An artificial miracle: Implant offers second chance at sight for blind

Monday, August 15, 2005

SPRINGFIELD, Mo. -- Ginger Flower could only marvel at the medical miracles that changed other people's lives: restored hearing for the deaf, new hearts and kidneys for the dying, mechanical hands for amputees. There would be no miracles for her, doctors had said long ago.

The Mansfield woman was born with a rare congenital eye condition, aniridia, marked by the absence of an iris. She also has scarring of the cornea, the clear "window" on the front of the eye that lets in light and helps the eye focus. She is legally blind, able to distinguish only light, color and words with the aid of a magnifier.

Flower's mother and older sister were also born with the condition, but efforts to improve their vision with human corneal tissue transplants failed.

Doctors discouraged Flower from going through transplant surgery -- family history made her a bad candidate.

But deep down, Flower never lost hope. This summer, her faith paid off.

She can already see better after only the first of a two-stage surgery to implant an artificial cornea in her left eye.

Her June 22 surgery, the first of its kind in the Ozarks, offers hope for a small number of patients who were told there was no hope.

"We're very excited," said St. John's Clinic ophthalmologist Dr. Shachar Tauber.

A temporary haze still shrouds her vision, but she's excited about being able to see figures, count fingers held in front of her and identify the big E on an eye chart.

Follow-up surgery in September will remove the haze, leaving a clear view and improved vision in her left eye.

"I'm pleased already with the results," Flower said. "Just seeing figures is better than nothing. ... I would be happy with just anything."

Plans for the future

Her new sight comes just in time for the expected births of two grandchildren.

"When the grandkids come I'll be able to see them, to see their faces a little better," she said.

"To somebody who can see, they don't think a lot about it. To me, it means a lot more."

Flower is already making plans for the future. After working as a certified nurse assistant in a nursing home for 20 years, Flower plans to study business management at Ozarks Technical Community College this fall. She wants to become a nursing home administrator.

Tauber, a cornea and refractive specialist and director of research at St. John's Clinic -- Eye Specialists, was pleased during her recent follow-up exam.

"The fact you can see better now is very promising," he told Flower.

At least 10 million people worldwide suffer from corneal blindness, according to the World Health Organization.

The cornea is the clear tissue covering the front surface of the eye, Tauber explains. It provides physical protection for the eye and part of the eye's focusing power required for sight.

But when the cornea is damaged by injury or disease, scarring and inflammation can reduce the passage of light and prevent vision.

Often it's possible to replace the cornea and restore sight by transplanting a donated human cornea.

Yet only about 100,000 people worldwide receive human cornea transplants every year -- 40,000 of those in the United States, experts say.

In addition, about 20 percent of the world's 100,000 transplant cases are unsuccessful. Often the body rejects the new tissue despite repeated surgeries, Tauber said.

Confident that artificial cornea implants can offer hope for many of those patients, Tauber is on a mission to find them.

"Most of these patients are tucked away because they've been told, 'We can't help you."'

Patients just like Ginger Flower.

Scientists envisioned an artificial cornea as early as 1789, and developed the first one in the 1800s, Tauber said.

Much later, a team of scientists and clinicians affiliated with the Lions Eye Institute of Western Australia developed the AlphaCor. It was one of the first two artificial devices approved in 2002 by the U.S. Food and Drug Administration.

Tauber now uses the AlphaCor, made by CooperVision Surgical in Western Australia. Some 236 U.S. patients have either begun or completed the two-step surgery using the AlphaCor since 2002, said Pat Kane, a Houston-based nurse and senior clinical account manager with CooperVision Surgical.

Results vary with the underlying health of the eye, she said.

The AlphaCor is a small, flexible plastic disc. The middle part is clear and acts like a lens, just like the natural cornea.

The white outer rim, or skirt, is spongy so that over time the patient's own tissue can grow into it and hold it in place.

The surgery is done in two stages, about three months apart, to allow for healing.

While Flower was under general anesthesia, Tauber made a small incision at the top of her left eye.

Then he inserted the artificial cornea into her damaged cornea. Tauber then stitched the incision closed.

Expensive implant

The first surgery can take 30 minutes to three hours, depending on the eye's condition. Flower's straightforward procedure took about 90 minutes, and she remembers only that her eye felt "uncomfortable" during recovery.

As with any surgery, there is a risk for infection. Patients also have to use special eyedrops to promote healing; they must use other drops the rest of their lives to prevent corneal scarring. One benefit: the artificial device doesn't trigger an autoimmune response that a human tissue transplant does, so patients don't require lifelong anti-rejection drugs, he said.

In late September, Flower will return for step two, a 20-minute procedure under local anesthetic in which Tauber will uncover the artificial cornea, leaving a clear view.

"If the rest of the eye is working well, that should be the defining surgery," Tauber said.

"She's already seen some vision restored," he added. "She should have better vision, and that will make her more independent."

Artificial implants are still expensive -- about $7,800 per cornea, Tauber said. Human corneas cost about $2,000 each, but they aren't options for patients like Flower.

Medicare paid for her surgery; the Springfield-based Rehabilitation for the Blind covers other expenses.

If the price drops over time, Tauber said, artificial implants could create more transplant options worldwide, especially in cultures that discourage the use of human donor tissue.

Patients who have completed the two-part surgery offer a message of optimism for the Ozarks woman biding her time until September.

Nashville, Tenn., resident Richard Simon said he was thrilled the day a Vanderbilt University surgeon placed an AlphaCor in his right eye June 8.

The first things he remembers seeing were the name tags of excited staff around him.

"It's like a rebirth," Simon said.

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