Victor Perez, M.D., associate professor of ophthalmology at the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, talks about a procedure that uses a tooth to restore sight.

What is the problem that you are trying to address with these patients?

Dr. Victor Perez: We’re talking about patients that have what we call end-stage corneal blindness. These are patients that the front part of the eye, which is the cornea – that’s where you put your contact lenses – has completely scarred down to the point that it doesn’t produce any tears. It’s totally dry, and not even a corneal transplant, which would be the standard of care for corneal blindness, would survive. It’s very frustrating because these patients are blind because the front part of the eye is scarred down. In most instances, the retina, the back part of the eye, is working, the optic nerve, so if we can just put a plastic window so they could see, we can change their life.

What options could you offer these patients before this procedure?

Dr. Perez: None. We and other groups have played with the idea of using other prostheses, but they don’t survive; their survival rate is low. They have many complications, and the Italian physician who has modified this technique throughout the years has demonstrated and polished that this technique works well in this type of patient.

Why is the mouth a good place to look when you start looking for options for these patients?

Dr. Perez: The population of patients that we’re treating with this technique is those where the ocular surface is totally scarred down – there are no tears; it’s totally dry – so if we can reconstitute that, the mouth is a perfect place to start with. First, we take the oral lining of the mouth that produces fluid and we cover the cornea with that, so now it’s wet. Then we take the tooth and the bone that communicates with that lining all the time in the mouth, and we put it in the eye, and those three units work very well together to maintain this cylinder to be exposed and integrated into the eye and allow the patient to see.

What is the cylinder?

Dr. Perez: The cylinder is the optical part – that’s what’s going to put the rays of light into the retina. It’s a cylinder made of this acrylic material. We custom made it for each patient so we know what the power is needed to put exactly the light in the retina. That’s probably the most important part of the prosthesis – it’s like the lens in your camera

Will something eventually be placed over the prosthesis in your patient, Kay’s eye?

Dr. Perez: The cylinder or the lens of her camera is going to be open, but the mucosa –the lining of her ocular surface, just so she looks like she has a normal eye – will make a plastic shell. It’s kind of like a contact lens – it will go over the surface of the cornea, and then it’s a tattoo with an iris and color. That way, cosmetically, it will look like nothing happened in that eye.

Long-term, will this be something that will allow her to see for years to come, and with relatively little chance of complications?

Dr. Perez: There are always chances of complications. This is a very complex surgery and it’s a slick, ocular surface. The polished data have between 80 and 90 percent success rate for 10 years. In some cases, they have up to 30 years’ survival. She had a good start – she had a 20/70 start – and everything has gone so far, very well, you know, good healing, so I’m optimistic – cautious optimism – but I would love to see Kay 10 years from now with the same vision, and I’m also hopeful she will.

What is her vision right now?

Dr. Perez: For distance, it is 20/70 without any type of corrective glasses, which compared to the shadows that she was seeing, it’s a lot. For reading distance, if we put a magnifying glass, she can see maybe 20/40, 20/50, which is the normal print you’ll see in a newspaper or magazine.

How exciting is this for you as a physician to be able to offer this to a patient?

Dr. Perez: It’s very exciting because we were so frustrated with this type of patient because these are the patients that are told we cannot do anything, and it’s very exciting to see that we can change the life of someone. We are really looking forward to treating more patients like Kay, and chemical and thermal injuries. A big population of those patients is soldiers that in war get all these chemical and thermal burns and they can’t see. We are working with the Department of Defense in order to establish a program.

What is the disease that she has that caused this?

Dr. Perez: It’s called Stevens-Johnson syndrome, which is kind of like an immunological burn. They develop kind of like a severe allergic reaction to a medication – sometimes it’s a virus, sometimes we never find out how they develop. In her case, it was the medication, and they get sick and blind in a matter of a week.

Are these corneal injuries fairly common, where their cornea becomes dry and scarred, and they can’t see?

Dr. Perez: They’re not as common as other forms of corneal scars that occur because of infection or trauma, but they are out there. They’re just hidden because there is someone who has told them they cannot do anything about it, so our hope is that those patients never make it to the clinic or the surgery. We don’t know how many are there, but I’m assuming that we’ll probably have close to 100, maybe 200 cases – that is the experience in Italy.

Using a Tooth to Restore Sight — In-Depth Doctor’s Interview

Victor Perez, M.D., associate professor of ophthalmology at the Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, talks about a procedure that uses a tooth to restore sight.

What is the problem that you are trying to address with these patients?

Dr. Victor Perez: We’re talking about patients that have what we call end-stage corneal blindness. These are patients that the front part of the eye, which is the cornea – that’s where you put your contact lenses – has completely scarred down to the point that it doesn’t produce any tears. It’s totally dry, and not even a corneal transplant, which would be the standard of care for corneal blindness, would survive. It’s very frustrating because these patients are blind because the front part of the eye is scarred down. In most instances, the retina, the back part of the eye, is working, the optic nerve, so if we can just put a plastic window so they could see, we can change their life.

What options could you offer these patients before this procedure?

Dr. Perez: None. We and other groups have played with the idea of using other prostheses, but they don’t survive; their survival rate is low. They have many complications, and the Italian physician who has modified this technique throughout the years has demonstrated and polished that this technique works well in this type of patient.

Why is the mouth a good place to look when you start looking for options for these patients?

Dr. Perez: The population of patients that we’re treating with this technique is those where the ocular surface is totally scarred down – there are no tears; it’s totally dry – so if we can reconstitute that, the mouth is a perfect place to start with. First, we take the oral lining of the mouth that produces fluid and we cover the cornea with that, so now it’s wet. Then we take the tooth and the bone that communicates with that lining all the time in the mouth, and we put it in the eye, and those three units work very well together to maintain this cylinder to be exposed and integrated into the eye and allow the patient to see.

What is the cylinder?

Dr. Perez: The cylinder is the optical part – that’s what’s going to put the rays of light into the retina. It’s a cylinder made of this acrylic material. We custom made it for each patient so we know what the power is needed to put exactly the light in the retina. That’s probably the most important part of the prosthesis – it’s like the lens in your camera

Will something eventually be placed over the prosthesis in your patient, Kay’s eye?

Dr. Perez: The cylinder or the lens of her camera is going to be open, but the mucosa –the lining of her ocular surface, just so she looks like she has a normal eye – will make a plastic shell. It’s kind of like a contact lens – it will go over the surface of the cornea, and then it’s a tattoo with an iris and color. That way, cosmetically, it will look like nothing happened in that eye.

Long-term, will this be something that will allow her to see for years to come, and with relatively little chance of complications?

Dr. Perez: There are always chances of complications. This is a very complex surgery and it’s a slick, ocular surface. The polished data have between 80 and 90 percent success rate for 10 years. In some cases, they have up to 30 years’ survival. She had a good start – she had a 20/70 start – and everything has gone so far, very well, you know, good healing, so I’m optimistic – cautious optimism – but I would love to see Kay 10 years from now with the same vision, and I’m also hopeful she will.

What is her vision right now?

Dr. Perez: For distance, it is 20/70 without any type of corrective glasses, which compared to the shadows that she was seeing, it’s a lot. For reading distance, if we put a magnifying glass, she can see maybe 20/40, 20/50, which is the normal print you’ll see in a newspaper or magazine.

How exciting is this for you as a physician to be able to offer this to a patient?

Dr. Perez: It’s very exciting because we were so frustrated with this type of patient because these are the patients that are told we cannot do anything, and it’s very exciting to see that we can change the life of someone. We are really looking forward to treating more patients like Kay, and chemical and thermal injuries. A big population of those patients is soldiers that in war get all these chemical and thermal burns and they can’t see. We are working with the Department of Defense in order to establish a program.

What is the disease that she has that caused this?

Dr. Perez: It’s called Stevens-Johnson syndrome, which is kind of like an immunological burn. They develop kind of like a severe allergic reaction to a medication – sometimes it’s a virus, sometimes we never find out how they develop. In her case, it was the medication, and they get sick and blind in a matter of a week.

Are these corneal injuries fairly common, where their cornea becomes dry and scarred, and they can’t see?

Dr. Perez: They’re not as common as other forms of corneal scars that occur because of infection or trauma, but they are out there. They’re just hidden because there is someone who has told them they cannot do anything about it, so our hope is that those patients never make it to the clinic or the surgery. We don’t know how many are there, but I’m assuming that we’ll probably have close to 100, maybe 200 cases – that is the experience in Italy.