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A 91-year-old man who became the first patient in England to save his sight through an artificial layer in his cornea, praised the procedure for allowing him to still see his wife.
Cecil Farley, of Chobham c Surrey, had problems with his right eye for about 15 years before he lost his sight. He needed a corneal transplant to save his sight, but his previous operation – a graft with a human cornea – failed and doctors warned the next one could too. And a shortage of human corneas from deceased donors meant Farley had to wait a year.
But an NHS first allowed him to bypass the tail: the implantation of an artificial cornea. While it’s still early days for such implants, experts say the approach could eventually become standard treatment and help reduce the NHS’s record waiting list.
“I can still see my wife after 63 years of marriage, we can just carry on as normal and live as fully as possible,” Farley said. “It makes your life fuller when your eyes are working properly – you don’t realize how draining it is until it happens to you.”
He said he would eventually like to take up tasks such as clock repair, but for now he is content to “look around” with his wife, Elizabeth, 83.
The device, called EndoArt, was created by EyeYon Medical and is the first artificial implant that can replace the inner lining of the cornea – the clear outer layer at the front of the eyeball. This shell plays an important role in regulating the hydration of the cornea. If it is damaged, whether from injury or disease, it can lead to blurred vision and other problems.
EndoArt is similar to a contact lens: it is a dome-shaped, collapsible, clear and transparent implant that says the company is made of a material designed to stick to the back of the cornea. Once placed in the eye, it can be maneuvered into place with an air bubble and secured in place with a single stitch.
Farley underwent the surgery, known as endothelial keratoplasty, in February, making him one of only 200 recipients of the artificial implant in the world to date.
Thomas Poole, consultant ophthalmologist at Frimley Health NHS Foundation Trust, who carried out the operation, said he and colleague Hanbin Lee had successfully given four patients artificial corneas in the past two months and
initial results show improvement in vision. The implant costs around £1,800, in the same range as using a human cornea.
“Looking forward to the future, I think this could lead to a human cornea replacement for certain types of corneal graft patients,” Poole added. “In maybe 10 or 20 years, this could become the norm where we don’t need a human cornea and can just take one out of the box.”
Poole added that Farley was a “technically very difficult first patient”. “I was prepared for things to be quite difficult, but once the graft was fully attached and started working, it was like, ‘wow, this is really working well,'” he said.
Prof Sir Stephen Powis, National Medical Director of NHS England, welcomed the new approach. “The use of artificial corneal transplants is an exciting and innovative step forward in eye care that has the potential to benefit many patients in need of treatment to improve or restore their vision,” he said. “This could provide an additional treatment option for those waiting for donated transplants, and it’s heart-warming to hear of patients like Cecil who are already benefiting from its use.”
NHS Blood and Transplant says that to meet all surgical and research needs he requires a weekly supply of 350 eyes. Between April 2021 and March 2022, it received an average of 88 donations per week.
According to NHSBT Transplant Activity Report 2020-21as of 31 March 2021, 10% of people who have joined the organ donation register have chosen not to donate their cornea – something which Kyle Bennett, assistant director of tissue and eye services at NHS Blood and Transplant, said it may be due to emotion and symbolism that people attribute to the eyes.
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