University of Missouri

Seeing a Clearer Picture

New corneal transplant procedure transforms woman’s world
Seeing a Clearer Picture

Following eye surgery, Betty Minor finds it much easier to read labels and shop at her local grocery store, Bings, in Sedalia, Missouri.

Reading labels at the grocery store, seeing the text on road signs and reading lyrics in the church hymnal were just a few of the daily activities that had become challenges for Betty Minor, 75, of Sedalia. Blurry vision was just a part of her life, and she had resigned herself to a world where colors were dull and large-print books were a requirement.

For more than 35 years, Minor has lived with Fuch’s dystrophy, an inherited degenerative condition that causes vision loss. In July 2014, Minor underwent a new corneal transplant procedure that changed her life.

“Until I had the surgery, I didn’t realize what I was missing out on,” said Minor, who has been painting china dishes as a hobby for more than 20 years.

“Now, colors seem brighter and everything seems more vibrant. That’s what really surprised me.”

Minor underwent a state-of-the-art corneal transplant procedure known as a Descemet membrane endothelial keratoplasty, or DMEK. She was the first patient within University of Missouri Health Care to undergo the surgery. Now, she can read everything so much easier.

“Imagine not being able to see the price of something at the grocery store,” Minor said. “It’s frustrating.”

“DMEK is a corneal transplant procedure that replaces a thin membrane on the inner side of the cornea,” said Rick Fraunfelder, MD, MBA, a fellowship-trained corneal disease specialist at MU Health Care. “In most cases, traditional corneal transplant methods can only restore vision to 20/30, but with DMEK, patients can achieve perfect 20/20 vision with a recovery time as short as a few weeks.”

Fraunfelder said the DMEK procedure is relatively new in the ophthalmology world. “There are fewer than probably 40 surgeons nationwide performing this procedure and it’s less than five years old,” Fraunfelder said.

Using donated corneas, Fraunfelder replaces the Descemet membrane inside the eye. This thin, cellophane- like membrane contains cells known as endothelial cells. These cells are responsible for pumping fluid out of the cornea to keep it clear. When these cells deteriorate, vision becomes gray and hazy, and can eventually result in blindness.

“Imagine taking a little dime-sized piece of plastic wrap and putting that piece of plastic wrap inside of a water- filled balloon and then getting that piece of plastic to unfold inside the balloon in the exact spot that you want,” Fraunfelder said. “That’s the surgery.”

The surgery also is less invasive than a traditional corneal transplant procedure and the recovery time after the surgery is significantly less. In a conventional corneal transplant procedure, the entire thickness of the cornea is replaced. In DMEK procedures, however, only the innermost corneal layers are replaced. By grafting a thinner cornea transplant, the patient’s cornea remains closer to its original condition, resulting in a quicker recovery. Because a thinner cornea graft is used, light is less distorted as it comes through the cornea.

“When a full thickness corneal transplant procedure is done, the patient faces a 50 percent chance of transplant rejection and they won’t see very well for about a year after surgery,” Fraunfelder said.

With the DMEK procedure, patients will be able to return to normal activities and regain their vision within weeks. “This new procedure is very quick,” Fraunfelder said. “You are awake during the surgery and you recover your vision very quickly.”

Most patients who are candidates for the less-invasive DMEK procedure suffer from Fuch’s dystrophy. Though the condition rarely affects individuals under the age of 50, it is estimated that one in every 2,000 people may be living with the condition.

“One of the first indicators that Fuch’s dystrophy is advancing is cloudy vision when you first wake up,” Fraunfelder said. “When your eyes are closed, the moisture in the cornea doesn’t evaporate. This generally starts to clear up as the day goes on, but if left untreated, the condition can eventually cause blindness.”

In addition to cloudy vision upon waking, other symptoms of Fuch’s dystrophy include:

  • Eye pain
  • Eye sensitivity to light and glare
  • Seeing colored halos around lights
  • Worsening vision throughout the day

Minor had the procedure done in her left eye, which has been her weaker eye. Minor expects to undergo a DMEK transplant procedure in her right eye later this year.

“My eyesight has improved greatly, and I’m looking forward to having the procedure done in my right eye,” Minor said. “My vision has gotten stronger each day, and I’m confident that I will be able to read again and see my grandchildren play ball.”