A 91-year-old man who faced a year-long wait for sight-saving surgery has become the first patient in England to receive an artificial cornea.
Pensioner Cecil Farley initially had surgery for a human cornea transplant, but after it failed his surgeonoffered him the chance to skip the queue by using an artificial one.
Cornea transplants usually come from deceased donors and medics hope artificial ones could tackle plunging numbers of human donors.
Since the introduction of 'opt out' transplant rules in 2020, the number of donor ops for kidneys and other organs have increased overall, yet numbers of cornea transplants have dipped by almost 40 per cent.
Experts say the public are uniquely concerned by the thought of donating eye tissue, meaning other options for patients at risk of blindness are vital.
Cecil Farley, 91, from Chobham in Surrey initially had surgery for a human cornea transplant, but after it failed his surgeon offered him the chance to skip the queue by using an artificial one
The implant used in the pioneering procedurehas been likened to a contact lens and it is surgically attached to the eye by a single stitch and put in place with a gas bubble.
WHAT IS A CORNEA TRANSPLANT?
A cornea transplant is an operation to remove all or part of someone's cornea if it is damaged by injury or disease and replace it with donor tissue.
The cornea is a see-through layer at the front of the eye which protects the vital parts such as the iris and pupil.
The operation may also be called akeratoplasty or a corneal graft.
And it is commonly performed to help people who have a condition called keratoconus, which is when the cornea changes shape.
The procedure can be performed on an entire cornea or just on the outer layers, depending on how seriously damaged it is.
Patients can be kept awake during the surgery but given local anaesthetic in their eye, or completely sedated under general anaesthetic. The op takes about an hour to complete.
Potential complications include the body rejecting the new cornea, infection, or further vision problems.
Source: NHS
Mr Farley, known to his friends as John, is just one of 200 people worldwide to receive the treatment and said the transplant surgery has enabled him to continue to see his 83-year-old wife Elizabeth.
Mr Farley, from Chobham in Surrey, had problems with is right eye for about 15 years.
He had no vison in his right eye and now following the operation in February his sight has been slowly improving.
'I can still see my wife after 63 years of marriage, we can just carry on as normal and live life as fully as we can,' Mr Farley said.
'It makes your life fuller when your eyes work properly — you don't realise how debilitating it is until it happens to you.'
Once his sight is fully restored he wants to do practical tasks like repairing a watch, but for now he is content 'pottering about'.
'It has made a great difference to my sight. It was very blurred and I couldn't distinguish a face. Now I can see better with it, the brighter the light the better. It's coming along slowly - they said it could take up to a year,' Mr Farley said.
The cornea is the clear outer layer at the front of the eyeball.
Damage, as a result of injury or disease, can mean it becomes less transparent or its shape can change.
This can prevent light reaching the retina at the back of the eye, resulting in poor vision.
A cornea transplant can be performed to improve sight, relieve pain and treat severe infection or damage.
Frimley HealthNHSFoundation Trust consultant ophthalmologist Thomas Pooleand his colleagues have successfully given four patients artificial corneas in the last two months and initial results have shown an improvement in vision.
Mr Farleyhad no vison in his right eye and now following the operation in February his sight has been slowly improving
One of the 'beauties' of an artificial cornea instead of a human transplant is the body isn't going to try and reject it, says Frimley Health NHS Foundation Trust consultant ophthalmologist Thomas Poole
He predicts that artificial corneas may end up replacinghuman corneas completely for certain patients.
In the next few decades there might be no need for ahuman cornea with surgeons instead just taking one 'out of the box', he says.
Speaking about Mr Farley's case, Mr Poole explains he had a failed corneal graft and his cornea, which is the clear window at the front of the eye, was cloudy and waterlogged before the operation.
'He'd had lots of previous surgeries and my concern was we could use a human cornea for him again, but that's got a high risk of failure... he was kind of getting to last hope,' Mr Poole said.
Speaking about Mr Farley's case, Mr Poole explains he had a failed corneal graft and his cornea, which is the clear window at the front of the eye, was cloudy and waterlogged before the operation
In 2022/23, the latest figures available, some 4,719 corneas were supplied to NHS Blood and Transplant Eye Banks and there were 3,529 transplants
Since Mr Farley had hisartificial cornea put it in February, Mr Poole said he can already see his cornea is much less swollen than before.
'It is improving in shape, and improving in clarity. Week by week he has been saying it is getting a little bit better each time,' Mr Poole said.
He added: 'I had a very frank discussion with him before and I said 'Look, your graft has failed, you're back on the waiting list. Because your other eye sees quite well, you're not a high priority on the waiting list and you could be waiting for another year'.
'He's in his 90s now and said 'I just can't wait that long. Is there anything else?' And so this sprung to mind, I had just read a publication on very good reports from this artificial graft and it was that that made me think actually, maybe we could use this for John.'
NHS England national medical director Professor Sir Stephen Powis said: 'The use of artificial cornea transplants is an exciting and innovative step forward in eye care, which has the potential to benefit many patients needing treatment to improve or restore their vision.
'It could provide an additional treatment option for those waiting for donated transplants, and it's heart-warming to hear of patients like Cecil already benefiting from its use.'
Mr Poole and his colleague, Hanbin Lee, have successfully given four patients artificial corneas in the last two months and initial results have shown an improvement in vision including for Mr Farley
In the next few decades there might be no need for a human cornea with surgeons instead just taking one 'out of the box', Mr Pools says
In 2022/23, the latest figures available, some 4,719 corneas were supplied to NHS Blood and Transplant Eye Banks and there were 3,529 transplants, which is a drop of almost 40 per cent since 2020.
In the past some potential organ donors have said they were willing to donate organs including hearts, livers and kidneys but chose not to donate their corneas.
Kyle Bennett, assistant director for tissue and eye services at NHS Blood and Transplant, said: 'We understand that people often attribute more emotion and symbolism to the eyes compared to other parts of the body so can be reluctant to agree to cornea donation.
'However, agreeing to this form of donation, even when solid organ donation may not be possible, means there can be light after darkness for the thousands of people who require corneal transplants.
'One donor alone can help up to 10 people to restore or improve their vision and allow them to see their friends and family properly again.
Since Mr Farley had his artificial cornea put it in February, Mr Poole said he can already see his cornea is much less swollen than before
The new artificial cornea, called EndoArt, was created by ophthalmological medical device company EyeYon Medical
'We are so grateful to all those who agreed to donate their corneas after their death and restored or improved the sight of 3,259 people last year through corneal transplants.'
The new artificial cornea, called EndoArt, was created by ophthalmological medical device company EyeYon Medical.
Only 200 have been implanted worldwide to date, including in Mr Farley.
'EndoArt is the first artificial endothelial layer, a promising treatment for select eyes with chronic corneal oedema,' said the company's chief commercial officer, Charles Holmes.
'EndoArt represents a new hope to patients who are suffering from chronic corneal oedema as an alternative to human tissue.'
