Me and my operation: How a doughnut in my eye cured my blurred vision.

Around 30,000 Britons are affected by the eye disease keratoconus, which causes distorted and blurred vision. Beckie Newton, 26, a full-time mother of one from west Wales, had her sight restored with a new implant. She tells CAROL DAVIS her story.

The Patient

About four years ago, when I was working for a car dealership, colleagues commented that I sat with my face almost touching the computer screen.
My fiance, Owain, was also concerned about how close I'd sit to the TV - I'd be just 18in from it. So I went to a High Street optician who tested my eyes, but didn't give me glasses.

He didn't say what he thought it was, but sent me to my GP, who referred me to an eye specialist, again without explanation.

My appointment wasn't for six months and I started to worry.

So I saw a specialist privately, who said I had keratoconus in my right eye, which was also beginning in my left.

He explained that a normal eye is round so the cornea - the transparent front part - focuses light onto the retina, the lining at the back of the eyeball.

In keratoconus, the cornea becomes stretched and thin near its centre. The thinned part bulges outwards and the cornea becomes rugby ball-shaped with a pointed end.

Your sight becomes blurred, as though you're underwater, because the light isn't falling on the back of the eye properly. I was told it usually progresses gradually and can be corrected by contact lenses or glasses.

I was prescribed rigid lenses that would press on the pointy tip of the eye to keep it in shape. Butut they didn't sit properly and made my eyes feel as though they were full of sand. I tried different types, but couldn't wear any for more than ten minutes.

Over the next few months my sight got rapidly worse. I struggled to read and watch TV.

Then I heard about a new operation for keratoconus called INTACS (Intracorneal Ring Segments), where they put a clear ring of plastic, like a doughnut, into the cornea to force it to flatten out.

The ring builds up the sides of the cornea; the pressure this puts on the cornea then flattens the central, pointy bit. I saw a private specialist who said I couldn't have this on my right eye because the disease had developed fast and I needed a corneal transplant.

By that point, my sight was so bad I had to give up my job. I had the corneal transplant on the NHS in December 2007. For two days, the pain was immense. Even after the transplant, my sight was blurred.

The specialist, Mohammed Muhtaseb, recommended INTACS for my left eye, though he warned I might still need glasses. I had the operation a few months later.

When I woke from the anaesthetic and took off the eye patch, I could see the INTACS. It was like a shadowy semi-circle in my eye. But within a day or so, I got used to it and simply didn't see it anymore.

A week after the op, I could see every detail on the TV from the other side of the room.

Now, I can watch my seven-month-old son Sam smile, read him stories and drive him to playgroup. It's just wonderful.

The Surgeon

Mr Mohammed Muhtaseb, consultant eye surgeon at Singleton Hospital, Swansea, and FOCUS Laser Vision in London, says:
Keratoconus is a weakening of the cornea - the clear window at the front of the eye - causing it to bulge. This changed shape means that instead of light being projected onto the retina for best focus, it is scattered, so sight becomes blurred.

The condition affects one in 2,000 people, for reasons we don't fully understand, though we know it can run in families and typically develops in the late teens and early 20s.

In the early stages, it can be corrected with glasses or contact lenses. But because the cornea becomes pointed, fitting lenses is difficult.

For many years, the only other option for patients with severe keratoconus was a corneal transplant - 20 per cent of patients have needed one. But this carries the problems of any organ transplant, including risks of infection and rejection.

Finding a donated cornea can be problematic and after surgery it takes between nine and 18 months to settle down. It's practically impossible to stitch a cornea into position accurately and it will never be as good as your own. But this exciting development means we can restore good vision to keratoconus patients.

INTACS involve putting one or two C-shaped plastic rings into the sides of the cornea to correct its shape (each is the size of this letter 'C'). This thickens the sides of the cornea, which forces down the top of the cornea so it flattens, and refracts light properly.

As the cornea is damaged, most patients will need glasses or contact lenses. But contact lenses will now stay on. The operation takes 15 to 20 minutes under a local or general anaesthetic.

First, I make a 2mm incision in the side of the cornea, cutting through 75 per cent of its thickness, before creating a semi-circular pocket where the INTACS semi-circle will sit.

Then I slide the ring gently into the pocket, which I leave for the cornea to heal around.

We protect the eye with a hard contact lens for a few weeks so the ring doesn't move.

Patients have combined antibiotic and anti-inflammatory drops for a month. After that, they can visit a specialist optician for glasses or contact lenses to fine-tune their sight.

In some cases, the implants may work loose or not work at all, in which case they can be removed.

However, this operation is successful for around 70 to 80 per cent of patients who would otherwise need a corneal transplant. Because keratoconus affects you only until you are in your 20s, the disease will have run its course.

The implant will go on working for life.

The operation costs £3,350 per eye privately, and a similar cost to the NHS. Visit www.ilase.co.uk or tel: 0800 587 6780.

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Students learn vital lesson that communication is key

A PIONEERING surgical procedure on a Swansea Metropolitan University academic has initiated a guest lecture on the importance of communications between medics and patients.

Consultant Ophthalmic and Cornea surgeon, Mr Mohammed Muhtaseb, visited the university's Townhill campus this week to talk to students.

The visit follows a unique operation performed by Mr Muhtaseb on the head of the Centre for Psychology and Counselling at Swansea Met, Professor Ann Edworthy.

Professor Edworthy underwent the surgery in 2008 to rectify a problem with her sight. She was so impressed with the surgeon's communication skills she invited him to the university to talk to students.

Professor Edworthy said: "I was overwhelmed with the level of communication I received from Mr Muhtaseb. He would spend hours explaining the procedure to me, contacting me whatever way he could via emails and telephone calls. I feel this communication between patient and medic is crucial and I wanted my students to understand its importance to help them with their studies".

Pioneering eye op for schoolboy

A boy whose sight had deteriorated so badly he could no longer play rugby is making good progress after undergoing pioneering surgery.

The corneas in Daniel Beresford's eyes changed shape due to a degenerative disorder known as Keratoconus.

The 11-year-old from Sketty in Swansea has had special implants inserted by eye expert Mohammed Muhtaseb at the city's Singleton Hospital.

He said the case had interested eye surgeons around the world.

Daniel's father Richard said when his son first started developing problems with his eyes about three years ago it was initially put down to some bad bouts of hayfever.

But a visit to a local opticians found that the problem was far worse and the pain he was suffering was having a big impact on his life day-to-day.

"It was a very upsetting time but it came to a stage when we needed to take action," he added.

"Daniel was having difficulty seeing written work at school and had a number of absences because the condition was worsening."

Mr Muhtaseb said Keratoconus had been changing the shape of Daniel's corneas - the transparent front part of the eye - which meant they were becoming shaped like a rugby ball rather than a football.

"The condition is relatively common in adults but not in children," said the consultant ophthalmologist.

"The concern was that scans of the cornea were showing marked deterioration, meaning the cornea was becoming increasingly pointed."

Implants called IntraCorneal Ring Segments (INTACS) are sometimes used to treat adults but had never been used for a child in the UK, and there were very few cases worldwide, said Mr Muhtaseb.

"It wasn't an intervention I wanted to make in the early stages because there's so little experience of using INTACS in children."

"But his sight had deteriorated so much it was almost essential.

"When colleagues overseas gave a positive reply to the treatment plan I'd put together I decided to go ahead with Daniel's surgery."

The implants - which look like a small ring in two halves and cost about £500 for a pair - are placed in the cornea to thicken the periphery and flatten the pointed tip.

It is hoped the cornea will move back to a normal shape and the eyesight will be corrected and prevented from further damage.

The operation took just 20 minutes to complete for each eye.

Daniel was back home just hours afterwards and will be regularly monitored at the hospital.

Mr Muhtaseb added: "The procedure went well. Within three weeks Daniel's vision was back to almost driving standard and the latest checks show he's making good progress."

Daniel's eyes have interested eye surgeons from across the globe.

Mr Muhtaseb has already given a lecture on the case to a group of consultants at an event in London.

Daniel said he was now looking forward to playing rugby again.

"My eyes feel much better but I'm still quite sensitive to bright lights at the moment.

"As soon as I get my eyes better I'll be back playing - I can't wait."

Cataract op that means I can throw my reading glasses away

How pioneering 'double lens' surgery transformed one woman's life

Every year 400,000 Britons undergo cataract surgery, having the damaged lens in their eye replaced with a plastic one.
However, they often need reading glasses afterwards. Ann Edworthy, 50, a lecturer from Swansea, was one of the first to have a new 'piggyback' lens, which restores sight completely.
She tells Daily Mail's CAROL DAVIS her story, and her surgeon explains the procedure.

The Patient

 

As a student, I used to suffer from really sore eyes after long spells of reading. My optician diagnosed congenital cataracts - a partial clouding over of the lens in both my eyes since birth.

While I didn't need any treatment then, he warned me they could cause sight problems later in life.

Two years ago, I noticed that when I looked at distant objects, it was as though there was a milky film on my left eye - I couldn't see clearly, and it felt as if it was covered in cling film; I wanted to rub it all the time. 

By chance, one of my students mentioned she'd been really happy with the treatment from a local eye surgeon.

So, as I had private health insurance, I asked my optician for a referral to him.

The surgeon, Mohammed Muhtaseb, explained that as well as the cataracts I'd had from birth, there was another cataract growing in my left eye, something that tends to happen with age.

He said he could operate to remove them, replacing each cloudy lens with a clear, artificial one.

I'd have to choose which kind of replacement lens I wanted - one for reading or one for seeing at a distance. Whatever I chose, I'd have to wear glasses for the other.

I couldn't bear the thought of wearing glasses for the rest of my life. But I had no choice, as the cataracts meant I was now struggling to read, while in dim light I couldn't see at all.

So last April I had operations to remove the cataracts and replace them with artificial lenses.

Afterwards, I could see for miles because the cloudiness in my vision had gone. But I hated the reading glasses I had to use: when I was lecturing, I'd have to put them on to read, and then take them off to look at the students.

Changing focus all the time made me feel queasy.

Then, in October, Mr Muhtaseb told me about a brand-new lens - the piggyback, so-called because it is implanted on top of, and works in tandem with, existing artificial lenses, meaning I would be able to focus on both distant objects and close print. 

Just before Christmas, I became the second person to undergo the procedure.
As with all eye operations, there is a tiny risk of blindness, so I had one eye done at a time; this way Mr Muhtaseb could check my sight was fully recovered.
An hour before the operation, a nurse put drops in my eye to dilate my left pupil and create a gap in front of the artificial lens.

After anaesthetic drops were put in my eye, Mr Muhtaseb pulled my eyelid back and shone a bright light into my eye.

The new lens was furled up in a syringe to be injected into my eye. I felt a slight tug as the syringe went in, but no pain. 

My eye was then covered with a clear plastic shield to stop me rubbing it while the lens settled into place. An hour later the shield was removed and Mr Muhtaseb handed me a medicine packet to read.

It was extraordinary - I could read all the small print, even down to the tiniest full stop.
My restored vision made my Christmas wonderful.

Suddenly, I didn't need to find glasses to read cooking instructions. Even though my right eye had yet to be done and was still blurry, I just closed or covered it and read with my left. 

That, too, was corrected five weeks later and my sight is now perfect. I can use the computer and read without glasses, and see for miles, too.

I don't notice when I move from lens to lens. And I've given away those glasses I hated so much, because I'm thrilled to know I'll never need them again. 

The Surgeon

Cataract operations are the most commonly performed surgery in Britain - we remove a lens which has clouded over as the patient ages and replace it with a clear implant.

But patients almost always still need glasses because their own lens has been replaced by an artificial one, which does not change shape to focus as their own did.

This is very inconvenient, particularly for people such as Ann who need glasses for work or for everyday activities including driving and computer work - they have to take their glasses on and off many times a day. 

Although you can implant a multi-focal lens, which focuses on both distant and close objects, these are not widely available on the NHS because of the cost - and you can't add one after regular cataract surgery, as there is not enough space in the eye.

Ann had been unsuitable for a multi-focus lens because she had previously had laser eye surgery, which changes the shape of the eye.

But a new lens, the Sulcoflex Multi-focal piggyback, is much thinner, which means we can slide it in front of the single lens.

This new type, which was invented in Britain, could help hundreds of thousands of people who have had cataract or other artificial lens implants by restoring their ability to see long-distance and read without glasses.

The operation takes about ten minutes. After clipping open the eyelids, I slide in a small blade through the side of the cornea - the transparent dome on the front of the eyeball - to form a tunnel to reach the natural space between the iris and the pupil; this is where the new lens will be inserted.

To prevent the eye from collapsing if it loses fluid, I inject a jelly-like substance to maintain pressure in the eye.

I load the piggyback lens into a plunger - like a syringe - so it rolls the lens in half. I then inject the rolled lens into the space, where it unfolds itself in front of the existing artificial lens.

I then check it's correctly centred over the other lens so the patient can see through its different zones of focus - near and far.

I use a syringe to suck out the jelly, and inject saline to maintain the shape of the eye. Pressure from the eye means the tunnel seals itself up.

Ann will have a check-up in a few months, and then regular checks over the next few years. But because this plastic lens will not degrade, it should last a lifetime.

Report from South Wales Evening Post, July 26th 2007. Photo used by kind permission

City Hospital Leads Way In Eye Surgery

The work of a pioneering surgeon is proving a real eye-opener for Swansea patients who could barely see.

New treatments are being offered on the NHS to people with severe or complicated eye conditions.
It is down to the work of Singleton Hospital - based Mohammed Muhtaseb, consultant opthalmic and cornea surgeon, who is one of a handful of UK specialists trained in cornea and refractive surgery.

Since he started in 2007, patients have been offered highly specialist treatment when laser vision correction was unsuitable.

Bricklayer Mark Evans, aged 36 from Cwmdu, could see nothing but a blurred outline of someone sitting only a few feet away.
He was diagnosed with the condition astigmatism, which means his vision was blurred by an irregularly shaped cornea.

Mr Evans was so shortsighted the optical power of his eye was measured at -22 dioptres. But now his vision is almost perfect (-1 dioptre) after he had a special lens placed behind the iris of each eye.

Following two operations, which took less than an hour to carry out on two different days at Singleton's day surgery unit, his vision has been completely transformed.

"I've needed glasses since I was five and they were the thick, bottle - bottom types," he said.

"I used ordinary contact lenses for a while, but I over - wore them and they damaged my eyes, so I had to go back to glasses. Since having these new contact lenses, my eyesight has been marvellous. In both cases the treatment was carried out very quickly. After one of them, I went straight to Birmingham to see Lionel Ritchie in concert because I felt so great."

Pensioner Douglas Marsden, aged 86 from Bishopston, has also benefited from the revolutionary eye treatment.
He had already undergone a cataract operation and further surgery to his eyes. But the treatment failed to improve his failing vision and he could not read or enjoy his love of gardening because his sight was so poor.

The retired Co-Op worker can now read the letters four lines down on the vision chart, after having a corneal graft and intraocular lenses fitted by Mr Muhtaseb.

"I can now see my seeds again and I've just spent the morning in the greenhouse," he added.

Mr Muhtaseb, who has trained in the UK and abroad, is developing a new service for the treatment of corneal diseases in Mid and West Wales.

Only one lens implantation is being carried out each month.

"This is the only service of it's kind in Wales and I am thrilled to be able to deliver it here in Swansea", he said.

Report from South Wales Evening Post, January 2nd 2008. Photo used by kind permission

Precious Gift Is In Sight For More

The gift of sight is something many of us take for granted. But when your life is all a blur, without wearing a pair of spectacles it's an entirely different story - as Fforestfach - based Lynda Wiberge knows only too well.

Since she was just a 14 year old schoolgirl, she has had to look at the world through glasses.

But she was so determined to live without them that when she saw an advert for laser surgery, she went across the Severn Bridge for treatment - but it went wrong.

For years she has suffered blurred vision. But now she, along with a number of other Swansea patients, is being given fresh hope of a brighter future thanks to the pioneering work of Singleton Hospital based eye expert Mohammed Muhtaseb.

Miss Wiberge, aged 53, said she thought corneal scarring would be removed from her eye as part of laser surgery.

But just minutes after the procedure, at the day surgery unit opposite Singleton Hospital, she said she was amazed by it's effects.

She said: "It's absolutely wonderful".
"I could'nt see without my glasses because it was all blurred, but now I can read without my glasses. I am shocked because I thought I was having the scarring taken off. I thought I would have to go back to glasses - but now I'm ecstatic."
"Mr Muhtaseb's wonderful - it is'nt even stinging."

She added: "I only had laser treatment so I would not wear glassed and because I had hazy vision - I hated glasses." Mr Muhtaseb said he hoped the work would help Singleton Hospital become the regional centre for laser procedures of this kind.

Since the consultant opthalmic and cornea surgeon started at the Swansea site back in 2006, patients have been offered highly specialist treatment when laser vision correction was unsuitable.

He is one of a handful of UK specialists trained in cornea and refractive surgery.

Mr Muhtaseb, who has trained in the UK and abroad, is developing a new service for the treatment of corneal diseases in Mid and West Wales.

Only one lens implantation is being carried out each month.

But now he is looking to transform the laser side of the service and prove it's worth by showing the dramatic improvement that it can make to the transformation of his patient's sight. Mr Muhtaseb said he and his team were making the most of the resources given to them.

He said: "Swansea Local Health Board said one patient could have treatment, because without it he could have lost his job.
"But because the laser company has a minimum callout fee, they were going to have to pay the minimum charge, so we got another two in.

"Hopefully the LHB will consider the case in particular in the funding of laser treatment for corneal scarring."

Currently a £250.000 Wavelight Allegretto Excimer laser - considered to be the Rolls Royce of such equipment - has to be hired out to the city hospital to do such work. But it is hoped in time there could be such a laser on site, which would also generate income for the trust through Mr Muhtaseb's private work - helping place Swansea at the forefront of such work.

He said: "If local health boards are willing to fund the treatment, it will make the case strongly for Swansea NHS Trust to buy a laser.

"Most of the income would be generated from my private practice, and if other LHB's fund the work that is coming through.

"We are trying to get this and put Swansea on the map - I think it's good all round."

ITV Video

During 2008, Mr Muhtaseb was featured in video reports by both the BBC and ITV television channels. Please use the links below to view them.

BBC Video