Margaret Ames, a retired San Francisco public school teacher, has a new outlook on life. One year ago, she underwent an innovative type of corneal transplant called DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty) at UCSF Medical Center. Since the procedure, her vision has dramatically improved.
"My vision has come full circle; it's off the charts," says 64-year-old Ames, who has been wearing glasses since she was 7 years old. "I'm able to see everything so much clearer now, especially colors. I immediately noticed their clarity and am able to differentiate shades now."
Ames is one of the tens of thousands of people who suffer from Fuchs' Dystrophy — a leading cause of vision loss and reason for corneal transplantation. A slowly progressing eye disease, it causes the cornea's endothelial cells to deteriorate. The endothelial cells function as a pump, continuously removing fluids from the cornea to preserve its clarity. As the cells deteriorate, the pump system breaks down, causing corneal clouding, swelling and reduced vision. In advanced cases, such as Ames', the condition greatly impairs a person's vision, requiring corneal transplant.
"Everything was really blurry and I had a hard time driving," says Ames, who used an antique magnifying glass to read and teach, "and in the early morning, dawn or dusk I couldn't see figures clearly."
Ames underwent four previous eye operations, but her vision was still compromised. Desperate for a solution, she visited Dr. David Hwang, director of the Cornea Service and founder of the Eye Bank at UCSF Medical Center.
One of the first surgeons in California to offer DSAEK, Hwang is a recognized leader in corneal transplantation. His research played a key role in developing the latest generation of corneal storage solution. This solution, used by corneal transplant surgeons and eye banks worldwide, boosted corneal viability from 72 hours to more than seven days after donation, which greatly expanded the availability of corneal tissue in the United States and around the world.
The first corneal transplant was performed in 1905, making it one of the first type of transplant surgeries. Now, an estimated 45,000 corneal transplants are performed each year in the United States. A corneal transplant replaces a cornea that has lost its normal transparency or structural integrity.
DSAEK is a more recently developed form of corneal transplantation in which the healthy portion of a patient's cornea is retained while the cornea's diseased or damaged endothelial cell lining is replaced with a new endothelial lining taken from a donated cornea. Ames' cornea was gifted by the families of anonymous donors — one donor in her 50s from Louisiana and the other from Oregon in his 60s.
"The new DSAEK procedure has been the most important advance in corneal transplantation during my 18 years at UCSF as a corneal surgeon," Hwang says. "The results that Ms. Ames obtained with this procedure would have been virtually unheard of prior to this surgical advance."
Because DSAEK allows a person to retain part of their own tissue, it has a number of advantages compared to conventional corneal transplantation, including a reduced rate of rejection, shorter operative time and recovery, better optics and quality of vision and lower risk of side effects. In addition, the procedure can be performed in high-risk patients who have had previous eye surgeries.
After a month of recuperation and rest following DSAEK surgery, which was performed in both of Ames' eyes, she says she was feeling marvelous. Now, she only needs to wear glasses for reading.
Ames often substitute teaches at her former school, Alamo Elementary and Katherine Delmar Burke School for Girls in San Francisco, where she was recently put in charge of planting the garden. "Now it's so much fun to plant flowers because I can see their different colors," says Ames, who has recently brightened her wardrobe with a spectrum of vibrant shades. "It's amazing, but I just have a much more positive outlook on life."
Story written in September 2008
Abby Sinnott is a freelance writer in San Francisco.