Ophthalmology’s ‘moon shot’: Donation fast-tracking Bascom Palmer‘s whole eye transplant initiative

(Image Credit: AdobeStock/Orawan)

A $1 million donation to the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine could fast-track researchers’ high-impact initiative to transplant the whole eye.

The donation was made by Florida philanthropist and humanitarian Lois Pope, according to a Bascom Palmer news release.¹

“My mother suffered terribly for many years from macular degeneration,” Pope said. “Of course, she is not alone. There are 20 million people here in the U.S. with that disease. And when you combine that with the millions facing blindness and vision impairment from many other conditions, you can quickly understand how essential it is for this project to come to fruition. If my gift to Bascom Palmer can in a small way make that happen more quickly, then I will have done what I’ve always set out to do with all my philanthropic work, which is to help transform lives of the most vulnerable members of our society.”

With the latest donation and Pope’s earlier gifts to create the Lois Pope Center for Retinal and Macular Degeneration Research and Lois’ Vision4Kids, Eduardo Alfonso, MD, director of Bascom Palmer and chair of the Department of Ophthalmology at the Miller School, offered his thanks for the gift.

“Lois Pope is, pardon the pun, a true visionary,” he said. “More than just being generous with her financial support of our Institute, she is generous with her time and energy.”

Alfonso noted that Pope’s philanthropy extends far beyond financial contributions.

“She invests her time and vigor into our endeavors,” he said in the news release. “Her interest in the whole eye transplant initiative is a perfect case in point. She is not one to simply offer financial aid.”

According to Alfonso, Pope seeks a profound understanding of Bascom Palmer’s goals and challenges.

“This active curiosity and commitment to our cause is both invigorating and invaluable,” he said. “We are immensely thankful for her unwavering support.”

Alfonso said a goal of whole eye transplant project is to provide blind patients with a seeing eye, perhaps by using a biological eye modified to make it functional for vision.¹

The “bionic eye” will likely include an electronic chip, with gene therapy to prevent allograft rejection, stem cell therapy to replace degenerating eye tissue and electronic connections to the brain.

Felipe A. Medeiros, MD, PhD, vice chairman of research at Bascom Palmer, pointed out that the goal of a whole eye transplant is a formidable challenge that will bring together the collective wisdom and dedication of the Bascom Palmer team. This collaborative venture will leverage the diverse expertise of the University of Miami’s College of Engineering, the Lois Pope LIFE Center, the Miami Transplant Institute and Miller School departments.¹

According to the news release, Medeiros explained that optic nerve regeneration and reconnection are far from the only challenges to a successful eye transplant. On the surgical side, the donor eye tissues must be removed and transported to the recipient. Microsurgery and oculoplastic procedures place the eye in the right position, reconnect the muscles and restore blood flow through the capillaries and veins.¹

Thomas E. Johnson, MD, professor of clinical ophthalmology at the Miller School, said he believes this is the right team for the challenge.

“Our oculoplastic surgery team is at the forefront of both clinical and fundamental research,” he said in the news release. “With our collective imagination, extensive experience and honed skills, we’re equipped to devise innovative solutions to even the most challenging and complex issues.”

Moreover, Daniel Pelaez, PhD. research associate professor of ophthalmology at the Miller School and scientific director at the Dr. Nasser Ibrahim Al-Rashid Orbital Vision Research Center, expressed optimism in the research.

“We have embarked on a journey that can provide many benefits to patients with different conditions,” he said in the news release. “It can lead to advances in many fields of medicine. It can shift the entire paradigm.”

Pelaez elaborated on the scientific foundation’s underpinning their work, referencing the research of Nobel Laureate Roger Sperry.¹

“In the 1960s, Sperry’s work with amphibians like frogs and salamanders revealed an innate biological capacity for regeneration,” Pelaez said in the news release. “Our challenge—and our opportunity—is to decode how these natural processes function and then translate them into therapeutic applications for humans.”

David T. Tse, MD, professor of ophthalmology and Dr. Nasser Ibrahim Al-Rashid Chair in Ophthalmology at the Miller School, developed a surgical technique to transplant and preserve the globe of the eye after it is removed from a donor’s blood supply. Researchers point out that quick restoration of blood flow is vital for tissue survival.

Organ rejection is another challenge, Victor L. Perez, MD, professor of ophthalmology at the Miller School, said in the news release. He pointed out that the immune privilege is a delicate balance that must be maintained to prevent rejection.

“Our ongoing research into ocular immunology seeks to understand and control the immune response to transplants, aiming to develop new methods that will allow us to integrate donor tissue seamlessly into the recipient’s immune system.”

Alfonso likened the effort to a “moon shot,” echoing President John F. Kennedy’s call to land a man on the moon and return safely home in the 1960s.

“I want Bascom Palmer to be the first eye center in the world to achieve the moon-shot goal,” Tse concluded in the news release. “Whole eye transplant is the final destination.”

There is a “space race” of sorts with a goal of a successful whole eye transplant, with other programs conducting similar research.

A surgical team of over 140 clinicians, including surgeons, nurses, and related health care clinicians from New York University (NYU) Langone Health, New York, performed the world’s first whole-eye and partial face transplantation on a 46-year-old man. The patient, Aaron James, a military veteran from Hot Springs, Arkansas, survived a work-related, high-voltage electrical accident that occurred in June 2021.²

The 7,200 volts of electricity resulted in loss of the patient’s dominant left arm above the elbow, loss of his entire nose and lips, front teeth, left cheek area and chin down to the bone, and destroyed the left eye.

During the surgery, the entire left eye and part of the face of 1 donor were transplanted to Mr. James, resulting in a medical first, ie, a successful human whole-eye transplant combined with a partial facial transplant.

The 21-hour transplantation procedure was performed in May 2023. Thus far, the facial transplant has shown no signs of rejection, which, Eduardo Rodriquez, MD, DDS, said, generally occurs in the early months after the procedure. He is the Helen L. Kimmel Professor of Reconstructive Plastic Surgery, and Chair of the Hansjörg Wyss Department of Plastic Surgery, and director of the Face Transplant Program at NYU Langone.

The transplanted eye is doing remarkably well, in that the retina has a good blood supply and intraocular pressure. It currently is protected by the closed left lid, which prevents the eye from suffering exposure damage. The eye care team in this case is led by Vaidehi S. Dedania, MD, a retina specialist in the Department of Ophthalmology at NYU Langone.

At the time, the clinicians did not know yet if the vision ultimately will be restored; however, since the procedure, the transplanted left eye has shown remarkable signs of health, including direct blood flow to the retina, according to a press release.

The eye and partial face transplant at NYU Langone Health differs slightly from the goal of a whole eye transplant at Bascom Palmer, but both efforts ultimately could provide sight to patients who have lost their vision.

Reference:

1. Release. Bascom Palmer Eye Institute’s “Moon Shot” Whole Eye Transplant Research Initiative. InventUM. Published March 5, 2024. Published March 5, 2024. Accessed March 27, 2024. https://news.med.miami.edu/bascom-palmer-focuses-on-whole-eye-transplants/

2. Face to face: World’s first whole-eye and partial face transplant. Ophthalmology Times. Published November 9, 2023. Accessed March 27, 2024. https://www.ophthalmologytimes.com/view/face-to-face-world-s-first-whole-eye-and-partial-face-transplant