When Brent Chapman’s doctor first approached him with the idea of surgically inserting one of his own teeth into his eye to restore his vision, he says he felt “a little apprehensive.”
But then he spoke to an Australian woman who had the same procedure with great success.
“She’d been completely blind for 20 years and now she was skiing,” said Chapman, 33, a North Vancouverite. “I know it sounds a little crazy, like science fiction.”
Chapman, who is blind in both eyes, was one of three Canadians to undergo an osteo-odonto-keratoprosthesis (OOKP) procedure at a B.C. hospital this week.
It involves removing a patient’s tooth (usually a canine), inserting a plastic optical lens inside it, and then implanting the entire lens in the eye.
While the procedure dates back decades, it’s never been done in Canada before. If all goes well, one of the doctors behind the initiative hopes to offer it long-term.
Why teeth? Dr. Greg Moloney, an ophthalmologist and surgeon at Mount St. Joseph Hospital in Vancouver, said that because teeth have dentin, the hardest substance the body produces, they are the ideal shell to connect the plastic lens to the patient’s eye.
“There is no risk of rejection because we are using a part of the patient’s own body,” he told Nil Kӧksal, host of As It Happens.
Moloney presided over three Canadian surgeries this week. He said all of them went well, though the patients will be closely monitored.
Before being recruited to do dental and eye surgery in Canada, he had successfully performed seven dental and eye surgeries in his native Australia. He said he was used to people being shocked and terrified by the procedure.
“It’s a rare procedure that most people haven’t heard of, even if you’re an ophthalmologist,” Moloney said.
It’s not a one-size-fits-all vision treatment, he said. It’s specifically for patients who have severe corneal blindness in the front of the eye due to conjunctival scarring from autoimmune diseases, chemical burns and other trauma, but the retina and optic nerve in the back of the eye are still healthy.
Moloney says it’s usually a last resort when all other options have failed.
That’s because the surgery is so complex, he says. The procedure requires two surgeries, a few months apart, which means Chapman and two other Canadian patients will be back in the operating room later this year.
In the first surgery, Moloney and his colleagues removed the patient’s tooth, shaved it into a rectangular shape, and drilled a small hole in it to accommodate the lens.
Then they removed scar tissue from the patient’s eye and filled it with a small patch of soft tissue from the inside of the cheek.
Finally, they implanted the lens, encased in the tooth, inside the cheek so that new tissue would grow around it.
A few months later, the doctor came back and removed the tooth from the cheek and sewed it in under the cheek tissue in front of the eye. This way, the eye becomes pink with a small black circle on it that the patient can see through.
Because the surgery is so extensive, he says, they only operate on one eye.
Moloney says the procedure is not without risks.
“Any type of eye surgery has the potential to cause an infection and cause us to lose all our vision,” he said.
However, he said the procedure has been performed for decades in 10 countries, including the UK and Australia, with a high success rate.
A 2022 Italian study found that, on average, 94% of patients could still see 27 years after surgery.
“We felt that the risk-reward ratio was worth it when these patients had completely lost their vision,” Moloney said.
Chapman spoke to CBC News on Thursday, a day before his first surgery, and said it was worth a try.
The massage therapist said he had good vision until he was 13, but after a school basketball game he took some ibuprofen, which triggered a rare autoimmune reaction known as Stevens-Johnson syndrome.
He was in a coma for 27 days and suffered severe burns all over his body, including his eyes. His vision never fully recovered.
He said he has undergone about 50 surgeries over the past 20 years, including 10 corneal implants. Sometimes, he said, the effects last for months. One surgery restored partial vision for two full years. But inevitably, he would always lose it again.
“When I got it back, you know, I was so excited,” he said. “Then I lost it again, and it was so sad, and I fell into depression.”
He hopes the two surgeries he underwent at Mount St. Joseph’s will be his last.
“I always imagined myself playing basketball and shooting again,” he said. “I want to travel more and see the world.”
Moloney aims to continue helping patients like Chapman by opening Canada’s first OOKP clinic at Mount St. Joseph.
The St. Paul Foundation charity has raised $430,000 to start the clinic and fund its operation for three years, after which BC health agency Providence Health Care will include the clinic in its annual budget.
Dr. Samir Jabbour, an ophthalmologist at the University of Montreal Hospital Centre, called the new clinic “a great opportunity for Canadian medicine.”
Jabr, who was not involved in the BC surgery, said few patients need the rare and complex procedure. But when that happens, they have to bear the cost of going abroad.
“Now that this technology is available in Canada, it definitely makes patient care easier,” he said.
Chapman said he is very grateful to Moloney and everyone who made this possible.
“Hopefully this will lead to a breakthrough,” he said. “I would be very happy if other people in Canada need this and it becomes a regular thing here.”
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