserts (Intacs) in the mid periphery of the cornea. This has shown to be an effective treatment for some patients.
What is pterygium?
Pterygium (sometimes called surfer’s eye) is a pinkish, triangular tissue growth on the cornea of the eye. It typically starts on the cornea near the nose. It may grow slowly, but rarely grows so large that the pupil is covered. Pterygia that are threatening the visual axis, causing significant astigmatism or irritation should be excised.
Our modern methods of pterygium surgery greatly reduce the incidence of recurrence and have a better cosmetic outcome. Dr. Verner is a national speaker and advocate for the use of amniotic membrane in ocular surface reconstruction. This method includes primary excision, polishing of the corneal bed, and precise application of an amniotic membrane transplant (AMT) graft in the bed of the former pterygium. While reports vary, such a method generally reduces the risk of recurrence from 50 percent with just primary excision down below 5 percent, and usually reduces post-operative pain as well.
What types of external and infectious eye diseases do you treat?
Patients with significant recurrent or chronic ocular surface problems can represent a diagnostic challenge. We welcome such challenges and are willing to run full evaluations and tests to get to the bottom of these cases and their systemic causes. Recently diagnosed cases include:
- Acanthamoeba keratitis
- Thygeson’s SPK’s
- Nodular scleritis due to undiagnosed Polyarteritis Nodosa
- Dry Eye due to Wegner’s granulomatosis
- Dacryocystocele with preseptal cellulitis
- Ocular cicatricial pemphigoid and ankyloblepharon
- Corneal and conjunctival neoplasms
- Bacterial corneal ulcers
- Fungal corneal ulcers
- Viral corneal disease
Infectious disease cases can be taken on an emergency basis. We will send cultures, microscopic, serological, and tissue tests as indicated and manage fortified topical or injected ocular medications and systemic medications as needed in these cases.
What types of corneal treatment options are there?
Corneal treatment options: Artificial Corneal Implantation, Cornea Transplants, Intacs, LASIK & PRK, Scar removal & Ocular Surface Reconstruction, and Visian ICLs.
What is artificial corneal implantation?
When human corneal transplantation has failed more than once, or if injury to the eye is severe enough, an artificial cornea may be the best hope for vision. Dr. Verner has experience with implanting both the Boston Corneal Prosthesis (K-Pro) and the AlphaCor artificial corneas.
What are the details surrounding cornea transplants?
Corneal transplant procedures may restore vision to eyes blinded by certain eye diseases or injuries. There are many conditions in which corneal transplantation may be considered. Frequent indications include:
- Fuch’s dystrophy
- Persistent corneal edema that my follow some cataract surgeries (pseudophakic bullous keratopathy or PBK)
- Corneal ulceration or infections including herpes simplex
- Corneal scars from previous infections or injuries
- Advanced keratoconus. Note that for many keratoconus patients, INTACS for keratoconus may be a better options
There are two main types of cornea transplants we perform:
- Penetrating Keratoplasty (PKP): PKP is traditional full-thickness corneal transplant
- Descemet’s Stripping Endothelial Keratoplasty (DSEK) & Deep Anterior Lamellar Keratoplasty (DALKP): DSEK and DALK are partial thickness “lamellar” transplants, both posterior and anterior. For patients who have Fuch’s dystrophy or bullous keratopathy a partial thickness, posterior surface transplant – DSEK – may be done. For patients with anterior scars from keratoconus or injuries, an anterior lamellar transplant – DALKP – might be best. Lamellar keratoplasties may require shorter recovery times and induce less irregular astigmatism.
We are also adept at managing existing corneal transplants, their evaluations, and medications.
What are Intacs?
Intacs® corneal implants provide an option to improve vision and postpone a corneal transplant in most patients with keratoconus. When contacts and glasses can no longer provide adequate vision, Intacs may be a great solution.
Benefits of Intacs for Keratoconus:
- Safe, replaceable, removable
- Decreases nearsightedness and astigmatism associated with keratoconus
- A more natural dome shape is restored to the cornea
- A few days of recovery compared to months for a corneal transplant
- May postpone the need for a corneal transplant
- A reversible alternative to LASIK for mild myopia
- May be used to augment previous laser vision correction
- May be paired with the Visian ICL to provide vision correction to people who are not LASIK candidates
What is LASIK and PRK?
Laser-Assisted In-Situ Keratomileusis (LASIK) is a surgical procedure that actually changes the shape of your cornea to correct refractive errors. Refractive errors occur when the cornea is not perfectly shaped, so light does not properly focus on the retina (the back of the eye). If you have a refractive error, you may have one or a combination of these vision conditions:
- Myopia (nearsightedness)
- Hyperopia (farsightedness)
- Astigmatism (blurry vision at all distances)
With LASIK, your eyes’ focusing power is restored, often eliminating the need for glasses and contacts.
Do you have more information on the scar removal & ocular surface reconstruction?
Given the intimate relationship of the ocular surface with the lids and orbit, our treatment plans address all of the necessary surgical procedures needed for best patient care with ocular surface reconstruction. These include applications of amniotic membrane, limbal stem cell transplants, corneal gluing or conjunctival flaps for the ocular surface. Therapeutic blepharoplasty for entropion or ectropion, and lid lesion biopsies with repair as needed.
Please provide more information on the Visian ICLs.
The surgeons at the Eye Care Centers of Northern Colorado are thrilled to provide this exciting innovation to our patients in Northern Colorado. If you have dreamed about throwing away your glasses or contact lenses forever, the Visian ICL just may be the answer you’ve been looking for. The advantages of this IOL are numerous and include:
- The Visian ICL can correct a wider range of myopia than LASIK or PRK, and the IOL can be removed
- It is invisible to you and others
- Requires no maintenance
- Is made from a collagen copolymer; collagen is the same naturally occurring substance present in our connective tissue and our eyes
- Success has been great with over 3 million ICL lenses distributed worldwide.
- The results are excellent with over 99% of patients reporting being satisfied with their vision after the Visian ICL procedure
Also, unlike other phakic IOLs, the Visian ICL is foldable, allowing surgeons to implant the lens using a smaller incision. The Visian ICL requires a 2.8 mm to 3 mm incision as opposed to the 6 mm incision required by other FDA-approved phakic IOLs. The smaller incision is obviously less invasive, does not require sutures, and is astigmatically neutral.
Although the Visian ICL is designed to stay in the eye permanently, if overcorrection or undercorrection occurs, or if a complication develops, or if the patient’s vision changes, the ICL can be removed or exchanged by your surgeon.
