Vision-restoring whole eye transplants may soon be a reality

 
The Byers Eye Institute at Stanford is a place of many “firsts,” but the biggest one may be just on the horizon: vision-restoring whole eye transplants — a potential panacea to bring back vision for the blind. 

Stanford University has received an award to bring together more than 40 scientists, doctors, and industry experts hand-picked from around the country to make whole eye transplants a reality. Jeffrey Goldberg, MD, PhD, Blumenkranz Smead professor and chair of ophthalmology at the Byers Eye Institute at Stanford, will serve as principal investigator. José-Alain Sahel, MD, professor and chair of the Department of Ophthalmology at the University of Pittsburgh, will co-direct the initiative with Goldberg.

“This group of people have been working for decades now on figuring out how to promote optic nerve regeneration and retinal neuron survival in glaucoma and other blinding diseases,” Goldberg said. “That positions this group of collaborators to be the best situated to take on optic nerve regeneration and neuronal cell survival in the context of eye transplant.”

The award of up to $56 million is from the  Advanced Research Projects Agency for Health (ARPA-H) Transplantation of Human Eye Allografts (THEA) program. The awarded project title is Viability, Imaging, Surgical, Immunomodulation, Ocular preservation and Neuroregeneration (VISION) Strategies for Whole Eye Transplant—a reflection of the breadth of the collaboration assembled to solve such a complex challenge.

"Scientific breakthroughs are impossible without strong collaborations," Sahel said. "By combining the deep knowledge about ophthalmology, tissue preservation and regeneration, immunology, and surgery of world-class scientists at Byers Eye Institute, University of Pittsburgh, and consortium members from top institutions, we are well-positioned to set the foundational steps toward restoring vision using whole eye transplant."

Transplants aren’t new in ophthalmology. Annually, more than 70,000 people in the United States donate their eyes after they die, allowing for life-improving and vision-saving transplants of the cornea, the clear, outermost layer of the eye. The cornea is one of the first tissues to be successfully transplanted in all of medicine.

But those transplants don’t address the most common causes of irreversible vision loss in the world, including glaucoma, macular degeneration, and diabetic retinopathy.

That’s where ophthalmologists and vision scientists hope that THEA will come in. The biggest challenge the team will face is moving whole eye transplants from aesthetic to functional by figuring out how to regenerate the optic nerve, which connects the eye to brain.

The ‘whole’ plan

The VISION for Whole Eye Transplant project is holistic in every sense of the word.

The team is made up of a potent mix of expertise and skill, which will be needed as they simultaneously advance and create cutting-edge medical devices, artificial intelligence integrations, new surgical techniques, regenerative medicine breakthroughs and rejection mitigation. The group will work dynamically, sharing information in real-time and pursuing the most promising leads.

Meticulous donor eye selection, advanced ocular imaging and specialized logistics in organ procurement and preservation will also be critical for success, and collaborators on this team are already the established leaders in these key areas of transplant science. In the end, tailored post-care rehabilitation for eye recipients will also be needed to set patients on the right track.

Amid the technical details, accessibility plays a big role in the plan.  

“Eye transplants stand to address the most severely blind, and because the risk of that severity of blindness goes up with decreasing access to medical care, the whole program stands to equalize access to care and access to vision,” said Wendy Liu, MD, PhD, professor of ophthalmology, one of eight Stanford faculty members working on the project.

While whole eye transplants are the north star of the three-phase, six-year project, the effort will undoubtedly bring with it more breakthroughs along the way, and that is just as exciting, Goldberg said.

“As we develop a series of new technologies that could be vision restorative in THEA and also in the many patients with glaucoma and other eye diseases, we’ll leverage all the proper channels to ensure new drugs, gene therapies, and devices can be accessible to all,” he said.

This research was, in part, funded by the Advanced Research Projects Agency for Health (ARPA-H). The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the United States Government.