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’ 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, Arkansas. “Maybe you’ll learn something from it that will help the next person.”
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’ 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.”
Some specialists had feared the eye would quickly shrivel like a raisin. Instead, when Rodriguez propped open James’ left eyelid last month, the donated hazel-colored 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’ brain that detected some puzzling signals from that all-important but injured optic nerve.
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.
“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.
Face transplants remain rare and risky. James’ 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’ 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’ 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 signaling.
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 nation’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.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
