Cornea Surgeon Joins Team

Integrates attentive care philosophy and advanced techniques

One chilly New York morning in early February 2009, Alisha Webb’s life was forever changed. As she drove along on her way to community college, she hit a patch of ice on the road. She lost control of her car, which was then crushed by an oncoming sport-utility vehicle. It was one day after her 19th birthday.Stock photo from istockphoto.com.
“She had blood throughout her brain and a diffuse axonal injury,” reports Janine Venturella, Alisha’s mother. “She also had a ruptured spleen, contusions of the heart and fractured vertebrae. Blood was seen in the base of her brainstem, the area responsible for consciousness. She was diagnosed with a severe traumatic brain injury and was in a coma.”
Doctors gave Alisha’s family no hope for her recovery. They believed she would remain in a vegetative state and have no quality of life. They asked the family to consider removing Alisha from life support.
“They wanted us to consider that, but we couldn’t do it,” says Janine. “We believed her situation was going to change and she would get a miracle.
“Alisha remained in a coma for one month, then woke up. She spent the next three months in a rehabilitation hospital. She got out of the hospital on May eighth of that year. She got her miracle.”
When Alisha first woke from her coma, she was like an infant. She could barely move. She couldn’t lift her head. She couldn’t walk or speak. She was forced to relearn all of the skills she had taken for granted before the accident.
“I was starting over as a child at the age of nineteen,” confirms Alisha. “I had to learn to think, write, walk and talk. I had to learn to eat and drink, to control my movements, and to groom and behave myself. It was awful, but I think about how far I’ve come since. I can’t believe I survived that accident.”
Alisha came full circle in her rehabilitation, but there was still one effect of the traumatic brain injury that needed to be addressed: her vision.
“Early on, the doctors felt Alisha’s vision was affected, but to what degree they couldn’t tell,” states Janine. “At that time, her vision was not a priority.”
As Alisha recovered, that changed. She visited an ophthalmologist, who referred her to an eye hospital in Pittsburgh, Pennsylvania. There, she met Steven E. Kane, MD, then a fellow in cornea, cataract and refractive surgery at the University of Pittsburgh.
Dr. Kane, a native of Florida, recently returned to his home state and joined the medical staff of The Eye Institute of West Florida in Largo. The Eye Institute of West Florida has been the go-to center for ophthalmic care in the greater Tampa Bay area for more than 40 years.

Changing Course

“Alisha was evaluated for refractive surgery a few years before I met her,” notes Dr. Kane. “It was recommended at that time she wear glasses because she was so significantly nearsighted. She was not a candidate for LASIK [laser-assisted in-situ keratomileusis].
“The reason she came to me and again expressed interest in refractive surgery was because her glasses would not stay on her face. And she could not put in contact lenses because of a tremor resulting from her injury.”
By this time, new technology, implantable collamer lenses, or ICL, were available for patients who are too nearsighted or don’t have corneas suitable for LASIK. Dr. Kane began evaluating Alisha for these lenses.
“Our mission was to do everything we could to get her glasses free,” he acknowledges. “Initially, we planned to do an ICL in one eye, which was very nearsighted, and LASIK in the other, because the degree of nearsightedness between her eyes was very different.

“Dr. Kane didn’t give up. He was very determined to see the surgery succeed.” – Janine

“During her workup, we performed an exam to test her eyes’ ability to accommodate, or change power. We blocked her accommodation in her eyes to get a true sense of how nearsighted they are when they’re fully relaxed. When we did that for Alisha, we were surprised because her accommodation was so strong.”
Dr. Kane reports that because of the magnitude of Alisha’s accommodation, he had to change his original treatment plan. It became apparent after doing additional confirmatory testing that she was in accommodation spasm, and he needed to relax that spasm to determine her true level of nearsightedness. Treating her while she was in accommodation spasm would have resulted in overtreatment, and she would have traded her nearsighted glasses for farsighted glasses in the long run.
“I had Alisha wear glasses reflecting the updated measurements,” recounts Dr. Kane. “It took many months for her eyes to relax and her brain to accept the new relaxed state. Since I was able to relax her accommodation spasm, the magnitude of her treatment decreased. She became a LASIK candidate in both eyes.”
Throughout the process preceding her surgery, Alisha had extensive family support. Her grandmother, Regina Venturella, assisted in her own, unique way. During the time of Alisha’s recovery from the accident, Regina was inspired to write a book detailing Alisha’s miraculous story. It’s titled It Only Took a Moment.
“I was a nurse and I kept journals of everything that was said and done throughout Alisha’s hospitalization and rehabilitation,” she relates. “Because they gave her no hope, I felt I had to try to give others hope.
“Then, I turned the book into a mission to raise money and awareness for research at the University of Pittsburgh. The other half of the money was for Alisha’s LASIK.”

Distorted Vision

Alisha’s vision deteriorated suddenly as the result of a brain injury. Christina Hoffman’s eye issues, however, built up over years due to a vision-stealing disease affecting her corneas.
“I have Fuchs’ dystrophy,” confides Christina. “That’s when the pump cells in your eyes don’t pump out fluid and the corneas become swollen. For a lot of people, it doesn’t get worse, but mine got progressively worse, especially over the last two or three years.
“The condition gave me blurred vision, and I started seeing halos. It happened mostly in the morning. I’m a medical assistant in a pediatrician’s office and I give vaccines. It got so bad that I couldn’t see the lot numbers on the bottles. I also had a hard time working on the computer. They got me a bigger monitor and made the screen big for me.
Stock photo from istockphoto.com.“The way to treat Fuchs’ dystrophy is with special saline eye drops. There’s a high concentration of saline in these drops to reduce the swelling, which makes the symptoms better. I was using the eye drops three or four times a day.”
Still, Christina’s sight deteriorated to the point where her symptoms lasted all day, and she became fearful of driving. The blurriness distorted everything she looked at, and the halos distracted her. She couldn’t read the road signs or see the other cars on the road. Her vision issues began interfering with getting around and even working.
“In the daytime, I couldn’t see any distance,” says the Pittsburgh native. “And I had a hard time driving at night. I would stay at home at night because I couldn’t see. At the office, they got someone to cover for me when we had evening hours because I was afraid to drive.”
During the past few years, Christina’s Fuchs’ dystrophy progressed significantly. She suspected she needed treatment beyond the eye drops and made an appointment with her ophthalmologist. The doctor referred her to the eye hospital in Pittsburgh, where she met Dr. Kane.
“I first went to see my ophthalmologist in August 2016,” Christina remembers. “He said, Maybe it’s time for a cornea transplant. So, I went to see Dr. Kane, and he agreed it was time.
“Dr. Kane was very reassuring, and he answered all my questions. He is passionate about what he does, and I felt very comfortable being in his care. He is a wonderful, kind and considerate man.”
“Christina came to us with a condition called Fuchs’ dystrophy,” notes Dr. Kane. “That’s a disease that affects the pumping cells in the endothelial layer at the back of the cornea. If these cells stop working, then the cornea takes on water and starts to swell.
“Thirty years ago, the treatment for this condition was a full-thickness cornea transplant, which carries many risks and complications. Today, we use an advanced procedure with fewer complications called DMEK.

Detailing DMEK

“DMEK is still a cornea transplant, but instead of transplanting the whole cornea, we transplant just the back layer of cells,” Dr. Kane explains. “We target only the part of the cornea that is diseased and leave everything else in place.”
DMEK stands for Descemet’s membrane endothelial keratoplasty. To perform DMEK, surgeons strip the affected back layer of cells and clear it out of the visual axis. The donor tissue is prepared with an eye bank, and surgeons insert and position it, then secure it in the eye using a no-touch technique such as fluid waves and air bubbles. Following DMEK, patients use steroid drops to avoid immune system rejection.

“I look outside now and everything is so clear, bright and sharp. Everything is so beautiful.”- Christina

“With a full-thickness transplant, it can take six months to a year before patients start to get decent vision,” reports Dr. Kane. “With DMEK, patients typically have a dramatic improvement in vision between the first week and the first month. Most people get to where they are going to be by month one.”
Christina underwent DMEK on her right eye in November 2016. Her left eye was done in March 2017. Both procedures were performed as same-day surgeries.
“I was at the hospital about six hours,” states Christina. “After surgery, I had to lie still for two hours. I went to see Dr. Kane the next day, and he was in awe that my eyes just took the transplants. He said it was beautiful, absolutely perfect.”
“Recovery depends on the severity of the patient’s condition. Less healthy corneas are more swollen, so recovery might take longer,” explains Dr. Kane. “Christina had good vision at her one-week visit, and certainly by her one month follow-up.”

Second Chances

The day after Christina’s second DMEK, her vision measured 20/40 on the charts. Her vision continued to improve, and now she can even make out the writing that scrolls at the bottom of her television screen.
“I look outside now and everything is so clear, bright and sharp. Everything is so beautiful,” marvels Christina. “Every day, every week I notice something different. I’m in awe when I look at the TV; it is so clear and I can read it.
“I don’t know how I managed to get around and live my life before.”
For Alisha, LASIK preparation was an intensive process. That was due to Dr. Kane’s efforts to identify her underlying eye problem and treat it beforehand, improving the surgery’s outcome. Alisha’s family is indebted for his patient attention to her care.
“It wasn’t just performing any LASIK surgery; Dr. Kane really had to take it on,” offers Janine. “Over a three-year period, he was able to get Alisha to the point where he was confident surgery would be successful. That led up to the procedure in May 2017, and it was a one hundred percent success.”
Now, Alisha’s back in college with a long-term goal of becoming a teacher.
Dr. Kane’s manner and care philosophy amaze Alisha and her family.
“I met Dr. Kane in January,” comments Regina. “He was professional, knowledgeable and extremely concerned about Alisha’s welfare.”Stock photo from istockphoto.com.
“Dr. Kane didn’t treat me like a patient; he treated me as a friend. When I told him my story, he walked up to me and said, Can I give you a hug? From that moment, we’ve been friends.”
“Dr. Kane didn’t give up. He was very determined to see the surgery succeed,” adds Janine. “He was realistic about the pros and cons, but he was going to do everything he could.”
DMEK gave Christina a second chance at clear vision, and she couldn’t be happier. Thanks to Dr. Kane and his advanced procedure, the complications of her Fuchs’ dystrophy are now gone. She’s passing the word about the doctor and DMEK.
Dr. Kane is offering DMEK at The Eye Institute of West Florida, which is devoted to providing the most advanced technology and innovative techniques to treat their patients. He is the only surgeon in the Tampa Bay area performing this procedure.
“I had a wonderful experience,” says Christina. “I want to tell others with my condition not to be afraid. You’re in good hands with Dr. Kane!”

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    • The Eye Institute of West Florida

      The Eye Institute of West Florida was founded by Stephen Weinstock, MD, in 1974. For more than forty years, the practice has provided excellence in eye care in a warm, personal environment combined with a tradition of service and devotion to th... Read More

    • Stephen M. Weinstock, MD, FACS

      Stephen M. Weinstock, MD, FACS, is a cataract specialist. He founded The Eye Institute of West Florida in 1974, pioneering sub-specialty eye care in Pinellas County. Today, as President and Medical Director, Dr. Weinstock is recognized as a worl... Read More

    • Robert J. Weinstock, MD

      Robert J. Weinstock, MD, is a board-certified ophthalmologist and is fellowship trained in cataract and refractive surgery. Dr. Weinstock joined the practice in 2001 after completing his residency at the St. Louis University School of Me... Read More

    • Steven E. Kane, MD

      Steven E. Kane, MD, is a fellowship-trained ophthalmologist specializing in disorders of the cornea. Dr. Kane completed his undergraduate education and graduated summa cum laude from College of William and Mary in Williamsburg, VA. After a b... Read More