By MARCIA MATTSON
The Times-Union (Jacksonville News Paper)

[Last modified Tue., November 11, 2003 - 12:55 AM
Originally created Tuesday, November 11, 2003]

Vision quest

A close-up of the artificial cornea. Gulani is among 10 U.S. doctors implanting the new devices. WILL DICKEY/The Times-Union

New artificial cornea seen as landmark in eye surgery

By MARCIA MATTSON
The Times-Union
Carletta Drew's right eye showed her a blurred, dark world for most of her life.And for most her life, the 79-year-old Westside woman has waited for medical technology to catch up to her need.Drew was a 6-year-old girl making sand castles when a cousin spun around with a bucketful of sand and struck Drew in the face. Vision in her right eye failed. But doctors at the time couldn't help. She waited dec- ades for doctors to develop the skills to transplant corneas from deceased donors.

"I lived for that day," she said. In 1991, she got her transplant, and shapes once again grew clear. But her body rejected the cornea a few years ago. Her sight dimmed again. This time she didn't have to wait long for the next medical breakthrough: Last week she became one of the first U.S. patients to receive a new artificial cornea. Her doctor, Arun C. Gulani, a University of Florida ophthalmologist based at Shands Jacksonville, is among 10 U.S. doctors implanting the new devices. "I look at this as a landmark event in eye surgery," Gulani said. "What's the dream of eye surgeons? To make an artificial eye. This is the first step into what we always knew as science fiction." The cornea is an eye's window to the world. Light passes through this clear dome on the front of the eye, behind which are the pupil, iris and lens. The cornea helps focus light to the retina at the back of the eye.

Until recently, about 10 percent of all people who needed a new cornea had no hope of regaining their vision, Gulani said. Some had rejected transplanted corneas. Others had eyes so severely diseased or so scarred from accidents that a real cornea could not adhere and survive.

University of Florida eye surgeon Arun C. Gulani uses a microscope to implant an artificial cornea into a patient's eye at Shands Jacksonville. The image in the background is a close-up of the cornea on a video monitor. WILL DICKEY/The Times-Union

"A real cornea still needs nourishment and tears, a good foundation for tissue," Gulani said. "Many of these patients are thinking they will be blind all their lives." "When I was told I was a candidate for an artificial cornea, I liked to have fainted," said Drew a few days before the procedure. "I was so happy, you'll never know." The artificial cornea, which the U.S. Food and Drug Administration approved in May, isn't living tissue. All it needs to do is stay in place and stay intact. In the past, artificial corneas haven't been able to do the job, Gulani said. Some models were prone to tearing or dissolving. So doctors over the last several years had largely abandoned their use. But the latest model, a water-based polymer manufactured by Australian company Argus Biomedical, is stronger than its predecessors because it's one single piece rather than two separate pieces, said Argus clinical account manager Beth J. Spearman. The clear middle, which provides vision, is surrounded by a sort of micro-mesh that biochemically bonds over time with the eye's own tissue. The artificial cornea has been used in human tests for four years, and about 80 percent of patients who received one were able to retain it.

Gulani talks with Carletta Drew the day after he implanted an artificial cornea in her right eye. WILL DICKEY/The Times-Union

This product won't replace the use of real corneas, which are still the best option for patients and are not in short supply in this nation, Spearman said. And they're not an option for patients who smoke or use a certain medications, she said, because those activities turn the device brown. An artificial cornea costs about $7,000. Medicare covers the procedure, as do private insurance companies, with a letter from a doctor, Gulani said. Putting in the cornea requires two outpatient surgeries under local or general anesthesia. In Drew's first surgery, Gulani created a tiny pocket within the bad cornea and inserted the artificial product. Three months from now, he will cut away the remainder of the tissue covering the artificial cornea's clear center. But Drew could already see better the day after her first surgery. "Now I can see your general shape," she said as she waited for a follow-up visit with Gulani. "It is just so wonderful to be able to see." Drew said she had worried she would grow completely helpless if the vision in her left eye failed as well. "I just prayed to God I don't go blind in both my eyes," she said. "I have prayed and asked God to give me some sight to see." Now, she's looking forward to the day she can drive again. In the meantime, she's going to return to one of her favorite hobbies. "I'm going to go out in my garden and plant flowers and plant shrubs," she said.

marcia.mattson jacksonville.com, (904) 359-4073