The little hole is only 360 microns (.36 mm) in diameter but it makes a world of difference for safety and visual quality. The little hole is the small central port placed in the middle of an ICL (Implantable Collamer Lens) from STAAR Surgical. This lens implant is called the EVO. The small hole eliminates the need to make an opening in the colored part of the eye (the iris). During implantation of the original ICL, an opening in the colored part of the eye (known as an iridotomy/iridectomy) was needed to prevent a type of glaucoma. Creating the opening during surgery in the iris could cause initial bleeding in some cases and, for some patients, could lead to visual distortions from the light passing through that opening. With the EVO lens, this is no longer the case. Over 1 million EVO lenses have been implanted outside the US prior to the recent FDA approval of the EVO lens in the US. An added feature is that it appears to be more physiologic having the fluid that is made behind the iris come through this middle hole instead of one made in the peripheral part of the iris. This appears safer for both the cornea (the window of the eye) and the natural crystalline lens. The development of cataracts is less likely to occur earlier than normal in eyes with EVO lenses based on what doctors tell me from outside the US. We are excited to be one of the first practices offering the EVO Visian ICL in the US. The EVO is easily removed later in life when cataracts naturally occur, and the EVO does not make changes to the corneal surface or increase the risk of dry eye symptoms. It is a great breakthrough.
THIS LITTLE HOLE by Dr. Francis Price
Why is this little hole such a big deal?
THE LATEST NEWS FROM PRICE VISION GROUP
Indianapolis, IN – March 10, 2021 – Price Vision Group announced today that it is the first site to initiate patient treatment in a clinical trial evaluating use an experimental drug treatment in conjunction with a surgical procedure that treats the back surface of the cornea to restore vision in patients with a condition called Fuchs Endothelial Corneal Dystrophy (FECD). More than four percent of the population over the age of 40 is at risk of developing FECD and this disease is the leading cause of corneal transplantation in the U.S.
FECD results from the loss of specific cells (endothelial cells) that line the back of the cornea, over time this leads to cloudy vision and potentially blindness. The clinical trial is being conducted in FECD patients who are already planning to undergo a surgical procedure, referred to as DSO (Descemet Stripping Only) or DWEK (Descemetorhexis without Endothelial Keratoplasty). This procedure removes diseased cells and the collagen bumps (guttae) they produce from a central area of the cornea. Normal cells then repopulate the area over time to improve vision. The clinical trial will evaluate whether administering an experimental drug, TTHX1114 (an engineered form of a natural protein called FGF-1) can accelerate and enhance the visual recovery process. Patients participating in the clinical trial will have the option to receive TTHX1114 in addition to DSO surgery or to receive DSO surgery alone.
“The Price Vision Group strives to provide state of the art care to our patients,” said Dr. Francis Price, founder of the practice. “DSO is an innovative new procedure that provides an alternative to corneal transplantation. As a provider of the DSO procedure, we are excited to participate as one of the sites in the U.S. in this clinical trial of TTHX1114.”
About FECD and corneal endothelial disorders
Corneal endothelial cells line the interior of the cornea and are critical to maintaining its appropriate hydration state, which enables the cornea to function properly. FECD, the most common corneal endothelial disorder, is the leading cause of corneal transplantation/graft in the U.S.
The hallmark of FECD is excessive loss of endothelial cells and the formation of collagen bumps (guttae), resulting in diminished vision and, in severe cases, blindness. Loss of these cells is also a contributor to poor outcomes in eye surgery, including cataract surgery.
Although transplant surgery with human donor corneas has been shown to be effective in restoring vision for many FECD patients, most patients require long‑term immune suppression therapy which can have unintended side effects. DSO, which has been developed as an alternative to corneal transplants, does not require donor tissue and therefore eliminates the need for immune suppressive drugs.
About TTHX1114
TTHX1114 is an engineered form of the naturally occurring molecule Fibroblast Growth Factor-1 (FGF-1), which stimulates cell proliferation and migration as well as protects cells from stress and injury. TTHX1114 has been engineered to increase FGF-1’s longevity in the eye, enabling its use as a pharmaceutical. The study is sponsored by San Diego-based Trefoil Therapeutics, a private biotechnology company developing therapeutics for corneal diseases.
About Price Vision Group
Price Vision Group is a d/b/a of Corneal Consultants of Indiana, P.C., an internationally recognized center for the diagnosis, treatment, and care in the field of corneal and refractive surgery. We, along with our research partner, Cornea Research Foundation of America, have conducted more than 160 studies including those that led to the FDA approval of LASIK.
For more than 30 years, The Price Vision Group has utilized the latest technology while conducting ground-breaking research to provide cutting-edge services to patients from all over the world.
In addition to training over 600 doctors from around the world, Price Vision Group surgeons have performed more cornea transplants than any other practice in North America. As some of the world’s foremost experts in corneal care, Price Vision Group are sent some of the most challenging surgical cases based on their expertise and experience with complex corneal procedures.
Contacts:
Patients
Marianne Price, Ph.D.
Executive Director
Cornea Research Foundation of America
317-814-2990
mprice@cornea.org
Media
Robert Gottlieb
RMG Associates, LLC
857-891-9091
robertmg52@gmail.com
Price Vision Group is currently enrolling participants for a LASIK clinical study. If you are nearsighted and need glasses/contacts to see clearly, you may qualify for this study. Qualified study participants will be compensated for their time.
There is no cost to the patient but the clinical study will require participants to attend several postoperative follow-up visits.
If interested, please complete and submit the following form.
Enrollment for the LASIK study has been placed on hold for the time being due to participant slots being full. We will update this post if additional slots become available.
People suffering from dry eye can experience a few or many of the following symptoms: It may be surprising but another common symptom of having dry eyes is the constant watering of your eyes. Your body’s natural response to low tear production or low-quality tears is to increase tear production.
We have several ways to identify the root cause of your dry eye. We will first have you fill out a questionnaire to understand the symptoms you are experiencing as well as the steps you’ve taken to treat the symptoms. We will perform a corneal topography scan to study the surface of your eye. This technology gives us a sense of the overall smoothness of the ocular surface by reflecting light off the cornea and back into a camera. A special infrared imaging device may be used to view how well your meibomian glands are functioning. Studies have shown that 70-80% of patients suffering from dry eye symptoms have “evaporative tear loss.” The meibomian glands are responsible for producing the oil layer of the tear film to prevent the tears from evaporating too quickly. Blocked glands will produce tears that have inadequate amounts of oil which leads to quickly evaporating tears. Meibomian gland dysfunction (MGD) is one of the most common causes of dry eye. Depending on our findings, your dry eye condition will be placed into one of three categories of severity.
If you’re in Category 1, we will typically recommend a warm compress placed over the eyes twice a day to help clear up the blockage in the meibomian glands. We might also prescribe artificial tears to help provide lubrication for the eyes.
If you’re in Category 2, your dry eye might be caused by inflammation. In this case, we would recommend prescription medication eye drops such as Xiidra, Restasis or Cequa. These drops work to break the inflammatory cycle by influencing the immune system.
If the diagnosis for your dry eye is evaporative tear loss, we might recommend Intense Pulsed Light (IPL) therapy to treat the obstructed meibomian glands. This technology uses quick bursts of light to change blood vessels near the surface of the skin around the eyes. IPL therapy has been shown to reduce the blockage and helps the eyes produce a better quality tear film.
If you’re in Category 3, aggressive management is required as the integrity of the eye itself is at risk. An amniotic membrane may be placed on the eye as it is packed with anti-inflammatory, anti-scarring, and pro-growth to jump-start the healing process. We may prescribe serum tears which are specialty tears developed from the patient’s blood. The patient reports to a lab, has their blood processed and then mixed with the typical components of artificial tears. Interestingly, our blood is enriched with many anti-inflammatory growth factors that help restore the normal functioning of the ocular surface.
I think I have dry eye, what are my treatment options?
At Price Vision Group, we have a comprehensive list of treatment options for dry eye (ocular surface disorder) depending on the level of severity. The first step is to identify the symptoms of dry eye.What are the symptoms of dry eye?
I have several of the symptoms described, what’s the cause of my dry eye?
An analysis will be performed to assess the stability of your tear film. During this test, a dark orange dye called fluorescein is placed onto the surface of your eye. Your doctor will view your eye using a special light to monitor how quickly your tears evaporate.
Category 1
Category 2
Category 3
Trefoil Therapeutics Begins First Clinical Trial at Price Vision Group for Patients with Corneal Endothelial Dystrophies
SAN DIEGO–(BUSINESS WIRE)–Trefoil Therapeutics today announced it has initiated the first clinical trial of its engineered Fibroblast Growth Factor-1 TTHX1114 for the treatment of people with corneal endothelial dystrophies (CED), including Fuchs Endothelial Corneal Dystrophy. To read the full press release, please click here.
Indianapolis, Indiana – Back in May, Price Vision Group started a promotion to thank the hardworking essential heroes by giving four lucky winners free LASIK eye surgery. Hospital worker, Carolyn Rogers was the first contest winner to undergo the procedure on Tuesday.
“The idea came up during a staff meeting for the refractive department. We were talking about a time when a staff member went grocery shopping and noticed that the cashier had her mask on but her nose was exposed. When it was pointed out that she was wearing her mask incorrectly, the cashier complained that her glasses kept getting fogged up when her mask covered both her mouth and nose,” said Brian Hogan, Practice Administrator for Price Vision Group. “These grocery store employees along with hospital workers, first responders, and other essential workers are out there every day putting their health on the line to keep our community safe and stocked with supplies. We wanted to do something to thank them and help make their lives a little bit easier and safer,” he added.
The promotion started with a nomination process where anyone can submit their story to nominate a frontline hero to get free LASIK. “We were in tears reading all of the stories about the sacrifices these heroes make day-in and day-out. It was definitely a tough decision to narrow down the list to a select few finalists,” said Erin Simpson, Refractive Coordinator for Price Vision Group.
Twenty four finalists were chosen among the hundreds of submissions. “Once we determined our finalists, we then had to call them in for a screening to determine their candidacy for LASIK,” said Refractive Consultant, Rochelle Vega. When all finalists were confirmed to be good candidates for LASIK, the voting process commenced on the Price Vision Group website. Throughout the month of June, visitors to Price Vision Group’s website were able to read the stories of all of the finalists and cast their votes for their favorite frontline hero. Over 24,000 votes were cast and four winners were selected to receive free CONTOURA Vision LASIK.
“CONTOURA Vision is topography-guided LASIK and is the latest in LASIK technology. It scans up to 22,000 reference points on the cornea and uses that data to offer a truly personalized LASIK treatment,” said Dr. Francis Price, owner of Price Vision Group. “We’re proud to be the first in Indiana and one of the first in the country to offer this new technology. Our patients have been extremely happy with the results; roughly 80% of them are seeing better than 20/20, like 20/16, 20/12.5 or even 20/10,” added Dr. Price.
Carolyn Rogers is the Operational Lead in the Emergency Department at Parkview Hospital Randallia in Fort Wayne, Indiana. Her role is both in management and also at the bedside. “Staying on top of the countless meetings and emails to ensure the department was up to date with the current information passing down from Incident Command. I would assist my staff with the care of the patients coming in – going from room to room, helping in any way possible,” said Carolyn when asked about her responsibilities. “Wearing glasses or contacts during this pandemic definitely has its challenges. Wearing glasses presents its own difficulties with wearing a mask as your glasses constantly get fogged up. With contacts, making sure my hands are EXTRA clean and disinfected before inserting or removing my contacts every day,” she said.
“I am also incredibly honored and grateful that I was chosen as a finalist. I know there were many others that had been submitted, that are just as deserving to be considered as I am. I want to thank each and every single essential worker out there – both healthcare and non-healthcare. We are all in this together,” said Carolyn Rogers.
After her LASIK surgery, Carolyn’s first reaction was, “I can see the clock!”
After her one-day post-op appointment, Carolyn was already seeing 20/16. Her vision will continue to improve over the next few months but she’s already excited with the results.
https://www.facebook.com/
Kyle Davis, a firefighter with the Indianapolis Fire Department recently had his CONTOURA Vision LASIK eye surgery. Kyle was a finalist for the contest but was not a winner. Non-winning finalists were offered a 50% discount on their LASIK eye surgery and Kyle was quick to schedule his appointment. Kyle recently came in for his one-week post-op appointment and was seeing 20/12.5. He was able to read three letters on the 20/10 line. “This is amazing! When I woke up from my nap, I immediately texted my coworker Nick (another contest winner), to let him know how happy he will be,” said Kyle Davis.
“We were so overwhelmed with the response of this promotion that we wanted to do more,” said Price Vision Group’s Marketing Coordinator, Sam Ven. “We want as many people as possible to enjoy the safety benefits of LASIK. We want to make it more affordable for everyone,” added Sam.
For a limited time, Price Vision Group is making its premium LASIK more affordable for everyone by taking $1,000 off. More information can be found here.
In the following video, Dr. Price gives an update on Price Vision Group and outlines the steps we’re taking to keep our patients and staff safe while maintaining the care of our patients.
Some highlights of the message:
- Non-emergency surgeries will be postponed
- Follow-up appointments will be kept if the doctor determines that the patient needs to be seen
- Non-emergency appointments will be rescheduled (we will be calling patients to reschedule)
- We are working on a telemedicine option. Please click here for more information. The page will be updated with information when it becomes available.
Join the EVO USA Study
Break free from Glasses & Contact Lenses
Ready to Experience Visual Freedom?
If you suffer from nearsightedness or astigmatism, EVO may improve your distance vision without glasses or contact lenses. Your eyeglass prescription can usually tell you how much nearsightedness and/or astigmatism you have. Consult with your eye doctor, who will conduct a thorough examination to find out whether you’re a candidate for the EVO USA Study and the EVO procedure.
It’s time to experience the EVO difference
The EVO procedure is designed to improve sight by treating a wide range of eyeglass or contact lens prescriptions. Made from Collamer®, a unique implantable material, the replaceable lens works naturally with your eye to improve vision-without changing your cornea. As a result, over 1 million lenses have been implanted outside of the US and 99.4% of patients would do the procedure again.
How EVO Works
The EVO biocompatible lens is placed behind your iris (colored part of your eye) and in front of the natural lens. The EVO lens focuses light on the back surface of your eye to improve your vision. Unlike other procedures, the EVO procedure does not remove corneal tissue, but is additive, and works in harmony with your natural eye.
Join the EVO USA Study
To learn more about this study, and to see if you qualify, please call (317) 814-2820 and ask to speak with Sam Ven. If you are eligible and participate in this research study, you will be asked to return for examinations to evaluate your vision.
Sam Ven
(317) 814-2820
Price Vision Group
9002 N. Meridian Street
Suite 106
Indianapolis, IN 46260
Price Vision Group Celebrates 25 Years of LASIK, the first in the state of Indiana.
January 2020 marks the 25-year anniversary of Price Vision Group providing LASIK eye surgery. We continue to see happy patients from those early years when Dr. Price performed LASIK as part of an investigational study.
From the start, we were able to correct both nearsightedness and astigmatism. Over time we have continued to refine vision correction options and now provide the most cutting-edge, vision-optimizing treatments available in the U.S.
We began offering refractive surgery in 1983, 37 years ago! We began using a laser to correct vision in 1991. We initially offered surface ablation and in 1995 we began offering LASIK.
Technological advances in the past 25 years have further improved the safety and accuracy of LASIK. We can now perform topography directed treatments, Contoura™ Vision LASIK, in which we plot 22,000 points on the cornea to generate a topographic map. This allows us to smooth out small imperfections on the corneal surface that cannot be corrected with glasses.
In the clinical trials that led to FDA approval of topography directed treatments, 30% of the patients could see better postoperatively without any correction than they could see preoperatively using glasses.1 Our patients are achieving these same amazing results. In fact, most of our patients achieve better than 20/20 vision.
A vision of 20/20 means that your vision is normal, but surprisingly only 35% of all adults have 20/20 vision without some type of correction, such as glasses. If you have 20/20 vision, you can see at 20 feet what most people see at the same distance. If you are 20/16, you can see at 20 feet what a person with normal vision would need to move up to 16 feet to see, and if you are 20/12, you can see at 20 feet what others would need to move up to 12 feet to see. These are fantastic, life-changing results!
At Price Vision Group, we are proud to be at the forefront in researching the newest in laser vision correction technology. We will soon be investigating whether we can further improve upon LASIK technology with even more sophisticated imaging and analysis. Both the topography-directed treatment and the next-generation treatment rely more on objective imaging of the eye rather than relying so heavily on the subjective assessment of “which is better, 1 or 2”, for greater precision.
As we look back with pride at all that we have accomplished in 25 years, we are also excited about the new technologies we are and will be investigating to provide our patients with the best possible visual outcomes in the safest and most effective ways.
This is an update to a post published on 9/25/17. You can find the original post here.
Descemet’s Stripping Only…a substitute for DMEK?
By Francis W. Price, Jr., MD & Matthew T. Feng, MD
We are always looking for better ways to correct the visual difficulties of patients with Fuchs’ dystrophy. In fact, that is why we helped pioneer the evolution of corneal transplants from full-thickness grafts (penetrating keratoplasty) to PLK/DLEK to DSEK to DMEK. Interest is building now to eliminate the transplant altogether and allow a person’s own endothelial cells to redistribute in a procedure called Descemet’s Stripping Only.
The corneal endothelium is a single layer of cells that lines the back surface of the cornea. These cells pump water out of the cornea to keep it crystal clear. In Fuchs’ dystrophy, these cells become unhealthy and die off, starting in the center and moving toward the periphery over time. This allows fluid to build up in the cornea causing swelling and hazy vision. Eventually, blisters can develop; this can be painful and cause light sensitivity.
The corneal endothelial cells are attached to a thin membrane called Descemet’s membrane. In Fuchs’ dystrophy, abnormal deposits called “guttae” accumulate on Descemet’s membrane. These guttae are like water drops on a windshield (guttae mean raindrops in Latin). They distort the light coming into the cornea and also cause glare and halos and must be removed to improve vision.
DMEK is a tried and true treatment for Fuchs’ dystrophy in which we remove the central corneal endothelium and Descemet’s membrane and implant healthy donor tissue, which has normal endothelial cells and a clear Descemet’s membrane without guttae. It provides rapid and reliable visual recovery within 2 days to one month after surgery with minimal risk of immunologic graft rejection (<1% with appropriate use of eye drops).[reference] With DMEK, the risk of developing glaucoma is reduced because of the improved corticosteroid eye drop dosing regimens we have developed, and long term graft survival is excellent.
In contrast, we and others have tried Descemet’s Stripping Only (DSO) which is performed in the same manner as with DMEK, except a smaller area of the central area of Descemet’s Membrane is removed and no donor endothelium is transplanted. We then wait to see if the surrounding endothelial cells migrate from the periphery to recover the central area. There are two benefits of DSO that excited us. First, there would be no risk of immunologic graft rejection (0% rejection rate) since we are not using a donor cornea so there is no immune response to foreign tissue. Second, the need to use long term topical corticosteroids to prevent graft rejection would be eliminated thereby reducing the side effect of intraocular pressure elevation that can affect up to one-third of transplant recipients.
In a prior analysis of DSO, we removed a 6-mm diameter area of the diseased Descemet’s membrane but we found that recovery was incomplete—the endothelial cells never fully filled in the area of cells that we removed, even after waiting for months.
We, along with other surgeons, are now removing smaller areas of Descemet’s membrane (4 to 5 mm diameter area) and have a higher rate of clearing. Despite these successes, DSO is not yet a replacement for DMEK for two primary reasons: clearing a smaller area may not always be sufficient to provide the best possible vision, and there is still the potential for prolonged corneal swelling that may last for months hindering visual recovery. By way of comparison, we typically remove unhealthy Descemet’s membrane and endothelium from a much larger area (over twice as big) when performing DSEK or DMEK. However, DSO may be a suitable first-line surgical treatment option prior to DMEK, for those willing to see if stripping alone will satisfactorily resolve their vision problems. If after a few months their cornea is not clear, they would then be a candidate for DMEK.
We have been told that patients are happy with the vision they get using a 4-mm area of treatment. But we wonder if they just notice some visual improvement with the central guttae removed without realizing how much better it could be if a wider area was treated. We know from laser refractive surgery (LASIK or PRK) that a small treatment zone causes patients to have significant glare and halos at night. We also know that the intraocular lenses used in cataract surgery do not perform well when the clear optical zone is only a 4-mm diameter. Typically, clear zones of 6-mm diameter or more are needed to avoid glare and halos.
Many of our Fuchs’ dystrophy patients tell us they only need one eye treated because their other eye is doing fine. But after DMEK, they realize the “good” eye was not as good as they thought, and then they want to have the second treated as soon as possible to eliminate glare and haze. Similarly, in the wintertime when it snows, you can drive your car after just clearing a small area of the windshield, but obviously, it is much better to clear a larger area to view the periphery. Since guttae generally begin forming in the central portion of the cornea, DSO may be a better option for patients earlier in their Fuchs’ dystrophy onset rather than more advanced cases. Your surgeon will determine in you may be a candidate for DSO, or whether DMEK is more fitting. This is an example of when it’s best to seek evaluation as soon as you observe changes in your vision, as you may have more treatment options at that time.
The second concern with DSO is slow healing. Often with stripping alone, it takes several weeks to months for the cornea to clear. In some cases it takes over 6 months. There is evidence that when the cornea is continuously edematous (swollen) from non-functioning endothelium for 6 months or longer, permanent changes occur so that when the edema does resolve, the vision does not return to a level as good as it would have been if the cornea had cleared faster. Two centers found that if they waited over 6 months to replace a failed transplant, the visual results were disappointing.4,5 In contrast, we find that when we replace a failed transplant promptly, the visual results are excellent.6 The longer a cornea remains edematous, the more likely it is that vision will permanently deteriorate.
In summary, we look forward to continuing research to assure the cornea will reliably clear within a month or sooner with DSO and are actively conducting studies to optimize this treatment option for Fuchs’ dystrophy patients. Two small studies found that the use of a “Rock Inhibitor” eye drop available outside the USA seemed to help the cornea clear faster and more reliably by helping the cells migrate and possibly regenerate.7 If you would like to learn more about DSO and determine if you are a candidate for a study, please call (317) 814-2996. Patients who have already had stripping alone and are dissatisfied with their vision or speed of recovery often remain candidates for DMEK and may benefit from evaluation sooner rather than later.
Looking ahead, cell culture techniques are improving, and someday we may be able to harvest your blood cells and reprogram them to become corneal endothelial cells. But until we can either do that or use medications to get your peripheral corneal endothelial cells to reliably heal the central cornea in less than a month, we will continue to recommend DMEK as the optimal treatment option for most patients with Fuchs’ dystrophy who are not able to face a potentially long recovery with DSO.
We certainly live in an exciting time with new developments occurring continually around the world. So stay tuned!
References:
- Bleyen et al. Spontaneous corneal clearing after Descemet’s stripping. Ophthalmology 2013l120:215.
- Arbelaez et al. Long-term follow-up and complications of stripping descemet membrane without placement of graft in eyes with Fuchs endothelial dystrophy. Cornea 2014 33:1295-1299 (our study)
- Koenig SB. Planned Descemetorhexis Without Endothelial Keratoplasty in Eyes With Fuchs Corneal Endothelial Dystrophy. Cornea 2015;34:1149-51.
- Baydoun et al. Repeat Descemet membrane endothelial keratoplasty after complicated primary Descemet membrane endothelial keratoplasty. Ophthalmology 2015; 122:8-16.
- Cirkovic et al. Clinical and ultrastructural characteristics of graft failure in DMEK: 1-year results after repeat DMEK. Cornea 2015; 34:11-7
- Price et al. Repeat Descemet Membrane Endothelial Keratoplasty: Secondary Grafts with Early Intervention Are Comparable with Fellow-Eye Primary Grafts. Ophthalmology 2015;122:1639-44.
- Moloney et al. Descemetorhexis Without Grafting for Fuchs Endothelial Dystrophy-Supplementation With Topical Ripasudil. Cornea 2017;36:642-648.
