Surgeons have performed the world’s first transplant of an entire human eye, an extraordinary addition to a face transplant — although it’s far too soon to know if the man will ever see through his new left eye.
An accident with high-voltage power lines had destroyed most of Aaron James’s face and one eye. His right eye still works. But surgeons at NYU Langone Health hoped replacing the missing one would yield better cosmetic results for his new face, by supporting the transplanted eye socket and lid.
The NYU team announced Thursday that so far, it’s doing just that. James is recovering well from the dual transplant last May and the donated eye looks remarkably healthy.
“It feels good. I still don’t have any movement in it yet. My eyelid, I can’t blink yet. But I’m getting sensation now,” James told The Associated Press as doctors examined his progress recently.
“You got to start somewhere, there’s got to be a first person somewhere,” added James, 46, of Hot Springs, Ark. “Maybe you’ll learn something from it that will help the next person.”
A moonshot in the quest to cure blindness
Today, transplants of the cornea — the clear tissue in front of the eye — are common to treat certain types of vision loss. But transplanting the whole eye — the eyeball, its blood supply and the critical optic nerve that must connect it to the brain — is considered a moonshot in the quest to cure blindness.
Whatever happens next, James’s surgery offers scientists an unprecedented window into how the human eye tries to heal.
“We’re not claiming that we are going to restore sight,” said Dr. Eduardo Rodriguez, NYU’s plastic surgery chief, who led the transplant. “But there’s no doubt in my mind we are one step closer.”
Aaron James says he’s getting sensation in his face, including when he pushes on his new eye. (Joseph. B. Frederick/Associated Press)
Some specialists had feared the eye would quickly shrivel like a raisin. Instead, when Rodriguez propped open James’s left eyelid last month, the donated hazel-coloured eye was as plump and full of fluid as his own blue eye. Doctors see good blood flow and no sign of rejection.
Now researchers have begun analyzing scans of James’s brain that detected some puzzling signals from that all-important but injured optic nerve.
‘An amazing validation’
One scientist who has long studied how to make eye transplants a reality called the surgery exciting.
“It’s an amazing validation” of animal experiments that have kept transplanted eyes alive, said Dr. Jeffrey Goldberg, chair of ophthalmology at Stanford University.
The hurdle is how to regrow the optic nerve, although animal studies are making strides, Goldberg added. He praised the NYU team’s “audacity” in even aiming for optic nerve repair and hopes the transplant will spur more research.
A fall 2010 family photo shows Aaron James and his wife, Meagan, before his June 2021 high-voltage electricity accident. (NYU Langone Health /Associated Press)
“We’re really on the precipice of being able to do this,” Goldberg said.
James was working for a power line company in June 2021 when he was shocked by a live wire. He nearly died. Ultimately he lost his left arm, requiring a prosthetic. His damaged left eye was so painful it had to be removed. Multiple reconstructive surgeries couldn’t repair extensive facial injuries including his missing nose and lips.
James pushed through physical therapy until he was strong enough to escort his daughter Allie to a high school homecoming ceremony, wearing a face mask and eye patch. Still he required breathing and feeding tubes, and longed to smell, taste and eat solid food again.
“In his mind and his heart, it’s him — so I didn’t care that, you know, he didn’t have a nose. But I did care that it bothered him,” said his wife, Meagan James.
Rare and risky
Face transplants remain rare and risky. James’s is only the 19th in the U.S., the fifth Rodriguez has performed. The eye experiment added even more complexity. But James figured he’d be no worse off if the donated eye failed.
Three months after James was placed on the national transplant waiting list, a matching donor was found. Kidneys, a liver and pancreas from the donor, a man in his 30s, saved three other people.
During James’s 21-hour operation, surgeons added another experimental twist: When they spliced together the donated optic nerve to what remained of James’ original, they injected special stem cells from the donor in hopes of spurring its repair.
Last month, tingles heralded healing facial nerves. James can’t yet open the eyelid, and wears a patch to protect it. But as Rodriguez pushed on the closed eye, James felt sensation — although on his nose rather than his eyelid, presumably until slow-growing nerves get reoriented. The surgeon also detected subtle movements beginning in muscles around the eye.
Then came a closer look. NYU ophthalmologist Dr. Vaidehi Dedania ran a battery of tests. She found expected damage in the light-sensing retina in the back of the eye. But she said it appears to have enough special cells called photoreceptors to do the job of converting light to electrical signals, one step in creating vision.
Normally, the optic nerve then would send those signals to the brain to be interpreted. James’s optic nerve clearly hasn’t healed. Yet when light was flashed into the donated eye during an MRI, the scan recorded some sort of brain signalling.
That both excited and baffled researchers, although it wasn’t the right type for vision and may simply be a fluke, cautioned Dr. Steven Galetta, NYU’s neurology chair. Only time and more study may tell.
Still, the surgery marks “a technical tour de force,” said Dr. David Klassen, chief medical officer of the United Network for Organ Sharing, which runs the U.S. transplant system. “You can learn a tremendous amount from a single transplant” that could propel the field.
As for James, “we’re just taking it one day at a time,” he said.
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
