Elite stem-cell transplant program for eye surface damage opens at UCI Health
February 01, 2023
Dr. Marjan Farid began training to performing rare and complex ocular stem cell transplants for corneal blindness more than 10 years ago. Now she plans to transfer that knowledge to UCI Health colleagues, multiplying the number of patients whose sight can be restored.
The UCI Health Gavin Herbert Eye Institute now offers sight-saving ocular stem cell transplants for severe eye surface damage, becoming only the second medical institution in the nation to treat this blinding condition.
UCI Health cornea specialist Dr. Marjan Farid, who leads the UCI Health Severe Ocular Surface Disease Program, is the first to be trained in the procedure by pioneering University of Cincinnati ophthalmologist Dr. Edward Holland, who has restored vision for hundreds of individuals with serious damage to their eye surfaces.
The Holland Foundation for Sight Restoration has selected the Gavin Herbert Eye Institute as the first of five planned centers of excellence for severe ocular disease care across the country in order to expand the availability of this complex treatment.
"The limbal stem cell transplant had been tried before but always failed, until Dr. Holland learned to leverage immunosuppressant therapy, based on kidney transplant protocols, to keep the body from attacking the newly implanted cells,” said Farid, the eye institute's director of cornea, cataract and refractive surgery and professor of ophthalmology at the UCI School of Medicine.
"Dr. Holland's program is the only one in the country that does this procedure well, and now we're transferring that knowledge to UCI Health to multiply the impact.”
Causes of ocular surface failure
Severe ocular surface disease can occur at any age, though it tends to impact younger adults. Often it's caused by contact with chemicals or extreme heat in the workplace. About 100,000 people each year experience a sight-impairing chemical or thermal accident. Others may suffer damage as a side effect to treatments like cancer chemotherapy.
A genetic disorder or autoimmune disease also can cause the body to attack eyes and eyelids, resulting in similar damage to eye surfaces.
Traditional therapies, including corneal transplants, don't work for these patients because the damage is so profound that the cells necessary to support the healing process have been wiped out.
To overcome this, Holland devised a treatment that involves transplanting donor limbal stem cells to the patient, then leveraging the best practices developed by kidney transplant teams to prevent the body from rejecting the new tissue.
Tapping kidney transplant experts
Holland began training Farid in the procedure more than a decade ago, seeing patients and conducting surgeries alongside her at UCI Health. She is now working toward increasing the number of patients with corneal blindness whose vision can be treated and restored.
A key component is having access to the expertise of the UCI Health Kidney Transplant Program, whose nephrologists play a critical role in supporting and helping to manage the limbal stem cell transplantation process.
As a major academic health system, UCI Health operates the largest kidney transplant program in Orange County and has the expertise and resources to support the complex care needs of patients waiting for an ocular stem cell transplant.
The transplant is just one of many steps and procedures in a process that may take up to a year for each patient and requires the expertise of multiple specialists.
But first, a stem cell donor must be found.
Siblings are usually the best match. A person with healthy eye tissue can safely donate up to half the limbal stem cells from one of their corneas because the cells replenish themselves naturally.
Lengthy process, multiple surgeries
Preparatory surgeries may be required to ready the patient’s damaged eye for a transplant. For example, if a patient’s eyelid has scar tissue attached to the eye’s surface due to injury or disease, an oculoplastic specialist would be needed.
After the transplant surgery, patients follow a regimen similar to kidney transplant patients, which includes seeing a nephrologist for immunosuppression therapy and blood monitoring. Finally, the patient may need a glaucoma specialist to manage secondary eye issues.
As an academic medical system, UCI Heath is able to bring together all the specialists and researchers needed for successful treatment. Farid plans to add one more critical skill set to the ocular surface disease transplant team to support these patients.
“The catalyst to help us fully establish this team is a nurse transplant coordinator who will manage and coordinate the many different aspects of a patient’s care — getting medications, scheduling monthly or weekly blood checks, calling insurance companies to make sure the medications, surgeries and other procedures are covered, and ensuring that patients are being seen regularly by our team as well as the immunologist,” she says.
Training others
Last July, the Holland Foundation hosted a star-studded fundraiser to support the sight-saving services they provide and to help fund and expand these services at the eye institute. A portion of the proceeds will be directed to the eye institute's Severe Ocular Surface Disease Program.
“It was overwhelming to see the generous donations from our community,” said Farid. “I’m grateful for the support our donors and grateful patients have shown for the eye institute in general, and for our severe ocular surface disease program, specifically. This is just the beginning for us.”
She also hopes to increase the number of UCI Health ophthalmologists who can perform the procedure.
“Just as Ed Holland trained me, I want to train our faculty so that we have an entire team of eye surgeons who can care for these patients."
Envisioning a world without blindness
UCI Health has a lengthy waiting list of patients whose vision could be restored by an ocular stem cell transplant.
This life-changing surgery also advances the eye institute’s vision of a world without blindness — something close to Farid’s heart because it reflects the legacy of her mentor, the late Roger Steinert, MD, chair of the UCI School of Medicine’s Department of Ophthalmology and founding director of the eye institute.
Steinert revolutionized laser surgery techniques to prevent blindness and improve vision that are commonly used today.
“It’s impossible to quantify all that I learned from Dr. Steinert,” she said.
“Not only about ophthalmology and corneal surgery, but about how to be a good doctor, to be gracious and humble, to be a leader both academically and in the ophthalmology world. I know that in developing this program, I’m walking in his footsteps.”
Learn more about the Holland Foundation’s ocular surface disease program ›
The UCI Health Gavin Herbert Eye Institute is home to internationally respected ophthalmologists who provide the highest quality eye care for conditions that range from mild myopia to rare retinal ocular disorders. Its faculty includes pioneers in the development and use of ophthalmic lasers and refractive surgery techniques. Their work formed the foundations of LASIK surgery, the development of the bladeless IntraLase™ laser and the most advanced techniques for corneal transplants and intra ocular lens implants.
UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system in Orange County. Patients can access UCI Health at primary and specialty care offices across Orange County and at its main campus, UCI Medical Center in Orange, Calif. The 459-bed acute-care hospital, listed among America’s Best Hospitals by U.S. News & World Report for 21 consecutive years, provides tertiary and quaternary care, ambulatory and specialty medical clinics, behavioral health and rehabilitation services. UCI Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. rel="noopener noreferrer" Follow us on Facebook, Instagram, LinkedIn and Twitter.
