After barely surviving an explosion by a rocket-propelled grenade (RPG) in Iraq in 2005, Staff Sgt. David Payton faced a whole new sense of devastation when several failed corneal transplants left him with only one eye that had count fingers vision. Because the RPG had struck a chemical tank near his compound, he suffered severe chemical burns on both his face and body, and he assumed he’d never see again. That is, until his wife, through an online search, found Edward J. Holland, MD, director of Cornea Services at the Cincinnati Eye Institute (CEI), in Cincinnati, Ohio.
Dr. Holland and his team have developed a reputation for unprecedented success in treating severe ocular surface disease with Ocular Surface Stem Cell Transplantation (OSST), due to a unique surgical and medical protocol that includes systemic immunosuppression. Now, with the launch of the Holland Foundation for Sight Restoration, the hope is to reach even more patients, like Staff Sgt. Payton, with this protocol.
It is currently suspected there are upwards of 100,000 patients in the United States who are in need of an OSST.1,2 These are patients who have been blinded by severe ocular surface disease caused by thermal or chemical burns, and genetic conditions such as aniridia and Keratitis-ichthyosis-deafness syndrome, or systemic diseases, such as Stevens-Johnson Syndrome and Mucous Membrane Pemphigoid.
Traditionally, most of these patients, like Staff Sgt. Payton, undergo a routine corneal transplant that fails because the ocular surface stem cell failure has not been addressed. Additionally, a small percentage of these patients who undergo an OSST will often have a high failure rate because of inadequate systemic immunosuppression.
According to Dr. Holland, corneal physicians have not been trained to embrace systemic immunosuppression the way that other organ transplant doctors do, and that has been problematic for patients like Staff Sgt. Payton.
“After having seen so much corneal transplant failure and OSST rejection firsthand, I knew I had to figure this out,” Dr. Holland recalls, and he did.
A Team Effort
Dr. Holland built a team to design the treatment protocols that are now in use. His team is comprised of his retina, glaucoma, and oculoplastic colleagues at CEI and the renal transplant team at the University of Cincinnati, and the Cincinnati Children’s Hospital.
“The renal team has guided us on the most up-to-date protocols on preoperative testing to determine best donor tissue matches, risk of rejection and postoperative systemic immunosuppression,” Dr. Holland explains.
In recognizing patients as individuals with their own specific needs and concerns, Dr. Holland says his patients spend a significant amount of time with a transplant coordinator, who handles preoperative testing and post-operative monitoring of medications and side effects.
Albert Cheung, MD, an ophthalmologist with Virginia Eye Consultants, who was a fellow under Dr. Holland, says Dr. Holland’s model is “unique,” and, therefore, foreign to most ophthalmologists, in his experience.
“Most ophthalmologists and corneal physicians isolate treatment of the eye, and we are used to managing our patients’ corneal transplants on our own,” he explains. “What’s unique about Dr. Holland’s program is that it does require a multispecialty approach, and I think it’s fair to say that this is a new concept to most ophthalmologists. However, I believe a team approach like this is the future for managing corneal transplantation in severe ocular surface disease.”
The need is certainly there, notes Dr. Holland, who says he’s seen patients from every state and from many countries outside the US, following them for several years after their treatment.
The average patient requires six to eight visits during the first year and four to six the second year, Dr. Holland says.
“There are so many fantastic corneal surgeons in this country, but they don’t perform ocular stem cell transplants and use current immunosuppression protocols,” he explains. “That means we can’t just refer our patients to another doctor for post-operative care.
To facilitate the use of Dr. Holland’s unique approach and, therefore, expand its reach to other patients in need, the Holland Foundation for Sight Restoration, which recently received its 501(c) classification as a nonprofit, was created.
Bindu Manne, an executive committee and Board of Directors member for the Foundation, who oversees the logistics of the foundation, says that the hope is that donations to the Foundation will help fund several Centers for Excellence in the US that will allow other clinics to replicate what Dr. Holland is doing in Cincinnati.
“Dr. Holland is getting referrals from some of the top corneal surgeons out there who are receiving these cases, but who do not have the transplant team to help facilitate success,” Ms. Manne explains. “The hope is to establish these trained Centers for Excellence by providing them with the resources they need.”
Dr. Cheung says that he’s excited for what the future holds.
“Dr. Holland is a pioneer in this area, and he wants to be able to lend a hand to others who want to continue his work,” he says. “He’s identified colleagues who already see these patients, and the hope is that the Foundation will be able to provide some of the funding needed to get a program up and running to successfully treat them.”
For patients like Staff Sgt. Payton, finding ways to improve access to care could be life-changing. Dr. Holland reports that Staff Sgt. Payton’s eyesight in his saved eye is 20/40, and he’s able to help his wife with their eight children — even driving them to and from their many activities.
“By the time David came to me, he was incredibly frustrated and upset. Multiple institutions had failed him. He briefly had his sight restored only to have it fail after an infected Boston keratoprosthesis caused him to lose one of his eyes,” Dr. Holland remembers. “We were very pleased to be able to help David and his family. He is an amazing person who went blind serving his country. Helping people like David is the reason we built this program.” CP
- Merle H, Gérard M, Schrage N. [Ocular burns]. J Fr Ophthalmol. 2008; 31(7):723-34.
- Holland EJ, Djalilian AR, Schwartz GS. Management of aniridic keratopathy with keratolimbal allograft: a limbal stem cell transplantation technique. Ophthalmol. 2003;110(1):125-30.