The cornea is the transparent outermost part of the eye that helps focus images by refracting light onto the eye’s neurosensory tissue. If the cornea is damaged, it can become swollen or scarred. This causes light that is entering the eye to scatter or distort resulting in glare or blurred vision. The cornea is comprised of several layers. The epithelium is the external barrier. The stroma, which is 95% of the corneal thickness, provides the corneal structure and transparency. The inside of the cornea is lined by endothelial cells, which contain fluid pumps that keep the cornea in a relatively dehydrated state.
A corneal transplant is sometimes necessary for people who have cloudy or scarred corneas (due to injury, infection, or stromal dystrophies), corneal swelling (Fuchs’ endothelial dystrophy or secondary corneal edema), or corneal thinning from keratoconus. An experienced corneal specialist should be consulted if you have severe corneal vision loss to determine the cause and the appropriate treatment.
Penetrating Keratoplasty (PK)
Penetrating keratoplasty is the transplantation of the full thickness cornea including the stroma, and endothelial cells. This procedure was first performed in 1905 and has been advanced over the past century to improve visual outcomes. Other innovations in corneal transplantation have focused on providing targeted replacement of the diseased or damaged corneal layers.
Endothelial Keratoplasty (DSAEK/DMEK)
Endothelial keratoplasty replaces the patient’s damaged corneal endothelium with either a healthy new endothelium alone (DMEK) or in combination with a thin strip of donor stroma tissue (DSAEK). These procedures are appropriate when the inner layer of the cornea, the endothelium, is the only layer that needs repairing. These techniques eliminate the need for sutures and decreases the patient's recovery time.
Deep Anterior Lamellar Keratoplasty (DALK)
Deep anterior lamellar keratoplasty is used in diseases that exclusively affect the middle stromal layer. In these diseases the stroma is sick, cloudy, or deformed, but the inner layers (Descemet’s membrane and endothelial cells) are healthy. Purely stromal diseases include keratoconus and some corneal dystrophies. The patient’s Descemet’s membrane and endothelium may be left intact which improves safety of the procedure, speeds visual recovery, and leads to longer graft survival.
A pterygium is an overgrowth of the conjunctiva, or mucus membrane lining of the eye, onto the corneal surface. The pterygium may need to be removed if it affects the vision or causes discomfort.
Irregularity or nodules under the epithelium (e.g. Salzmann’s nodules or anterior basement membrane dystrophy) that affect the smoothness of the cornea’s outer surface can distort the vision or cause discomfort of the eye surface. These can be removed and the surface of the eye smoothed with a procedure called superficial keratectomy.
Holly B. Hindman, M.D., M.P.H.
Graduated from Stanford University with a BA in Human Biology in 1998.
Graduated from Harvard Medical School, 2003
Completed internship at University of Maryland Medical Center, 2004.
Completed residency in Ophthalmology at The Wilmer Eye Institute at Johns Hopkins University School of Medicine, 2007.
Completed fellowship in Cornea and External Disease at University of Rochester’s Flaum Eye Institute, 2008.
Received Masters of Public Health (MPH) degree from the University of Rochester in 2015.
Certified by the American Board of Ophthalmology
Serves on the Medical Advisory Board and the Statistical Task Force to the Eye Bank Association of America.
Associate Professor at the University of Rochester.
Member of the American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Wilmer Residents Association, New York State Ophthalmological Society, Contact Lens Association of Ophthalmologists, the Cornea Society, and the Paton Society.
Dr. Hindman was born in Rochester, NY and was excited to return to the area in 2007. Her husband, Spencer Cook, works in Bloomfield, NY and together they are raising one daughter, one son, and one cat. Her interests include skiing (she is a member of the National Ski Patrol), exploring the Finger Lakes region’s talents and treasures, spending time by the water, and reading.