News Update
New View of Cornea is Real Eye Opener
By Robert L. Epstein, MD
How clear we see depends on all the structures of our eyes being healthy. Critical to vision is the clarity of the front window, or cornea, of the eye. Now a rapid, no-touch test done in some eye doctors offices provides a very high power look for the doctor and the patient at the critical inside cell lining of the cornea. The view of these cells is positively "eye opening".
The internal corneal cell lining is critical for keeping the cornea clear, but the lining cells slowly die off each year of life without being replaced. With fewer cells in the lining, the cornea becomes thicker and less clear, and in severe cases developing a steamy front surface.
The second most optically important part of the eye is the internal crystalline lens of the eye. With age, the crystalline lens can become cloudy and produces glare, loss of sensation of color, and generally poorer vision. Clouding of the lens is called a cataract and doctors may employ sound wave energy in a brief outpatient procedure to remove the clouded lens and then implant a clear artificial lens to restore vision. Although the cataract removal process is typically quite successful, there is always some irreversible damage to the inside cell lining of the cornea, and that is a worry.
Whether a person should have cataract removal, or not, depends greatly on the degree of visual disability from the cataract. The worse the disability from cataract, the more compelling is the reason for cataract removal.
But another factor is that the denser the cataract is, the more sound wave energy is needed for cataract removal and the more irreversible damage happens to the cell lining of the cornea. Thus, for people whose corneal cell lining is relatively weaker, it may be better to not wait until the lens has become too dense because surgical results may not be as good later due to extra damage to the corneal cell lining. Corneal cell linings are weaker from inherited disorders, from increased age, from past bouts of inflammation inside the eye, prior eye surgery or eye injuries, and importantly from years of contact lens use.
Therefore, if you have been told that you have a cataract, then ask about what is the degree of visual loss from your cataract and also ask what is the cell count on the inner lining of the cornea. Even if you do not have a cataract and you believe you may have a reduced cell count, ask to have the test and record the cell count among your permanent records.
