Saving a skaters sight

While the Summer Olympics start this month, the athlete you're about to meet is already training for the 2018 Winter Games. An eye disease threatens to keep him from competing.

"I really just like the feeling of flying and spinning and jumping in the air and rotating as fast as you can,” says Adrian Huertas suffering from an eye didease. “I just think it's an amazing feeling and it is so much fun."

Figure Skater Adrian Huertas has his sights set on the 2018 Olympics.

"I would really like to be part of the U.S. team," says Huertas.

But a problem with his vision could ice those dreams.

"About 3 years ago I told my mom my eye was blurry and I just thought it was blurry in one eye but it turned out to be more than that," explains Huertas.

Adrian's eye doctor diagnosed him with keratoconus, a common eye disease affecting one in 2,000 people.

"In keratoconus the cornea becomes misshapen so that the light rays aren't focused," describes Kathryn Colby, MD, PhD, a Cornea Surgeon at Mass. Eye and Ear, and Associate Professor of Ophthalmology at Harvard Medical School.

Sometimes it can lead to blindness. The only option used to be a corneal transplant, but now as part of a clinical trial at Massachusetts Eye & Ear, Adrian tries a new treatment to save his sight called collagen cross linking.

"What this does is strengthen the structural proteins of the cornea," explains Dr. Colby.

Doctors first soak the eye with the B-vitamin Riboflavin. Then they apply UV light. The combination forms the cross links or bonds that strengthen the collagen molecules and stabilize the cornea.

"In Europe it's standard of care for keratoconus," describes Colby.

In a three year trial in Italy, the procedure improved vision in almost 70 percent of patients. Promising stat for Adrian as he eyes Olympic glory in 2018.

"Hopefully I can make it and be good enough to do it," says Huertas.

Collagen Crosslinking still needs FDA approval in the United States. Doctors aren't sure when that will happen.

Keratoconus currently has no approved treatments in the US and accounts for 15 percent of the country's corneal transplants.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY

TOPIC: EYEING THE OLYMPICS: SAVING A SKATER'S SIGHT
REPORT: MB# 3486

BACKGROUND: Keratoconus, also known as KC is a non-inflammatory eye condition in which the normally round dome-shaped corneas become progressively thin, causing a cone-like bulge to develop. This causes distortion and reduced vision. It has been estimated to occur in 1 out of every 2,000 people. Keratoconus is generally first diagnosed in young people at puberty or in their late teens. (Source: http://www.nkcf.org)

WHAT CAUSES KC: The exact cause of keratoconus is unknown. There are many theories based on research and its association with other conditions. However, no one theory explains it all. It is believed that genetics, the environment and the endocrine system all play a role in keratoconus.

SYMPTOMS: In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to light. These symptoms usually first appear in the late teens and early twenties. Keratoconus may progress for 10-20 years and then slow or stabilize. Each eye may be affected differently. Most people who develop Keratoconus start out nearsighted. The nearsightedness tends to become worse over time. (Source: http://www.nkcf.org)
It can usually be diagnosed with slit-lamp examination of the cornea. The most accurate test is called corneal topography, which creates a map of the curve of the cornea. When keratoconus is advanced, the cornea will be thinner at the point of the cone. This can be measured with a painless test called pachymetry. (Source: http://www.ncbi.nlm.nih.gov)

TREATMENT: In the early stages, eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism caused in the early stages of keratoconus. As the disorder progresses and the cornea continues to thin and change shape, rigid gas permeable (RGP) contact lenses are generally prescribed to correct vision more adequately. The contact lenses must be carefully fitted, and frequent checkups and lens changes may be needed to achieve and maintain good vision. (Source: http://www.nkcf.org)

NEW TECHNOLOGY: Because numerous visits to the doctor to constantly have contacts and glasses prescriptions modified can be exhausting and not to mention frustrating, a new surgery is undergoing clinical trials at Massachusetts Eye & Ear. It's called Corneal Collagen Crosslinking (CXL). CXL works by increasing collagen crosslinks which are the natural "anchors" within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular. During the corneal crosslinking treatment, custom-made riboflavin drops saturate the cornea, which is then activated by ultraviolet light. This process increases the amount of collagen cross-linking in the cornea and strengthens it.(Source: http://www.nkcf.org)
Collagen crosslinking is not a cure for keratoconus. The aim of this treatment is to halt progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation. Glasses or contact lenses will still be needed following the cross-linking treatment, although a change in the prescription may be required, but it is hoped that it could limit further deterioration of vision.(Source: http://www.nkcf.org)
While crosslinking is used in virtually every country around the world, it is still in the FDA approval process in the United States. (Source: http://www.allaboutvision.com)

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FOR MORE INFORMATION, PLEASE CONTACT:

Mary Leach
Director, Public Affairs
Mass. Eye and Ear
Mary_Leach@meei.harvard.edu


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