NHS rolls out artificial corneas to cut waiting list for sight-saving surgery

A 91-year-old man has made history by becoming the first patient in England to receive an artificial cornea.

Cecil Farley faced a year-long wait for sight-saving surgery after a human cornea transplant failed, but his surgeon offered him the chance to skip the queue by using an artificial one.

Medics hope that one day the new artificial corneas could reduce the need for human cornea donations.

Frimley Health NHS Foundation Trust consultant ophthalmologist Thomas Poole told the PA news agency the use of artificial corneas is a “great advancement for patient care”.

The new product replaces the inner part of the cornea.

It has been likened to a contact lens and is surgically attached to the eye by a single stitch and put in place with a gas bubble.

Mr Farley, known to his friends as John, said the transplant surgery has enabled him to continue to see his 83-year-old wife Elizabeth.

Mr Thomas Poole, consultant ophthalmologist at Frimley Health NHS Foundation Trust, with patient Cecil Farley (Jordan Pettitt/PA)PA Wire/PA Images - Jordan Pettitt

He had no vision in his right eye but his sight has slowly been improving since the procedure, which took place in February.

Mr Farley, from Chobham in Surrey, had problems with his eye for around 15 years.

Medics from Frimley offered the procedure, which is a type of corneal implant called endothelial keratoplasty and involves removing the abnormal inner lining of the cornea and replacing it with an artificial cornea, rather than a donated human one.

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

Artificial cornea patient Cecil Farley

“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 told PA.

“It makes your life fuller when your eyes work properly – you don’t realise how debilitating it is until it happens to you.”

The pensioner, who used to own a flooring company, said that 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.

‘I can still see my wife after 63 years of marriage,’ said Mr Farley (Jordan Pettitt/PA)PA Wire/PA Images - Jordan Pettitt

When a cornea is damaged as a result of injury or disease, it can become less transparent or its shape can change.

This can prevent light reaching the retina at the back of the eye and causes the image transmitted to the brain to be distorted or unclear.

A cornea transplant can be performed to improve sight, relieve pain and treat severe infection or damage.

Cornea transplants usually come from deceased donors.

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.

“It is a great advancement for patient care, and it’s going to be a great opportunity for some patients who either can’t wait too long or have other comorbidities in the eye,” Mr Poole said.

“We now have a very long waiting list for a human cornea, which we’ve been using for many years very successfully. The problem is if you’ve got patients whose eyes are getting worse, you can’t get a human cornea for over a year.

“There are risks with staying on a waiting list with an unwell eye; there are risks in not doing anything as well, such as picking up an infection.

“One of the beauties of (the artificial cornea) is that it is not human tissue so the body does not try to reject it.

“Looking forward to the future, I think this may end up replacing human corneas for certain types of corneal graft patients. In maybe 10 or 20 years’ time – this may become the norm where we don’t need a human cornea, and we can just take one out of the box.”

Four patients have already had the procedure at Frimley Health NHS Foundation Trust (Jordan Pettitt/PA)PA Wire/PA Images - Jordan Pettitt

Mr Poole added: “I’ve just booked three people for this. All three have had failed grafts in the past, all three are looking at a year-long waiting list. We can just get it off the shelf. I can do it in the next couple of months rather than waiting for a year.

“The three patients I’ve listed today are case in point – they are now not going to need a human cornea so it will take pressure off the waiting lists.”

Speaking about Mr Farley’s case, Mr Poole said: “He has had a failed corneal graft and his cornea – which is the clear window at the front of the eye – was cloudy and waterlogged.

“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.

“John has had this artificial cornea put it in February and clinically we can already see that his cornea is so much less swollen than it was, 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 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.”

Cecil Farley’s sight is improving ‘week-by-week’ (Jordan Pettitt/PA)PA Wire/PA Images - Jordan Pettitt

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.

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.

“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.”