My name's James Bull.
I'm a consultant ophthalmic surgeon specialising in cornea
and I'm based at St James' University Hospital in Leeds.
The cornea is the window at the front of the eye
and it's made of three layers.
It's got a delicate skin, then a structural, thicker bit
and then a very delicate lining.
People need corneal transplants for two main reasons,
either because the shape of the cornea is quite poor
or because the lining of the cornea has failed.
Generally those reasons fall into two different age groups.
So the two commonest reasons for doing a corneal transplant
is either because the cornea's become misshapen,
ie the front structural part has become thinned,
and this is a condition called keratoconus.
It tends to affect patients who are in their late teens, early 20s.
The other big group are patients in whom
the delicate lining of the cornea has failed,
and these tend to be elderly patients.
Most of the conditions that affect the cornea come on quite gradually,
so if we talk about keratoconic patients,
as I said, they're young patients
and the first thing they may notice is that they think they need glasses.
The elderly patients, usually they've seen very well for most of their lives.
As the lining of the cornea stops working in these elderly patients,
what they first notice is their vision's a bit blurry first thing in the morning.
What we try and do is just replace the part of the cornea
that isn't working so well,
so this means actually we're trying to do a different operation
for these two largely different groups of patients.
So the elderly patients in whom the lining has failed,
we leave most of their cornea alone
and we just remove the lining that doesn't work so well any more.
We make just a small wound off to the side
and, having prepared a donor sheet of healthy cells,
post that into the eye and use an air bubble
to just stick it into place on the back of the patient's cornea,
so that we've just replaced the unhealthy lining.
With the younger patients with keratoconus,
their lining is fine, there's nothing wrong with it.
The problem is with the shape of the cornea.
So what we do for these patients is split the cornea
so that they keep their healthy lining
and then we provide them with a nice-shaped donor
and we stitch that into place.
With all the kinds of corneal transplant that we do,
in the early period it's important that people don't rub their eye.
We give them a protective shield that they must wear whenever they sleep
or whenever they have a nap.
It's important that in the shower they don't get tap water in their eye.
When it's sticky, just bathing it open with some cooled boiled water.
No eye make-up for the first month.
No swimming for at least the first month.
It's also really important that they don't rub their eye.
Both kinds of corneal transplant are extremely effective
and full thickness transplantation for keratoconus,
we know that at five years over 95 per cent of these patients
will have a healthy, functioning transplant
which is giving them significantly improved vision.