Tears are necessary for a healthy emotional life. They’re also necessary for a healthy cornea. When the cornea senses pressure or stimulation, we blink and produce tears that nourish and protect the eye. If a cornea loses sensation (called a neurotrophic cornea), the formation of tears slows down, the tissue begins to dry out, and the cells of the cornea break down — resulting in ulcerations that become infected and scar the tissue. Scarred corneas can lead to impaired vision and even blindness.
Until recently, people with neurotrophic corneas could receive treatment for symptoms but not for the root cause — the lack of sensation itself. “We could only offer lubrication, closing the eyelids and other supportive measures to patients,” says Fasika Woreta, M.D., a cornea specialist at the Wilmer Eye Institute and 2019 Johns Hopkins Physician of the Year.
That changed when Woreta teamed up with Richard Redett, M.D., the interim director of the Department of Plastic and Reconstructive Surgery at Johns Hopkins, to offer a procedure called corneal neurotization.
This surgery involves removing a nerve from the leg, grafting it to a working nerve in the forehead or neck and connecting that nerve graft to the neurotrophic cornea. The working nerve will sprout nerve fibers that eventually grow into the neurotrophic cornea to restore sensation.
Redett is an expert in restoring nerve function to the face and procedures that restore sensation and movement to parts of the body that have lost it. When former colleagues at the Hospital for Sick Children in Canada informed Redett that they had begun performing the corneal neurotization procedure and were getting great results, he decided to introduce the procedure in Baltimore. He could harvest and graft the nerve, but would need an ophthalmologist for the delicate eye surgery required to attach the nerve graft to the cornea.
“[Luckily], we have a long history of collaborating with Wilmer — one of the best ophthalmology hospitals in the country, with thousands of patients and a very strong corneal service,” says Redett. He approached the chief of Wilmer’s cornea division, Albert Jun, M.D., Ph.D., who recommended Woreta as a potential partner.
Woreta quickly signed on to the idea. “There was no surgery we could offer patients before this procedure,” says Woreta. “The fact that we can restore sensation and improve the health of their cornea is exciting.”
The restored sensation allows tears to bathe the cornea as often as needed, which sustains and preserves it. For some patients, if they have the procedure early enough in the progression of their condition, the scarring will stop, which will halt their vision loss. Other patients, however, may require a corneal transplant because of the damage. In those cases, having a cornea with restored sensation exponentially increases the success rate of a corneal transplant.
A complex procedure such as corneal neurotization can only happen when experts join forces. “One of the great things about working at Hopkins is the ability to collaborate with other surgical specialists. I think it makes us all better surgeons,” Redett says.