Grene Vision Group Offers Latest in Corneal Care

By Amy Geiszler-Jones
Friday, October 20, 2017

The Wichita-based practice, which has 21 clinics in south-central and southeast Kansas, is at the forefront of medical and surgical treatments in all ocular specialties, for all ages.

Grene Vision Group Ophthalmologists (Front L-R): David M. Chacko, MD, PhD; Dasa V. Gangadhar; MD; Terria L. Winn, MD; Anita Campbell, MD; Samuel W. Amstutz, MD. (Middle Row L-R): Donald B. Scrafford, MD; Michele M. Riggins, MD; David T. Truong, MD. (Back Row L-R): Brian H. Strange, MD; Mark L. Wellemeyer, MD; Charles R. Whitfill, MD; Alan R. Hromas, MD.

If there’s a new procedure related to corneal care, it’s a sure thing that patients can receive it at Grene Vision Group.

The practice, based in Wichita, Kansas, has 21 clinics in south-central and southeast Kansas, and provides total eye care, including optical and primary, medical and surgical treatments in all ocular specialties, for all ages.

Dasa V. Gangadhar, MD, and David T. Truong, MD, are both highly skilled ophthalmologists with extensive experience related to corneal transplantation and care. The former has been with Grene Vision Group for more than two decades and has established a record of incorporating new procedures in the specialty as soon as they are available to his patients. The latter just joined the practice — one of the largest doctor-owned eye-care practices in the U.S. — this fall, after completing residency and fellowship training at two renowned U.S. eye-care centers, where he worked on complex corneal-care cases.

The two physicians provide patients with access to the most transformational corneal transplant procedures, as well as treatments for all corneal and external disease issues, with some procedures being a patient’s last hope to save their vision.

Dasa V. Gangadhar, MD, and Grene Vision Group’s newest ophthalmologist, David T. Truong, MD, are both fellowship-trained with extensive experience in corneal transplantation and corneal and external disease care.

Saving Austin’s Eyes

For a long time, as her 6-year-old son Austin was fighting a rare, serious condition, Amanda Brack never saw his eyes. Stevens-Johnson Syndrome was attacking his body, causing almost burn-like rashes on his skin, blistering the insides of his body and attacking his mucous membranes, including his eyes.

Austin Brack recovers following a five-hour surgery performed by Grene Vision Group ophthalmologists Dasa V. Gangadhar, MD, and Samuel W. Amstutz, MD. The procedure involved lining the entire corneal and ocular surfaces of Austin’s eyes with thin, cellophane-like sheets of amniotic membrane harvested from a placenta.

Even before the boy was transferred from Great Bend Regional Hospital to Wesley Medical Center in Wichita, a Great Bend ophthalmologist noticed his eyes were being attacked, says Amanda, who documented the syndrome’s progression in her son. Austin was later transferred to Via Christi Regional Burn Center.

“You could see early on that his eyes were swollen and he was having problems seeing,” Amanda says.

Stevens-Johnson Syndrome is a rare disorder, often triggered by certain medications. Austin’s case was even rarer because it was triggered by a high microplasma count, activated by a bout with pneumonia.

It became too painful for Austin to open his eyes as he was being treated at the burn center, so he kept them closed. His mother worried that he’d lose his vision, which is a frequent side effect of the disease.

“I never saw his eyes unless Dr. Gangadhar came in and would ask if he could touch him and open his eyes,” Amanda says.

With his skills and training to handle the most complex eye-care cases, Dasa Gangadhar, MD, from Grene Vision Group, had been called in to consult about saving Austin’s eyes.

“It wouldn’t matter how late it was, he would come to see Austin every day, if it was 6 o’clock or 10 o’clock. He really cared about Austin,” Amanda says.

“Without intervention, there’s a high risk of permanent bilateral blindness,” Dr. Gangadhar says. “In fact, my colleague Dr. David Truong and I just saw a patient like this who came in and hadn’t had intervention and is now bilaterally blind.”

Dr. Gangadhar researched and proposed a new treatment to save Austin’s vision. The day after Thanksgiving of 2013, he and Grene Vision Group colleague Samuel Amstutz, MD, conducted a five-hour procedure in which the entire corneal and ocular surfaces of Austin’s eyes were lined with thin cellophane-like sheets of amniotic membrane harvested from a placenta.

“The sheets have very significant anti-inflammatory and healing properties that prevent destruction of the ocular surface, which can happen without intervention,” Dr. Gangadhar says.

Almost immediately after the procedure, Austin was able to open his eyes. “It was amazing,” his mother says.

Now 10 years old and in fourth grade, Austin has recovered from the disorder. He wears glasses, but doctors have told his mother that since most of the family wears glasses he was likely destined to wear them anyway.

“I’m really blessed that Dr. Gangadhar came into our lives,” Amanda says. “We could have had a whole different outcome.”

The cornea, the clear tissue at the very front of the eye, plays an important role in one’s vision, allowing light to pass through to the retina, which is in the back. If a cornea or parts of it are damaged or unhealthy because of disease or trauma, a patient may require a transplantation of new tissue to restore one’s vision.

“In 2005, there was essentially a revolution in corneal transplantation surgery,” Dr. Gangadhar says. “We went from a very invasive procedure, where we were replacing the whole cornea with a new one, to a selective transplantation where we could replace just those parts of the cornea that were abnormal.”

That treatment is known commonly as DSEK, which stands for Descemet’s stripping endothelial keratoplasty. Within months of the procedure’s approval, Dr. Gangadhar, a Harvard-trained, board-certified ophthalmologist, completed the first DSEK surgery in Kansas. Since December 2005, he’s completed about 1,400 DSEK procedures.

With DSEK, qualifying patients no longer need to undergo a full corneal transplant. Instead, surgeons remove and transplant the most posterior layers of the cornea.

“The replacement of just the inner layers of the cornea allows for much faster vision recovery, a much safer surgery and much better results than we had previously,” Dr. Gangadhar says.

The DSEK procedure was refined even more. That variation is DMEK, or Descemet’s membrane endothelial keratoplasty. In that procedure, only the endothelium and Descemet membrane are removed and transplanted. Dr. Truong is one of the first surgeons in Wichita to offer DMEK.

David T. Truong, MD, uses a slit lamp to examine a patient’s eyes. Dr. Truong is the latest addition to Grene Vision Group’s ophthalmology staff. He specializes in cornea and external disease, including corneal transplantation and cataract and refractive surgery.

“With DSEK, you work with a more solid form of tissue because of the stroma,” explains Dr. Truong. Because it is a much more fibrous layer, the stroma “helps provide more stability. With DMEK, the tissue can scroll up.”

Patient outcomes have improved even more with DMEK.

“With this new procedure, patients recover from it so much faster than under DSEK because, theoretically, there is less overlap of the tissue, so patients achieve better visual outcomes and there is less risk of rejection because the antigen load is less,” Dr. Truong says.

While DSEK and DMEK are variations of corneal posterior surface transplantations, deep anterior lamellar keratoplasty, or DALK, is a selective transplant of the front surface of the cornea, using just the stroma.

Grene Vision Group Covers All Eye Care, All Over Kansas

Grene Vision Group is one of the largest doctor-owned eye-care groups in the U.S., with 12 ophthalmologists, 37 optometrists and more than 350 opticians, technicians and support staff who work in 21 clinics in Kansas.

The practice provides total eye care for the entire family and covers all primary, medical and surgical services. The 12 ophthalmologists at Grene Vision Group and their services are:

In the eyes of the patients, all of these options offer far better outcomes than transplanting the entire cornea. In a traditional corneal transplantation, known as penetrating keratoplasty, or PK, the incisions are larger, which entail higher post-recovery risks and require more healing time.

New procedures in corneal transplantation are continuing in the field of ophthalmology, including artificial telescopic corneal transplantation. Dr. Gangadhar has done two such procedures.

In December 2016, Dr. Gangadhar began offering another revolutionary and recently FDA-approved procedure, to treat keratoconus, a disease in which the cornea becomes diseased and misshapen or deformed. Dr. Gangadhar had been one of the clinical investigators of a procedure known as corneal cross-linking as it underwent the FDA approval process.

Grene Vision Group has undergone tremendous growth over the years and particularly in the past year, as more doctors have been added to the practice and optical and clinical spaces have been remodeled and built to provide more efficient and expanded facilities. The need for eye care is increasing — in part because of a growing population and in part because of the advances in eye-care treatments, Grene Vision Group officials say.

Dr. Dasa Gangadhar is performing a corneal transplant using microsurgical techniques. Eye surgery is only possible with the use of an operating microscope, which allows for magnification of very fine, delicate structures of the eye.

The minimally invasive procedure involves using special eye drops containing riboflavin and a device that produces ultraviolet light, the combination of which strengthens the chemical bonds within the cornea.

Until now, there has been no medical or surgical procedure to halt the progression of the disease, which often presents in the teenage years and throughout a person’s 40s. Many patients with keratoconus eventually require corneal transplantation.

“I saw a 12-year-old boy with the disease today, and we just signed him up for corneal cross-linking,” Dr. Gangadhar says. “Our hope is that in 15 years, we will have significantly reduced the need for transplantation among keratoconus patients.”

The addition of Dr. Truong will be a significant boost to Grene Vision Group, as the practice will be able to serve more patients, says Dr. Gangadhar, who’s been honored repeatedly since 2001 by fellow physicians as one of the best doctors in America.

Dr. Truong, who joined the practice in August, completed his residency in ophthalmology at the largest and busiest ophthalmology program in the country, the University of Texas Southwestern Medical Center. Following his residency, he obtained further training in cornea and refractive surgery as a fellow at the well-respected Jules Stein Eye Institute, where he routinely managed the most complex corneal disease cases from all over the world.

Together the pair will be involved in FDA trials, allowing regional patients access to newer procedures, and they will continue to treat the most complex corneal cases.

“Having two trained ophthalmologists will allow us to be available for the very, very complicated and difficult corneal situations pretty much seven days a week, 365 days a year,” Dr. Gangadhar says.

For more information about corneal treatment and transplantation, contact Grene Vision Group at 316-684-5158 or visit