Professor David Gartry offers specialist tailored treatments for a number of medical conditions affecting the cornea. Over the years, David has conducted extensive research of corneal surgical techniques and therapies and published a number of books and peer-reviewed articles. His work has helped to advance the development of techniques that are used in the present day. For example, he authored the first-ever series of articles that detailed the use of ‘excimer laser’ in the treatment of corneal surface conditions.
A condition affecting the cornea should be thoroughly assessed to enable treatment to be administered for more serious conditions and provide the best chance of maintaining vision. During your appointment, you will undergo a comprehensive assessment of your vision and eye health. This will include advanced technology scanning as well as observation of your corneal integrity and shape using a specialised microscope called a ‘slit lamp. A yellow dye called ‘fluorescein’ may be used under the blue light of the instrument to observe weakened or damaged corneal cells and evaluate the quality and volume of your natural tears. On occasion, anaesthetic drops may be required to aid our examinations by temporarily numbing the eye, and alleviating discomfort or excessive tearing.
David offers specialist tailored treatments for a number of conditions that affect the cornea.
Phototherapeutic keratectomy (PTK) is a minimally invasive laser surgical treatment that can help to delay or prevent the need for more advanced transplant surgery. It is aimed to manage conditions affecting the outer surface (epithelium) of the cornea, such as corneal scars, injuries and inherited conditions by:
The procedure is similar to a type of laser vision correction surgery called LASEK (Laser-Assisted Sub-Epithelial Keratectomy), but rather than reshaping the cornea to correct vision, it is used to treat surface level disease. During PTK, the top layer of corneal ‘epithelial’ cells is removed using an alcohol solution. An excimer laser is then applied with UV light to vaporise and remove microscopically-thin layers of affected tissue, providing a smoother corneal surface than would be achieved using a traditional surgical blade or diamond burr. This provides a better quality base layer to which new cells can adhere more effectively, promoting more complete healing across the eye surface. The procedure is performed under local anaesthesia with recovery within a matter of days. The success rate in improving corneal repair is in excess of 80% for all conditions, and above 90% in Recurrent Corneal Erosion (RCE).
To restore vision, relieve long-term discomfort or improve how the eye looks when non-surgical interventions are no longer effective. David performs various simple and complex surgical procedures of the cornea such as corneal transplant or graft.
A corneal transplant (also known as a graft) is a highly specialised operation in which the damaged cornea is removed and replaced with healthy donor tissue. The procedure is usually performed to improve sight and relieve pain where the cornea is permanently clouded by disease or injury. Conditions that more frequently require corneal transplant surgery include severe eye trauma and age-related degenerative conditions such as Fuchs dystrophy.
Depending on the extent of damage to the cornea, the graft can be ‘full thickness’ in which the entire cornea is replaced with donor tissue, or ‘partial thickness’ where only the diseased tissue is replaced. During the ‘full thickness’ procedure, an 8mm circular section of the cornea is removed and replaced by a donor cornea. It is secured in position by micro-stitches that are virtually invisible to the naked eye. Each procedure can take approximately an hour to perform and can be carried out under general or local anesthesia. Thereafter, a section of unhealthy cornea is sent for microbiological analysis to help provide the best, tailored aftercare for your eyes.
David has extensive experience in performing complex corneal transplants both within the NHS and in private clinics, and is world-renowned for his micro-surgical skills and post-operative patient care to reduce chances of donor tissue being rejected by your immune system.
– Antimicrobial preparations to treat and prevent eye infections (frequently in the form of eye drops with additional oral preparations where necessary)
– Artificial lubricant eye drops and ointments to relieve discomfort/ dry eye and aid healing of the eye surface
– Anti-inflammatory preparations to reduce swelling and scarring (frequently in the form of eye drops with additional oral preparations where necessary)
– Salty eye drops (5% Sodium Chloride) and/ or ointments to reduce corneal swelling
Bandage contact lens
A contact lens (usually soft) that forms a protective barrier between the outer corneal surface and inner eyelid, aiding healing and improving comfort. Unlike standard contact lenses, it does not usually have the ability to bend light and correct vision and is worn continuously to provide protection overnight.
The cornea is the clear, dome-shaped window at the front of your eye. Its primary function is to bend light and help it focus on the back of the eye. In fact, it accounts for approximately ⅔ of the focusing power of the eye, while also providing a barrier against germs and particles that can harm the eye.
The cornea is a unique structure because it is as clear as glass. Unlike most of the tissues in the human body, it does not contain blood vessels. It is made up of six layers, with each playing a specific role in maintaining health and clarity. The thickest middle layer (stroma) contains collagen, an important protein that can be found in your skin, bones, ligaments and the white protective coat (sclera) of your eyes. The transparency of the cornea is due to the precise and even spacing of collagen fibres into sheets, and the positioning of sheets at slightly different angles to one another.
A disease of the cornea can cause a breakdown of this complex collagen network, leading to a loss in transparency such as clouding or scarring. This can prevent light from reaching the light-sensitive layer at the back of your eye (retina), or distort its path causing blurred or cloudy vision.
The term ‘corneal disease’ is used to describe a range of conditions affecting the cornea including injuries, infections, allergies, and inherited disorders. Here we expand on five common conditions that are routinely managed by David Gartry:
Keratoconus (derived from the Greek term for ‘cone-shaped cornea’) – a condition that usually affects both eyes in which the cornea weakens, thins and develops a cone-like outward bulge. It is caused by a fault in collagen production, a protein that provides the building blocks of the cornea. It is part of a larger group (>20) of ‘degenerations and dystrophies’ that change the transparency of the cornea through structural faults and the buildup of cloudy material. They require individual and tailored treatment as they affect vision and comfort in very different ways.
Who is affected? It is estimated that Keratoconus affects between 1 in 500 and 1 in 2000 individuals. The condition is usually diagnosed in teenagers and young adults. There can be a family history of the condition. It also presents more frequently in people of Asian and Mediterranean origin, and those with allergies like asthma or eczema.
What are the symptoms? Most people with Keratoconus experience blurred or distorted vision. The changing shape of the cornea as it weakens, thins and bulges outwards, causes it to resemble more of a rugby ball or back of a spoon than a round football. As light passes through, some parts bend more than others splitting the focus into two separate points at the back of the eye. This is termed ‘astigmatism’, and is a type of refractive error that also occurs commonly in healthy eyes. However, eyes affected by Keratoconus have a higher level and complexity of astigmatism, which usually occurs in combination with ‘shortsightedness’ causing a more severe reduction in vision.
How can it be treated? There is no cure for the condition, but there are ways to improve vision by correcting the astigmatism and short-sightedness. Spectacles or readily available ‘soft’ contact lenses are prescribed in early stages. As the condition progresses, specially-made ‘hard’ contact lenses may be required to better correct the abnormal shape of the cornea and improve the quality and stability of vision. Some people with stable Keratoconus can benefit from a relatively new treatment called ‘Corneal Crosslinking’, in which a type of UV light is used with vitamin B2 (riboflavin) eye drops to strengthen the cornea and slow down the disease process. In most cases, the change in corneal shape naturally slows after a few years without major impact on vision. However, David may need to perform corneal transplant or ‘graft’ surgery in advanced cases where the central cornea becomes swollen and scarred, or when a person is unable to tolerate contact lenses. This operation is successful in improving vision quality in the vast majority of cases, usually in combination with spectacles or contact lenses worn after surgery.
Abrasion (scratch) or injury of the cornea that affects surface layers usually heals within 24-48 hours, as new cells migrate to fill and smooth the affected area. In some cases, these cells are unable to attach properly to underlying corneal layers preventing the wound from healing completely. The area of weakened cells form a blister which can wear or peel away spontaneously as it rubs against the inner eyelid, often repeatedly for months or years after the initial injury. This is better known as Recurrent Corneal Erosion (RCE).
Who is affected? Eye trauma accounts for approximately 3% of all emergency department visits. Of these, the vast majority are caused by foreign bodies and corneal abrasions (usually by objects like fingernails and branches). They can affect anyone but tend to occur more frequently in people of working age who are at greater risk of injury during the course of their day. RCE is estimated to occur in 1 in 150 cases of corneal abrasion but it can also happen in the absence of trauma, for example following corneal surgery, or when a person has a degenerative or inherited condition such as Basement Membrane Dystrophy (a condition that affects the outer layer of the cornea, in which abnormal development of the membrane beneath prevents it adhering properly).
What are the symptoms? The cornea has the most densely packed nerve endings of any other part of your body. This means that even a minor, surface abrasion or RCE can cause significant pain and tearing, often with increased sensitivity to light and temporary reduction in vision depending on the area affected. RCE episodes typically happen when the eye surface dries during the night or on waking in the morning. The pain tends to lessen over the next 24 to 72 hours as the cells gradually heal.
How can it be treated? The cornea has a remarkable ability to repair itself. This means that most minor abrasions when treated in a timely and appropriate manner, heal within 24 to 72 hours without developing infection or RCE:
Management of RCE is focussed on prevention through the long-term use of lubricating eye drops and ointments. Where conventional management fails to prevent recurring episodes or in eyes at risk of permanent vision loss and scarring, David will recommend alternative therapies such as:
Advanced cases of trauma that can affect the cornea, iris (coloured part of the eye) and even the crystalline lens may require more complex surgical intervention and reconstruction by David.
Dry eye is a common condition affecting 1 in 4 people in the UK in which your natural tears are unable to cover the eye surface adequately, causing it to dry and sometimes become inflamed. Most people who work in an air-conditioned office and spend long hours staring at a computer screen will have experienced ‘dry eye’ at some stage.
Who is affected? Dry eye affects people of any age, but the chances of developing the condition are higher among older people, women experiencing hormone changes and those who use certain medications. The condition can also occur after certain types of laser surgery, but it is usually self-limiting as damaged nerves regenerate over the coming weeks to months.
What are the symptoms? Symptoms can range from mild redness and irritation to grittiness, burning and foreign-body sensation (a phantom sensation of ‘something in the eye’). Some people also report watery eyes known as ‘reflex tearing’, where our eyes overproduce tears in an attempt to alleviate dryness. In some cases, vision can be temporarily affected as the drying tear layer creates the illusion of looking through a frosted window in between eye blinks.
How can it be treated? David and our specialist optometrists will advise you on simple steps you can take to prevent or reduce the effects of dry eye, from treatment of glands along your eyelids to making changes to your diet (e.g. increasing Omega 3 levels to improve tear quality) and room environment. They will also recommend individual or combination artificial tear drops, gels, and ointments to alleviate your symptoms. For more advanced cases, David will formulate a tailored plan that can include additional therapies to improve your tear quality and volume.
Fuchs Dystrophy is a common age-related cause of cloudy cornea that is part of a larger group (>20) of ‘degenerations and dystrophies’ that lead to a loss in transparency. It is caused by fluid build-up in the cornea as the innermost layer loses the ability to pump out excess fluid.
Who is affected? Fuchs dystrophy occurs in approximately 4 in 100 people, with higher numbers affected in European countries relative to other areas around the world. It is usually diagnosed in people aged 50 years and older, and affects 2-4x more females than males. Other risk factors of developing the condition include heavy smoking and a family history of the condition.
What are the symptoms? In early stages, the most common complaint is painless blurring of vision in both eyes, which tends to be worse on waking in the morning as the cornea swells overnight. This can occur with increased sensitivity to bright light and the perception of glare/ haloes around light sources. The change in corneal shape and thickness can also affect the focusing power of the eye, making it temporarily more short-sightedness. All visual symptoms usually improve over the course of the day as the cornea dehydrates. As Fuchs dystrophy advances, it can cause pain and severe impairment of vision.
How can it be treated? Corneal swelling can be reduced by using dehydrating eye drops and ointments, and applying warm air to the eye surface using a hair dryer or alternative. As the condition worsens, a bandage contact lens may be worn to improve comfort. If the vision continues to deteriorate, a transplant (graft) may be needed to replace the damaged cornea with healthy donor tissue.
Pterygium is a pink-white triangular growth that begins at the edge of the cornea, and gradually grows inwards towards the centre.
Who is affected? Pterygium is more common in people who have lived in sunny and dry climates, and in particular, among those who have spent more time outdoors without protecting the eyes against UV light.
What are the symptoms? As pterygium encroaches across the cornea, it can alter the shape so that the surface resembles more of a rugby ball or back of a spoon than a round football. As light passes through, some parts bend more others splitting the focus into two separate points at the back of the eye. This is termed ‘astigmatism’, and usually presents as distorted or blurred vision that can be corrected using spectacles or contact lenses. The raised growth can also impair the natural flow of tears across the eye surface causing dryness, redness, and irritation.
How can it be treated? In early stages, eye comfort can be improved using artificial lubricant eye drops and ointments. Surgical intervention is only necessary if the pterygium advances, causing a permanent reduction in vision, long-term discomfort that cannot be managed using conventional means, or to improve how the eye looks.
Over the years, David has conducted extensive research of corneal surgical techniques and therapies, and published a number of books and peer-reviewed articles. His work has helped to advance the development of techniques that are used in the present day. For example, he authored the first-ever series of articles that detailed the use of ‘excimer laser’ in the treatment of corneal surface conditions. Here are some of the most important references:
D S Gartry, M G Kerr Muir, J Marshall
Excimer laser treatment of corneal surface pathology: a laboratory and clinical study.
Br J Ophthalmol 1991; 75: 258269
CNJ McGhee, HR Taylor, D S Gartry, SLTrokel
“Excimer Lasers in Ophthalmology – Principles and Practice”
Martin Dunitz 1997
AC Poon, JE Forbes, JKG Dart, S Subramaniam, C Bunce, P Madison, LA Ficker, SJ Tuft, D S Gartry, RJ Buckley
Systemic cyclosporine A in high risk penetrating keratoplasties: a case-control study
Br J Ophthalmol March 2001; 85:1464-1469 doi: 10.1136/bjo 85.12.1464
“Corneal Surgery – Essential Techniques”
Zuberbuhler B, Tuft S, DS Gartry, Spokes D