Necessity is the mother of invention, they say — and there are few things more necessary to people than vision.
To be clear, we’re not sure who the “they” is in the aforementioned aphorism. But it holds water, especially when it comes to basic sensory perceptions. Most people will go far out of their way to retain or improve their vision, especially when the grim spectre of blindness looms over the horizon.
It’s for this reason that corneal transplants were one of the first successful transplants of any kind. Surgeons more than a century ago recognized the value of corneal transplants, and the practice has come a long way. Indeed, unbeknownst to most of the general public, there is a whole worldwide infrastructure built around eye banks and international corneal exchanges that facilitates this vision-saving surgery.
That infrastructure itself has been challenged like never before by the ongoing pandemic. Even that hurdle, however, has led to innovation. If nothing else, people are creative and adaptive. One could make a solid argument that such traits are our most valuable survival tools, and the same can be extrapolated to organizations and companies.
So let’s start by taking a brief look backwards at just how corneal transplants came to exist in the first place — and then the recent struggles and innovations that have taken place much more recently.
A Brief Retrospective of Corneal Transplants
The first successful human corneal implant took place in 1905, performed by a Czech physician named Eduard Zirm. Zirm used the cornea of an 11-year old boy who had suffered eye trauma and had to have his eye removed; that cornea was successfully implanted on a 45-year old man who had suffered lime burns to his eyes. By “lime” we mean calcium oxide, a natural fertilizer. It’s also a natural enemy of eyes, since it reacts strongly with water.
After a week, the cornea implanted on the right eye had to be removed, but the left eye remained stable. This went contrary to popular opinion at the time, which held that no graft would remain transparent for more than two to three weeks. However, months afterward the man’s left eye continued to work well and the graft remained stable. Thus was a medical breakthrough born.
Note the words “successful” and “human” in the first paragraph of this section. The concept of corneal transplants had been around for some time — and by 1905 the idea was quite ancient.
Indeed, the concept goes as far back as the 2nd century AD physician Galen, though realistic attempts at corneal transplants didn’t occur until the 19th century. The first successful corneal transplant happened to a gazelle, of all animals, in 1837. There were several attempts to transplant animal corneas to humans around the same time, which did not go well. The extant belief was that corneal tissue had to come from a living donor — and taking corneal tissue from a living human was an unpalatable idea, to say the least.
In case you’re wondering about the 11-year old boy who provided the cornea for the first successful transplant, he survived — his eye had to be removed after an injury. He was not the subject of some grisly experiment.
Eye Banks Go Global
The following few decades after Zirm’s successful transplant saw the birth of modern corneal transplants. It was the Russian ophthalmologist Vladimir Filatov who introduced the idea of using cadavers as the source of corneal tissue, which meant surgeons no longer had to wait for an unfortunate accident for one person to lead to corneal tissue being available for their patient.
The first eye bank was born in 1944 under the auspices of the American ophthalmologist Richard Paton. From there, practices were consolidated, clearing houses established, and essentially the modern infrastructure that allows worldwide corneal transplants was built. That story itself could (and might) be its own article, but from here we jump forward in time to now.
The Covid-19 Bottleneck: Forcing Innovation
In May and June of 2020, CAKE magazine reported that there were serious bottlenecks developing in the eye banking world. These bottlenecks occurred due to a “preponderance of safety” according to Monty Montoya, CEO of CorneaGen, the largest supplier of corneal tissue in the world.
At the time, CorneaGen was operating at around 5 to 10% of capacity, and international shipments of corneal tissue had essentially ground to a halt. A looming shortage expected to last from 12-24 months seemed entirely likely due to two concurrent problems. First, there was a lack of corneal harvesting from cadavers due to safety concerns that the cadaver may have carried the COVID-19 virus. Second, lockdowns both regionally and internationally meant that transporting corneal tissue was nearly impossible. Some regions provide more corneas than they use, so there needs to be a worldwide distribution network.
Mr. Montoya noted that developments were underway to help generate new corneal tissue via cell therapy. Essentially, a small amount of corneal tissue is placed in a medium that helps to grow new tissue — leading to lab-grown corneas. If this process gets ramped up to speed, it could help forestall any shortages that have arisen due to the COVID-19 crisis.
It’s hard to overstate just how much the industry has been impacted. Many are unaware of the complicated behind-the-scenes workings of the cornea bank industry, but the foundations have been laid bare. They weren’t a secret — they just weren’t in the spotlight that often.
The First Artificial Corneal Transplant
This brings us back to our original point: Necessity is the mother of invention. To wit, the first artificial corneal transplant took place in early January of 2021. It’s fairly mind-blowing news, really.
A 78-year old blind man had the fortune to be on the receiving end of this transplant, which took place in Israel. The artificial cornea, dubbed CorNeat KPro, was created by the Israeli company CorNeat (Raanana, Israel), who had been developing the technology for years.
The surgery was an immediate success, with the patient able to read and recognize friends and family the day after surgery. It’s been hailed as a huge victory and medical breakthrough: The procedure requires no donor corneal tissue and carries no risk of disease as it is entirely artificial.
More trial transplants are set to follow at the Rabin Medical Center, and further test sites are set to open in Japan and Canada, and later in other countries. The company aims to acquire FDA and other international regulatory approvals. For many, the idea of a wholly lab-grown or artificial cornea was the “holy grail” of corneal transplantation technology. Well, here it is.
If we can take one lesson from the ceaseless and sometimes breathless development of corneal transplantation, it’s that ophthalmology is on the cutting edge of medical science. Perhaps it’s because people rank sight among the most important aspects of their lives.
We fully expect to see continued innovation in this area and will do our best to keep our jaw from hitting the floor at each new development. Despite setbacks, the medical community always finds a way forward — and we’re always impressed.