Modern Management of Keratoconus Brian S Boxer Wachler
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1MODERN MANAGEMENT OF KERATOCONUS
MODERN MANAGEMENT OF KERATOCONUS
Edited by Brian S Boxer Wachler MD Boxer Wachler Vision Institute Los Angeles California, USA
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
B-3 EMCA House, 23/23B Ansari Road, Daryaganj, New Delhi 110 002 India
Phones: +91-11-23272143, +91-11-23272703, +91-11-23282021, +91-11-23245672
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Modern Management of Keratoconus
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2008
9788184482096
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
4Dedication
Typically, the editor writes the Dedication. Because this book is about helping patients, I thought it would best if an extra special patient wrote the Dedication for this book; Kenny Atkins was the first reported patient in the United States to have Intacs for keratoconus.
— Brian S Boxer Wachler, MD
When I started college I became an Ocean Lifeguard. At school, I found it was becoming harder to focus on textbooks. At first I thought it was just the chlorine – I swam competitively, and at the time we didn't wear goggles for pool workouts. One day a teacher noticed that when I was reading in class I was reading with only one eye. I had my eyes checked and I was diagnosed with astigmatism in one eye and I started wearing glasses while studying. Those glasses for reading books became prescription sunglasses at work, as lifeguarding became my chosen profession. I found it hard to focus in the afternoon as the Southern California sun set lower in the sky.
Prescription sunglasses were expensive and easily scratched. When running out for a rescue, I would often lose them as I threw them on the beach. I tried soft lenses, but the wind blowing sand into my eyes made this very uncomfortable. The lenses often slid up behind my eyes and even floated away when I swam with them. I went for several weeks at a time without correction because of the irritation. By late afternoon I would see double images of objects far away, such as a boat on the horizon.
When laser eye surgery became available, I was excited about the chance to retire my prescription sunglasses and buy ones “off the shelf.” However, I was discouraged to learn that I had keratoconus in one eye and was not a candidate for LASIK. I was very frustrated with my problem.
I came across an article and some studies by Dr Boxer Wachler. I was optimistic after my first meeting with him in 1999. Dr. Boxer Wachler explained a new procedure that involved inserting Intacs between the layers of the cornea that would help correct its irregular shape and subsequently my vision. At that time, the procedure had not been reported on a patient with keratoconus in the United States, but he felt the procedure was ready to be attempted. Since my condition was primarily in one eye, I was a good candidate and I welcomed the opportunity.
A week after surgery, the vision in that eye improved to a great degree. I was able to see nearly equally with both eyes and it was unnecessary to wear glasses or contacts at work. After a few months I noticed that I was relying more and more on the corrected eye!
It has now been about eight years since I had Intacs and I still do not wear corrective lenses. I am able to pick objects out of the glare on the horizon and street signs on the freeway well before I need to turn. The freedom I have gained and the confidence I now have in my vision has proven invaluable to me and my ability to continue in my profession. The ability to see well in lifeguarding is critical, and I no longer have the worry that I might miss something that could result in someone's pain, suffering or their life. I owe this self assuredness to Dr Boxer Wachler and to Intacs.
I feel fortunate to have been at the right place at the right time in history. I can appreciate the saying, “Nothing ventured, nothing gained.” I am glad that my pioneering experience helped pave the way for the thousands of other patients who have subsequently benefited from innovative advancements for keratoconus. I am pleased to dedicate this book to the thousands of future patients who will benefit from these innovations.
Kenny Atkins, first reported Intacs for keratoconus patient in the United States
5Contributors 6Acknowledgements
The editor would like to express his deep gratitude to Selina his wife whose unwavering support was critical for this book.
He would also like to acknowledge the dedications of all the contributors who spent countless hours on their chapters to provide the invaluable information contained within.
The editor would like to specifically acknowledge Joseph Colin, MD and Theo Seiler, MD, PhD and his group for their pioneering work in the field. Without their efforts, there would be no foundation upon which to build this book.