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Aya, a 38-year-old high school teacher from Jerusalem, suffers from keratoconus, a corneal disease in which the cornea — the transparent window at the front of the eye — becomes increasingly deformed. Instead of remaining round and symmetrical, it gradually becomes cone-shaped, causing severe distortion of vision.
"For years, I was treated with special and rigid contact lenses," said Aya. "They are meant to stabilize the cornea and improve my vision, but in recent years my condition has gotten a lot worse."
Some of the symptoms she faced were eye rejection of lenses, constant eye pressure, redness and pain. "It affected my whole life, gradually affecting so many aspects. I stopped driving and doing simple, everyday tasks," she shared. "I'm a teacher by profession, and I was supposed to work quite a bit on the computer, but after five minutes in front of the screen, I couldn't do it anymore. I would start having strong and unbearable headaches. Life as I knew it just changed, and I suffered a lot."
According to her, she tried to return to the lenses but to no avail. "Every time I tried, my eyes were red, and the pressure was unbearable."
For a long time, Aya suffered greatly, lost her quality of life and needed help wherever she was. "Sometimes I would stumble or bang into the door in the morning because I didn’t see it," she said. "One time I even missed my flight because I couldn't see the timetable at the airport."
The main difficulty that accompanied Aya's condition was the fact that the pain and distorted vision were internal, so that to an outside observer it did not seem at all that she needed help or was going through something unusual. The environment continued to expect her to go on as usual, as it became increasingly difficult for her to do so.
Even at her workplace, in the high school where she teaches, she needed help and began to ask for it more and more. "I found it very difficult to do simple things. For example, when I was teaching, I had to get very close to the board."
In the early stages of Aya's disease, glasses can usually suffice, but as the disease progresses, many patients require hard or special contact lenses that create a uniform optical surface over the distorted cornea, improving vision.
Aya didn't think there was a real solution for her. She made an appointment to have her lenses routinely changed. The optometrist asked her if she had been examined at the hospital and recommended that she see a specialist at Hadassah hospitals.
That's how she met Dr. David Smadja, director of the Refractive Surgery Unit of the Ophthalmology Department. The meeting with the doctor led to a change in Aya's life.
"He understood what I was going through without too many explanations. After the tests from which he learned about my condition, he told me that there was surgery that could help me," Aya recalled. "I immediately felt that I was in good and professional hands."
Dr. Smadja explained that in more advanced cases of the disease, such as Aya's, it was customary to implant tiny plastic rings into the cornea in order to flatten it and improve its shape. Since plastic is an artificial material, complications related to the implant itself may develop over time. When these solutions are also insufficient, it may be necessary to perform a full corneal transplant.
"The new procedure we are carrying out at Hadassah offers a different approach from all of these," explained Dr. Smadja. "Instead of implanting a plastic ring, a ring made from a donor's human corneal tissue is used. Using an advanced femtosecond laser (Femtolasik), a precise ring is cut from the donor's cornea while simultaneously creating a delicate channel within the patient's cornea. The ring is then implanted into the deformed cornea, where it helps stabilize it, flatten the shape of the cone and improve the quality of vision."
The main advantage of the method, according to the Hadassah ophthalmologist, is the use of natural biological tissue rather than synthetic material, which allows for better integration with the existing cornea and reduces some of the problems that may arise with artificial implants.
"The goal of the procedure is to significantly improve the patients' vision and quality of life," said Dr. Smadja, who performed the procedure together with Itay Lavy, head of anterior segment surgery, "and in some cases even to postpone or prevent the need for a full corneal transplant in the future."
Aya said that within the first three minutes of the operation, she already began to feel her vision stabilize. "It wasn't surgery under general anesthesia. I was awake and fully present, and I felt my vision improve even during the operation, and I felt safe. I knew that Dr. Smadja knew what he was doing and was an expert in keratoconus surgery."
After the surgery, Aya underwent a few light days of recovery and went straight back to her life. "The first thing that improved was the pressure in the eyes. Suddenly I could see my surroundings much better," Aya said excitedly. "I saw colors again, the pain disappeared and my mood improved dramatically. I went back to my life, something I was already afraid would not happen."
Aya returned to driving, working and teaching. According to the doctors, Aya's vision before the surgery was about 10 percent, while after the surgery it was about 90 percent with glasses.
"Not only has my eyesight improved," she concluded with a smile. "I got my independence back."
