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Dr. 米勒: Your vision has been changing rapidly over time, could that be a problem with your cornea?
I'm here with Balamurali Ambati, and he's a professor of ophthalmology . And we're going to talk a bit about problems that arise with the cornea, 眼睛面向环境的最前面是哪一部分.
圆锥角膜的早期症状和体征
Dr. Ambati: The cornea is the front window of the eye, and it has layers to it. 虽然它很薄，但也只有0.5毫米厚，有5层. The two most common problems of the cornea are a condition called keratoconus, where the cornea changes from its normal spherical shape into more of a cone-like shape.
Dr. 米勒: 随着时间的推移，它会这样做?
Dr. Ambati: 随着时间的推移，它会这样做. 通常，这种情况发生在青少年晚期，20多岁和30多岁. So it's a condition primarily of young adults who may know or report that the eye has been unstable and changing. Most people, the eye stops growing by age 20 or 21, and the prescription...
Dr. 米勒: 就像骨头一样.
Dr. Ambati: 没错，处方很稳定. 但是如果一个人的散光发生了变化... Astigmatism is when the cornea is shaped more like a football than a perfect sphere. 这可能是圆锥角膜的早期征兆, and patients might report needing to go from soft lenses to soft toric lenses, 或者硬隐形眼镜. They might report increasing near-sightedness and increasing astigmatism over the course of years. 这通常要到晚期才会被诊断出来, and so if you do have an unstable refraction or fluctuating vision over time it would be wise to get a cornea scan with an ophthalmologist.
波动视力vs进行性视力丧失
Dr. 米勒: 两者有什么区别, 正如你提到的, 视力波动和视力逐渐恶化? 你能给它下个定义吗? I know you mentioned that when we talked about keratoconus as a problem.
Dr. Ambati: 在波动的视野中, 尤其是在富克斯营养不良症中, 上午和下午的视觉是不同的. 随着时间的推移，视力逐渐丧失, 人们意识到他们的视力一年前并没有那么差, 或者两年前.
Dr. 米勒: The end result of that would be at some point perhaps the contacts and lenses are no longer effective in changing the vision, 这将是最后的阶段吗?
圆锥角膜的治疗选择
Dr. Ambati: 这是可能发生的. The end stage of keratoconus requires what is called a cornea transplant, to replace the cornea with a donated cornea from someone who's passed away and donated their eye. 幸运的是现在, 在过去的五年里, we've really changed the management of keratoconus to where we can prevent advancement from mild or moderate keratoconus to advanced keratoconus.
就像intacs, which are rings that are placed inside the cornea that provide structural support, they're essentially an under-wire for the cornea to change it from a cone to a sphere. 以及新兴的交联技术, where we use a laser to stiffen the cornea and prevent weakening of the cornea.
Dr. 米勒: 所以在治疗中有不同的选择?
Dr. Ambati: 确实如此.
圆锥角膜的遗传风险和筛查
Dr. 米勒: 这是遗传问题吗?
Dr. Ambati: 这是一个遗传问题，被称为可变外显率. So if you have a first-degree relative with it you're at a higher risk for it.
Dr. 米勒: 有点像青光眼.
Dr. Ambati: 事实上.
Dr. 米勒: And so if someone has a family history of keratoconus should they seek out an ophthalmological examination and a cornea scan?
Dr. Ambati: I think that would be advisable if they have any significant near-sightedness or astigmatism. And certainly, it would be advisable if they are considering LASIK. One of the things that we do at Moran Eye Center is to carefully screen patients coming in for potential LASIK or laser vision correction to make sure they don't have keratoconus or other cornea problems.
Dr. 米勒: 所以为了确保, 如果有圆锥角膜，是否总是需要移植手术, 还是有, 如你所说, 问题发展的不同阶段?
Dr. Ambati: 这绝对是一个进步的过程, and if we can catch it in the mild or moderate stage the goal would be to employ intacs, 或交联, or some of these other options to prevent the need for a cornea transplant.
紫外线辐射和翼状胬肉对角膜的损害
Dr. 米勒: 角膜还有其他问题吗? I notice since the cornea is the forward-facing part to the environment, UV radiation, and sunlight. Does that affect the cornea more so than other parts of the eye such as the lens or retina?
Dr. Ambati: Certainly patients who are exposed to a lot of sunlight and UV light can develop pterygium, 哪个是角膜表面的生长物.
Dr. 米勒: 所以这是紫外线照射的结果?
富克斯的营养不良和角膜移植手术
Dr. Ambati: 事实上. The UV radiation can also damage the back layer of the cornea, which is the endothelium. And those cells are actually what's called post-mitotic, they can't replace themselves. 这就会导致一种叫做富克斯营养不良的疾病, 角膜后部的细胞在哪里慢慢死亡. 这就需要部分角膜移植, 但不是完全的角膜移植, 只是替换角膜的后一层. 这两种情况, 福克斯的营养不良, 和圆锥形角膜, are probably the two most common causes of needing a cornea transplant procedure.
Preventive Ophthalmologic Exams for Family History of Corneal Conditions
Dr. 米勒: 总结一下, would it be advisable if one has a family history of either of these problems to probably seek an ophthalmologic examination sometime in their 20s, 或者如果他们有视力变化或散光?
Dr. Ambati: 是的, if you have fluctuating vision it is advisable to see an ophthalmologist at any time of your life. 如果你有圆锥角膜的家族史, 在你的兄弟中, 姐妹, 或父母, I think it would be advisable to see an ophthalmologist in the early or mid-20s. 如果你有富氏营养不良症的家族史, 这通常出现在四五十岁, 所以这是最好的演讲时间.
Dr. 米勒: Untreated what would be the end result of this if it continues untreated?
Dr. Ambati: Without therapy, you would eventually lose vision, and your eye would become cloudy and scarred. 但一般来说，人们在那之前就来了.
Dr. 米勒: 非常感谢.
Dr. Ambati: 谢谢你！.
更新日期：2024年10月1日
最初发布日期：2015年8月18日