Keratoconus has a tremendous impact on an individual’s life. Causing substantial distortion in a person’s vision, this potentially blinding eye disease often makes taken-for-granted activities challenging, if not impossible. Typically diagnosed in the adolescent years, the deterioration in vision can eventually affect a person’s ability to read, watch TV, drive or even work.
However, there’s one person at the University of Houston who can give a second chance to people with this disabling condition. Chances are, if you’re seeking out the best in the nation for management and treatment of keratoconus and other corneal diseases, you’ll be referred to Dr. Jan Bergmanson, an optometrist and professor right here at the UH College of Optometry.
“We’ve had people crying in the chair when they realize how much better they can see,” Bergmanson says. “And it’s happened more than once. We can make a dramatic difference. It’s almost a hidden secret that we have that capability here, and it’s not just me. In our clinics, you’ll find some of the most accomplished, experienced, published specialists.”
With an O.D., Ph.D. and D.Sc., Bergmanson is not only a clinician, he is also an anatomist and pathologist. A founding director of the Texas Eye Research and Technology Center (TERTC) and diplomate in the Cornea, Contact Lenses and Refractive Technologies section of the American Academy of Optometry, Bergmanson is one of the preeminent doctors for corneal conditions in the nation.
The cornea, which is the clear window of the eye, is responsible for two-thirds of the eye’s focusing abilities. Since it’s the first optical surface light meets, any abnormalities result in a bad image on the retina, making vision very distorted or blurred. This is the case with keratoconus, severely affecting the way a person sees the world and making simple tasks difficult. In fact, with one in 2,000 people having this disease, it’s one of the two most common corneal pathology causes for corneal transplants.
While extreme cases of keratoconus must ultimately resort to corneal transplants, the standard of treatment for many patients is the use of a special type of contact lens, called a scleral lens. These lenses are quite a bit larger than regular gas permeable (hard) contacts. What makes them the preferred choice is that they don’t touch the cornea. Instead, they sit on the sclera, or white part of the eye. These types of lenses are Bergmanson’s specialty.
He says the cornea has more sensory nerve fibers than anywhere else in the eye, so if a lens touches it— as is the case with traditional hard contact lenses— it’s not comfortable. Where scleral lenses sit, there are far fewer sensory nerve endings, which makes the fit more comfortable. Instead of sitting on the cornea, the weight of the lens is placed over a larger area, away from this extraordinarily sensitive tissue. Bergmanson likens it to sitting in a recliner chair, rather than on the tiny seat of a racing bicycle.
A phenomenal lens
Another advantage to scleral lenses is their ability to be contoured. Thanks to a combination of computer advances and technology, as well as modern materials and manufacturing techniques, Bergmanson says lenses now can be made with extremely complex curves cut into them.
In addition to keratoconus, he says, scleral lenses are the go-to choice for vision correction after corneal surgery and for many corneal diseases, such as post-corneal transplant surgery, corneal scars and pellucid marginal degeneration, which Bergmanson also treats.
“Even though the principle of scleral lenses has been around since the 1880s, we only recently have been able to get it to work,” he says. “It’s taken more than a century to get it to this point. It’s a phenomenal device, a modern marvel that really changes people’s lives, and this is very stimulating for a doctor to make such a difference in somebody’s life. The scleral lens can be the difference between driving or not driving. And, for some people, it’s the difference between working and not working.”
What sets Bergmanson apart from others is that he approaches treating corneal diseases both as a clinician and scientist.
“It became apparent to me that in order to understand this disease, we must first learn the anatomy,” he explains. “We know too little about what the cornea should look like normally. We can’t just look at the abnormal and not know what it should look like. So that’s where my background as an anatomist plays in. You can’t study pathology without knowing the anatomy.”
Additionally, he takes his research a step further by studying pathologically what’s going on in the keratoconic cornea using an electron microscope, which enables him to make observations at cellular and subcellular levels. This allows him to give patients directions on what to try and what to avoid. He adds that the TERTC is one of the few places in the world where research is conducted on keratoconus and on scleral lenses. Complications and challenges do occur, but he says it’s important to learn how to deal successfully with it all. It takes both clinical and basic research to understand how it works and what needs to be done when it doesn’t.
Corneal Anatomy Expertise
Another facet of his work involves studying both normal corneas not suitable for transplant surgery from eye banks and contrasting this normal anatomy with that of pathological tissue obtained from surgeons. Bergmanson says that, as a result, UH is the leading institution for expertise on corneal anatomy and in the pathological description and definition of keratoconus. His team is on the verge of explaining the mechanism behind the forward collapse of the cornea that causes the condition and, thereby, distorting vision.
Bergmanson works closely with Dr. John Goosey, an ophthalmologist and corneal surgeon, who comes to UH once or twice a month to medically evaluate special cases.
“What Dr. Goosey and I found from our research is that keratoconus is focused to the anterior third of the cornea, so you don’t have to take out the entire cornea to treat or manage the disease,” Bergmanson explains. “The standard seems to be to take out the whole cornea, but Dr. Goosey can do the partial transplant, which has several advantages over the full thickness transplant.”
And while Bergmanson estimates that Goosey does more transplants than any other corneal surgeon in Texas, Goosey’s first instinct is usually to check whether contact lenses could solve the problem. A big supporter of the research done at UH, he continually refers patients to Bergmanson for evaluation.
In addition to his clinical practice and research, Bergmanson authored a textbook on the anatomy and physiology of the eye. As it’s typically difficult to find an up-to-date text on this subject, he went to the pharmaceutical industry, Alcon Laboratories, asking them to support production of the book and to give it to students for free through a grant. The book is also used at other institutions and internationally.
“I’ve been at UH for 40 years and have had a good career here,” Bergmanson muses. “UH has been great in letting me develop and change. Very few places would have been able to give me the same opportunities and resources. That helps me spread the word around the world, representing the University in various meetings and places. I can tell you that in Europe, in my field, they look at UH like Harvard.”