An Arkansas man has a new eye after being the subject of the first ever human eye transplant in May.
The eye transplant is part of a complex partial-face transplant performed by a team of surgeons at NYU Langone Health in New York City. Aaron James, a high-voltage utility line worker, lost most of his face in a work accident in June 2021, when it accidentally touched a 7,200 volt live wire while leaving work.
Dr. Eddie Rodriguez, one of James’ doctors for the transplant, said it was not an injury that would have saved many.
“He’s alive. They brought him down. They rushed him to the regional burn unit,” said Rodriguez. “And he was in bad shape. They had to cut off his arm (above the elbow), so it was in the middle of the arm. His face was destroyed … Forget replacing the arms, the face. We have to bring this man back to life.”
James, 46, said he had “no recollection of it,” but when he woke up, he was missing his nose, his front teeth, his left eye and his dominant left hand. He also lost his chin to the bone, 20% of his tongue, his left cheek, and his lips. After several reconstructive surgeries, he could no longer eat or drink normally, and had trouble speaking, so he agreed to undergo a face transplant, including the world’s first transplant of a donor eye. The transplant came from a single donor, making it “the only successful combined transplant case of its kind,” according to NYU Langone Health. The donor was a man in his 30s who donated tissue to three other people, as well as James.
“A whole eye transplant’s never been done,” explained Rodriguez, who performed the world’s first successful face and double hand transplant in 2020. His colleagues doubted the idea of a face and eye transplant, but James immediately riding.
“He didn’t hesitate,” Rodriguez recalled. “He said, ‘If I can help other people and then I can help other soldiers, it’s worth it. He’s had three tours … He knows the value of helping his fellow soldier.”
James served in the Army National Guard and completed tours in Egypt, Kuwait and Iraq, according to NYU Langone Health.
Dr. Vaidehi Dedania was involved in the operation as James’ eye specialist. Dedania, an associate professor of ophthalmology and the director of the Vitreoretinal Surgery Fellowship at NYU, is a retina expert who works to see if the new eye can send the right signals to the brain to process an image, to restore James’ sight.
In late May, Rodriguez and the surgical team spent 21 hours in surgery, transferring the donor’s face, eye socket and eye to James. A major challenge is providing blood flow to the transplanted eye.
“It’s an exciting moment just to see the blood supply coming to the retina,” Rodriguez said.
The team also has to worry about nerve regeneration and immune rejection. These concerns are part of what makes whole-eye transplants so difficult, NYU Langone said. The research team combined the donor eye with donor bone marrow-derived stem cells in an attempt to promote nerve regeneration – something that had never been attempted before. Those bone marrow cells were injected into James’ optic nerve during surgery.
After a few weeks in the hospital and some rehabilitation, James was considered to have recovered from the transplant. He said he still has trouble speaking, but it’s getting better, and he’s trying to get the feeling back in his lips and open his jaw more than it can. According to NYU Langone, he can now do things that were impossible before, like eating solid foods. The transplant also boosted his confidence.
“It’s just my thought,” James said. “I tell everybody, when I go to a mirror, I just look at it. … Now I want to go out there so people can see me, you know?”
However, one question still remains: Is the light shining on the transplanted eye recognized by the part of the brain that processes vision?
To find out, James underwent two functional MRIs, which measure small changes in blood flow that occur with brain activity. Dedania said that the team first confirmed that James has blood supply, eyeball pressure, and a healthy retina, then put a bright light on his eye and measured the electrical response of the retina.
“What we’re showing is that the photoreceptor cells … are actually sending a signal back,” Dedania said. “That’s the moment where we say, ‘Wow, so there’s a blood supply. The cells are still preserved, and he can, at least the retina can respond to a stimulus like light.”
Dedania and Rodriguez tested this in another functional MRI, where they worked with a research team and a neuroradiologist. First, the team covered James’ transplanted eye and turned on the light. That image is usually recorded in the visual cortex, said Rodriguez.
Next, the team covered James’ functional eye and tested the transplant.
“We found an answer there!” Dedania said. “Could we be more amazed? Each level, each test further increases our understanding of how this eye works within its body.”
While James was able to process the light, the vision in that eye was still not restored. Dedania doubts it will return completely, but said he “would never say no.” James will continue testing to see if his sight can be restored.
“This is unprecedented. The question is, can it be done? Yes,” Dedania said.
“We haven’t seen it yet, but I’m an optimist,” Rodriguez said. “The one thing I can say for sure now is that we are one step closer.”