Thursday, February 16, 2006



Yesterday I had a patient that enquired about a relatively new procedure called "Intacs" for keratoconus. Today I see the following article:

"Cutting hair for a worthy cause
Moxie hairdresser sets up fundraisers for a friend in need
By John C. Ensslin, Rocky Mountain News February 13, 2006

Erynn Simone looked across the room at Moxie Hair Co. in Denver, where a few feet away Talie Ayers, one of her childhood friends, was straightening a young woman's jet-black hair.
Simone, 22, could not see Ayers, nor the young woman.
That was why Ayers and six other hair stylists were working on a Sunday when the Capitol Hill hair salon normally would have been closed.
Simone is gradually losing her eyesight to keratoconus, an eye condition in which the normally dome- shaped cornea thins, causing a cone-like bulge of the cornea and blurred vision.
On Friday, Simone is scheduled to undergo a procedure to correct the condition. She will receive Intacs, which according to the National Keratoconus Foundation's Web site, are trademark prescription inserts approved by the Food and Drug Administration in July 2004.
Intacs are micro-thin, semi-circular plastic rings that are inserted into the mid-layer of the cornea, in an attempt to flatten it and improve vision.
The relatively new procedure will cost Simone about $7,000 and it is not approved by her medical insurance. So on Sunday, the hair stylists set to work, hoping to raise as much as they can toward the cost.
"Without the fundraiser, I probably wouldn't have the option of doing it. There's no way I would have the money," said Simone, who teaches environmental education in an after-school program at the Wild Bear Center for Nature Discovery in Nederland.
Ayers, who grew up with Simone in Three Rivers, Mich., had to convince her friend to let the hair salon do the fundraiser.
"I've just known her for so long," Ayers said. "If I could do anything to help her out, I would do it."
Just the facts on keratoconus
• Who gets keratoconus?
Researchers estimate the disease affects one in 2,000 people.
• Symptoms?
Subtle vision changes in early stages to bulging eyes in later stages.
• Are both eyes affected?
Yes, in about 90 percent of keratoconus cases. "

Intacs was first developed as an alternative for low prescription laser eye surgery. This was appealing at the time as it promised to be a reversble procedure if it did not work. From what I can understand it really did not take off as laser proved to be a better option. A few years back Intacs was first used to treat keratoconus with mixed results. The latest peer reviewed paper that has been published is:

Kanellopoulos AJ, Pe LH, Perry HD, Donnenfeld ED.
Modified intracorneal ring segment implantations (INTACS) for the management of moderate to advanced keratoconus: efficacy and complications.Cornea. 2006 Jan;25(1):29-33.

The conclusion was:
"The procedure appears to be effective in improving UCVA and BSCVA of patients with clinical keratoconus. In our small study group, however, there were significant (6/20) postoperative problems with regards to thinning and ring exposure."

Essentially what the take home message is that Intacs can be effective in allowing to get better vision from spectacles, which in itself is a great thing, but approximately 1/3 of the patients had significant complications 3 - 6 months later. I can guarantee that the group of ophthalmologists that have published this study are some of the best in the world.

The young lady in the article above that is having the hair cut fund raiser is hoping that this procedure will rid her of her keratoconus. I hope she has been advised accurately of the success rate of this technique.

We have just started using Intacs in Australia just recently. I am sure it will have a role in the management of keratoconus. At present I can see it helping patients with low levels of keratoconus or patients that cannot be fitted with contact lenses but do not want to have a corneal transplant. Stay tuned and I am sure more information will be coming out soon.

Will INTAC stop the progression of keratoconus or just temporary relief?
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