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Medical Forum / General / Vision / January 2005Advice on corneal dystrophy?
I've got a fairly rare condition which is getting worse as I get older (age 76 now). My opthalmologist also calls it "map-dot-fingerprint" and corneal dystrophy.. The outer layer of the epithelium on the cornea flakes off, only in my case it acts like ice burgs breaking up. Often makes my vision blurry; sometimes hurts. Vision varies a lot. He says I can go conservative (Refresh Liquigel and gels at night) and live with it, or radical and get laser PRK treatment which will scrape off the outer layer of epithelium - excepting that there's no guarantee the new layers won't do the same thing all over again. Having a stubborn Swede heritage, I'd bet on it's reaccurance. and something I read in Medscape makes me think it's heredity. OK. Any suggestions? Advice? Anyone else out there with a wierd condition? Nan, diabetic tax preparer who needs to see. I have had excellent results with soft contact lenses such as the Focus Night & Day for patients with EBMD. The contact lens seems to smooth over the epithelial irregularities. DrG Another therapy for moisture production is the antibiotic Restasis. I have a epithelial dystrophy caused by LASIK. MDF is also callled epithelial membrane dystrpohy (EBMD), where the epis don't lay down well on the underlying cell bed, I believ the Bowman's layer, causing sloughing of the epi cells, blurry visison, pain, also called RCE, or recurrent corneal erosion, in severe cases. PRK dusting or manual scraping is a common and proven technique for reducing or eliminating. It may come back, but a combiination of the PRK, antibiotics and steroid drops following the procedure should give you a healthy epi. Good luck, take your time... To correct some of your mis-information: > Another therapy for moisture production is the antibiotic Restasis. Restasis is not an antibiotic. Cyclosporin is an immuniosupressive agent and acts as an anti-inflamatory drug in the eye. I can see where you might make that mistake, from the "sporin" ending. For some people, simply taking a few grams of omega-3/flaxseed oil orally a day provides relief from a similar mechanism of action. Meanwhile, as Dr. G stated, the use of a silicone hydrogel as a bandage lens is an excellent therapy. I have a number of patients who do that, including myself! (Although I now use Menicon multifocal GP lens, at least until I get another RCE ;-) It's all about management---drops for lubrication, puncta occlusion for chronic dry eye, Restasis/omega-3s, contact lens for protection, PRK for a possibly more lasting treatment---and never, ever rubbing the eyes. -LB, OD > To correct some of your mis-information: > > > Another therapy for moisture production is the antibiotic Restasis. > > Restasis is not an antibiotic. Cyclosporin is an immuniosupressive agent > and acts as an anti-inflamatory drug in the eye. I can see where you > might make that mistake, from the "sporin" ending. > [quoted text clipped - 4 lines] > lens is an excellent therapy. I have a number of patients who do that, > including myself! (Although I now use Menicon multifocal GP lens, at > least until I get another RCE ;-) > [quoted text clipped - 3 lines] > > -LB, OD I have heard of some patients taking Salagen (Pilo?) to increase tear production, but that the other glands start to flood as well. This was primarily for Sjogren's, but does it have application for post-RS dry eye? Also, what does rubbing the eyes do that's bad? > Also, what does rubbing the eyes do that's bad? Weak epithelium attachment + dry eye + rubbing = removal of epithelium causing ocular surface defect = pain. For some people with EBMD, removing dry eye from the equation doesn't change the outcome. -LB, O.D. Well, it is indeed heredity, hence the term "dystrophy." As the previous poster said, PRK or PTK or epithelial scrape are all treatments for EBMD. However, I have had great success with contact lenses. They not only smooth over the epithelium, but improve the vision in the process. You decide. I particularly like the Focus N&D because it is approved for 30 days of overnight wear and also because its thickness tends to produce good visual acuity. DrG > Well, it is indeed heredity, hence the term "dystrophy." > [quoted text clipped - 8 lines] > > DrG My bad, Dr. G. Isn't this called a "bandage contact" to help the recalcitrant epi cells to calm down and bind more effectively to the BL? You're right, that would be the best first approach. > > Well, it is indeed heredity, hence the term "dystrophy." > > [quoted text clipped - 12 lines] > recalcitrant epi cells to calm down and bind more effectively to the > BL? You're right, that would be the best first approach. No, not your bad. As a post-RS patient, you have come to associate EBMD with recurrent cornea erosion, and that is completely understandable. Many cases of EBMD I have seen do not have RCE as a concurrent pathology, but simply an uneven epithelium and uneven tear film, with substandard visual acuity. The power of the contact lens is to provide a smooth refractive surface. DrG |
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