Nancy Donovan pulled into her wide, one-car garage. She always had bad eyesight – wearing glasses since she was 8 years old – so she paid special attention to the space between her left mirror and the wall because it appeared she was right up against it. She heard a sickening crunch.
She had hit the mirror on the right side.
Nancy's quality of vision had dropped precipitously in just months. She compared it to wearing Vaseline-covered glasses.
"I couldn’t see, couldn’t read, my eyes were so blurry in the morning and it would take until noontime for the fluid to go down so I could finally see," Nancy said.
"I got really scared. One night, I was out because I had to go get my father and it was dark and my vision just went. I don’t know how. Nobody blew the horn at me, but I just dead stopped, and when I could see again, I was in the center turn lane driving down the wrong side of the road."
She saw Dr. Sudeep Pramanik at Mid-Atlantic Cornea Consultants at GBMC in September 2016 who explained cataract surgery alone would be insufficient to bring back her sight. Her Fuchs' dystrophy would cause the cornea to fail after cataract surgery.
According to Dr. Angelique Pillar, Dr. Pramanik's partner at Mid-Atlantic Cornea, Fuchs' dystrophy is "a disease that affects both eyes and gradually leads to decrease in vision over time so that instead of looking through a crystal clear cornea, you're looking through a fog, a haze. Generally, it effects both eyes at the same time so it can be very debilitating for somebody, especially when they're independent like Ms. Donovan and they're doing their own driving and they don’t have a family support network to rely on."
In the past, Nancy's only solution would have been different type of drops, which don't offer optimal clarity and must be administered frequently throughout the day. Some drops even have potential side effects that could cause patients to develop glaucoma.
Luckily for Nancy, GBMC is the first hospital in the region to offer cutting-edge technology for optimal vision.
In November 2016, Nancy got a new kind of corneal transplant on both eyes called DMEK surgery.
"You can't even imagine. I see things now that I haven’t seen in years," Nancy said. "I went to the doctor one day and I was looking at my arm and I said, 'look at my arm' and he said, 'you didn’t know you had spots did you?' Even my friends look different. I can drive now. I don’t drive a lot, but I can. I am still cautious with steps and things, mostly out of habit and my knees. I can see without my glasses.
"It's truly a miracle. I can't believe it."
Essentially, Dr. Pillar removed the diseased inner layer of the cornea, an alternative to traditional corneal transplantation where the entire cornea would be replaced. The recovery time for a traditional cornea transplant would be anywhere from 6 to 12 months, while with DMEK, Dr. Pillar is able to rehabilitate patients in weeks and potentially get them to 20/20 vision in one or two months.
"It's pretty revolutionary because what we're doing is offering somebody a quick solution, a quick way of rehabilitation as opposed to a very long recovery process," Dr. Pillar said. "We're also offering them a quality of vision that's anatomically, the closest approximation of the vision they had when they were young. I think that offers a lot of advantage in getting people back to the vision goals of their youth, and to be able to do what they want to do and see what they want to see."
Alternatives to full cornea transplantation are just one option. For some patients, corneal transplantation can be avoided altogether.
As the first practice in the region to offer cross-linking surgery, Drs. Pramanik, Pillar and Brett Levinson are helping patients with keratoconus to stop the disease process, stabilize vision and, in some cases, avoid further treatment.
"Whenever you think about corneal transplantation, there are benefits of being able to rehabilitate the vision but there's a lot of downsides because of the long recovery time, because of the risk of rejection down the line, and because of the need for drops throughout the rest of their life," Dr. Pillar said. "So to avoid having keratoplasty reduces future visits and provides a good stabilization of the vision that can be enjoyed the rest of somebody's life.
"We're able to stop a disease process, whereas in the past, everything we did for keratoconus was in order to support it. To be able to get at the true root, that's pretty revolutionary."
Revolutionary, and potentially curative. Cross-linking stops the disease process where it is, so if caught early enough, further treatment isn't necessary. For DMEK, as with any organ transplant, there is always a risk of rejection, but it is low for these patients because there is less foreign tissue in the eye.
The GBMC community is at an advantage having these types of procedures right in our own backyard. Nancy belongs to a Fuchs' dystrophy group on Facebook of approximately 1,600 members, some of which have had to travel across the country just to see a doctor that can perform these types of surgeries.
But innovation is only half of the puzzle in how GBMC strives to reach its vision of treating every patient, every time with the care we would want for our loved ones. The other half is compassionate care.
"She has been wonderful," Nancy said of Dr. Pillar. "She explains everything to me. Whenever she sends an email or puts something in my record, she tells me as she's typing it. If I ask her questions, she explains it. I've never had a problem getting an appointment. I felt really comfortable with her. I never felt scared or anything.
"It was well, well worth it."
Groundbreaking Eye Surgery Changing Lives
Greater Living - GBMC HealthCarehttps:/www.gbmc.org/greater-living
December 4, 2017