Specific Questions Related to Corneal Disease
One of the objectives of The Royal College of Ophthalmologists is the education of the general public in all matters relating to vision and the health of the human eye. Towards the end of 2004, the College agreed to collaborate with Dr Foster, one of the leading publishers of healthcare information in the UK, on a range of articles. These articles were to be published in The Times 'Body Beautiful' Supplement but in the event, lack of space meant that not all the copy was featured. We believe that the work deserves an audience and we are able to post in full the articles on cataract surgery, glaucoma, laser refractive surgery and corneal disease on the College website. We hope that the readers find the pieces interesting and informative although they are not a substitue for a detailed medical consultation.
How do you decide whether surgery is advisable?
Ask your consultant if surgery is necessary in your case. Various types of corneal disease can sometimes be treated with eye drops or tablets, and specialised contact lenses can be used as an alternative if there is minimal scarring present. The path of light to the retina can be distorted so the picture passed to the brain is not clear. In more severe cases, a corneal graft ("keratoplasty" or transplant) is required, where part of your cornea is removed and replaced with a similar piece from a donor eye. The operation can be combined with other procedures such as cataract surgery if required. Graft surgery is usually done to improve the sight of the eye, but might also be necessary for pain or to repair a weak area. Ask your surgeon to explain what level of vision you might realistically be expected to gain if you do have surgery.
How long will I have to wait for treatment?
According to Dr Foster's hospital data the average wait for all ophthalmic procedures is 96 days, but can be as long as 167 days or as short as 48 days.
How long will it take?
The operation takes about an hour and patients are usually admitted on the day of the operation and discharged the following day. Dr Foster statistics show that the day case rate is almost 21 per cent, and those that remain in hospital stay for an average of 2.3 days - see how your hospital compares.
How many operations have you done?
Some surgeons might have carried out many corneal transplants, whereas others are relatively inexperienced in the procedure. Up to 1700 corneal transplants are carried out in NHS hospital each year and some non-specialist hospital trusts carry out as many as 91 operations a year while some will only do one or two, if any. Find out how experienced your surgeon or hospital is, but with corneal grafts it is often more important that you have access to good aftercare.
Do you specialise in this surgery?
For complex cases, try to see someone that specialises in the surgery you are undergoing. Full details of consultant's special interests can be found by going tohttp://www.drfoster.co.uk/Guides/ConsultantGuide/
Who is the anaesthestist and what is their experience?
Either a local or general anaesthetic can be used, depending on your circumstances. Doctors having operations themselves worry as much about the anaesthetist as the surgeon. If undergoing a general anaesthetic your life is in the anaesthetist's hands even in what is a routine surgical procedure. If possible, it's good to meet the anaesthetist before the operation to check you are indeed fit for general anaesthetic.
Are there intensive care facilities?
If things go wrong with a general anaesthetic, you need access to good intensive care. And the unexpected can happen even in apparently routine surgery, so it is important to know whether there is a facility on site or else how far away the nearest one is.
What are the risks and what is your complication rate?
There is a risk that your body rejects the transplanted cornea, but this does not necessarily lead to failure with prompt and appropriate aftercare. Rejection is most likely within the first year, but could occur at any time after the operation. It is more likely in some corneal diseases than others. Your consultant should highlight the danger signs - such as poor vision, redness or pain - so that the eye can be treated immediately and you should be given an emergency contact number. Other complications are quite common. Blurring because of astigmatism (distortion or exaggerated curvature of the graft surface) is common and about one third of grafted eyes need contact lens correction to achieve optimum vision. More serious complications such as infection, glaucoma and cataracts are less common after the operation but can cause severe problems, so follow-up appointments are very important. Ask your surgeon about complications experienced and their causes. Complications can result in emergency readmission to hospital. The average readmission rate following a corneal transplant is 2.5 per cent, so see how your hospital compares.
When can I return to work and what further treatment is necessary?
You should be able to resume normal activity soon after a corneal graft, but this will also depend on your condition and overall vision. Ask about when you can return to work or do sports, especially swimming. Contact sports are not advisable for someone who has had a corneal transplant. For the first few months your vision will fluctuate as the eye heals and prescriptions for glasses or contact lens might not be given for months. You need to have a clear programme of aftercare - you will be given eye drops for six months (possibly indefinitely) and you'll need regular visits to your hospital in the first year or two. Stitches will usually be left in place for one to two years, possibly longer. Stitches can be removed easily in the clinic and are taken out if they are causing astigmatism, or have broken or loosened.