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James P. McCulley, M.D. Answers Questions On Ophthalmology

James P. McCulley, M.D. Answers Questions On: Ophthalmology

What has driven the advances in corneal transplantation?

This is one of the most exciting areas in ophthalmology today. The development of the surgical microscope and finer suture material has helped tremendously when it comes to working on such a delicate and small area as the eye. These tools have allowed us to modify transplant procedures. We used to perform full-thickness corneal transplants in all corneal transplant operations, meaning we replaced the entire cornea, even the healthy, disease-free layers of tissue. With a technique called lamellar surgery, we preserve the healthy part of the cornea by removing only the diseased layer. Lamellar surgery has given us a better understanding of preventing and treating corneal graft rejection, which increases the chances of success after surgery. Leaving more of the patient’s own healthy corneal tissue intact reduces the likelihood the transplant will be rejected.    

Will there ever come a day when we’ll live in a contact lens- and eyeglass-free society?

It’s possible. For younger patients, we have surgical techniques like LASIK that can correct nearsightedness, farsightedness, and astigmatism by reshaping the cornea. As we age, we might encounter problems with our crystalline lens focusing on objects at near and mid-ranges, such as text in a book or on a computer screen. This is called presbyopia (or “over-40” eyes). A young person’s crystalline lens is flexible, which enables the eye to variably focus on objects at all distances. The development of astigmatic and presbyopic-correcting intraocular lenses (IOLs) means we can replace the aging crystalline lens with one that focuses at near, middle, and far distances. If necessary, we can correct any residual refractive error with laser surgery.    

Why is this an exciting time for ophthalmology?

We’ve made major advances in diagnostic and therapeutic technologies that allow us to safely see and image tissues from the front of the eye to the back at the cellular level. We can perform safe, noninvasive visual biopsies without harming eye tissue.

The fields of molecular biology and molecular genetics have had a tremendous impact on ophthalmology. Understanding the genetic mechanism of eye diseases has led to new and more effective measures in preventive therapy.