How to Repair Warpage and Distortion in the Cornea

A normal cornea is smooth and symmetrical in shape. It easily focuses light entering the eye through its even surface. In contrast, a warped and distorted cornea is irregular in shape. It scatters light with its uneven surface. Let’s learn more about corneal warpage and what you can do to repair it.

Causes of Corneal Warpage and Distortion

A normal cornea is smooth and symmetrical in shape. It easily focuses light entering the eye through its even surface. In contrast, a warped and distorted cornea is irregular in shape. It scatters light with its uneven surface. 

There are many causes of corneal warpage and distortion. Rigid gas-permeable contact lens wear can distort the cornea’s shape, but thankfully this effect is temporary. Simply discontinuing contact lens wear will allow the cornea to regain its normal shape. This can take weeks to months, depending on the length of contact lens wear and the severity of corneal warpage. 

The more concerning causes of corneal warpage are those that are permanent. Certain diseases such as keratoconus and pellucid marginal degeneration cause an irregular cornea. Alternatively, trauma to the cornea could distort its shape. Corneal surgery may also induce warpage. Laser-Assisted In Situ Keratomileusis (LASIK) decentration, post-LASIK ectasia, and radial keratotomy are some examples of surgical causes.

Opthamologist consulting with patient

Symptoms of Cornea Distortion

When a cornea is warped or distorted, the light that hits the eye is not focused like it should be. This causes blur, distortion, double vision, halos, glare, shadows, eyestrain, and headaches. When a patient’s cornea distortion is a result of surgery, these symptoms can be especially problematic. Patients can be rather disappointed when their vision is worse, instead of better, after their procedure. They may be hesitant to pursue further surgery, though as you’ll read that may well be the best solution.

Surgical Repair of the Cornea

People with cornea distortion were historically out of luck. That is no longer the case with the advent of laser corneal reconstruction. Dr. Motwani is one of the few surgeons that performs this revolutionary procedure. This cornea repair surgery is done with a laser called the Wavelight EX500. This laser is guided by a topographer, which is a machine that provides a map of the cornea. 

Dr. Motwani uses the Wavelight Contoura system to guide his procedures. It is the most powerful corneal topographic guided ablation system in the United States. It maps up to 22,000 unique points in the cornea. Although it has been used in the rest of the world for many years, it was only approved by the US Food & Drug Administration (FDA) in 2016. It is indicated for use in corneal repair and treatment of irregularity and warpage. The laser is able to remove the tissue causing the irregularity, smoothing out the cornea to restore vision. It can also correct refractive errors such as myopia, hyperopia, and astigmatism to decrease a patient’s dependency on glasses. 

This procedure is truly customized to the individual’s cornea. Dr. Motwani has published his innovative San Diego protocol in medical journals, in order to share his successful technique with others, which is the only published protocol in the United States for repairing corneas with topographic guided ablation. He remains one of the few surgeons performing cornea repair surgery. This is because there is so much intricate knowledge and expertise required to perform this procedure well. 

The goal of cornea repair surgery is to correct all imperfections, but sometimes this has to be done in a staged fashion. Repair of the irregularity itself can dramatically improve the correction and vision, so a second laser procedure may be required to fine-tune the initial result.

Combining Laser Corneal Reconstruction with Collagen Crosslinking

Collagen crosslinking (CXL) is a procedure that lends strength to a weakened cornea. It involves first gently sloughing away the outermost corneal cells. Eye drops made of riboflavin, a vitamin B, are then put in the eye. Finally, ultraviolet light is applied. This combination of a photosensitizer with ultraviolet light results in the strengthening of the collagen layers in the cornea. 

CXL is especially useful in weak corneas, like those with keratoconus or post-LASIK ectasia. Because the cornea is frail in these conditions, it is prone to changing shape. After surgical repair of the cornea, CXL can serve to lock the result in place. The cornea will be cured in its desired shape to avoid shifts post-surgically. There is a minimum corneal thickness requirement of 400 micrometers to undergo CXL safely. A test called pachymetry will be used to screen for this pre-operatively.

Quality of Life After Cornea Repair Surgery

Corneal distortion and warpage can interfere with patients’ ability to live life. They may have trouble driving, leading to a loss of independence. They may be at risk for injury due to their diminished sight. They may be dealing with headaches, anxiety, and depression. They may be suffering with the loss of reading ability, loss of ability to pursue interests, and loss of employment prospects. They may feel as though their life has been put on hold. 

Why continue to live like this when we have a solution? Dr. Motwani is trained and experienced in cornea repair surgery to finally restore patients’ sight and lives.

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