Severe Ocular Surface Disease Program

Severe ocular surface disease can occur at any age, though it tends to impact younger adults. It can result from thermal or chemical exposure such as acid or alkali burns. About 100,000 people experience such accidents annually, often in the workplace.

Some autoimmune diseases also can burn the eye surface from the inside out. Side effects from chemotherapy and radiation therapy can cause limbal cell damage as well.

Standard therapeutics or cornea replacement cannot reverse this condition because too many of the eye surface stem cells have been destroyed.

To overcome this, the pioneer of this life-changing procedure, Dr. Edward Holland, an ophthalmologist at the University of Cincinnati, 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. Dr. Farid trained with Dr. Holland, and his Foundation for Sight Restoration chose UCI Health Gavin Herbert Eye Institute as it's first of five planned U.S. centers of excellence to offer this life-changing treatment. 

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.

We also supplement with cadaver tissue that has been meticulously prepared and processed.

All this occurs prior to the transplant surgery.

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. Therefore, each patient will be lead by 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 managing extensive pre and postsurgical appointments.

Once we have transplanted the donor cells, we usually know within the first week or two if the limbal cells are reproducing nicely.

Results often can be dramatic because just by removing scar tissue, patients may see clearly as early as the first day.

Depending on the underlying cause of the corneal damage, some patients have as high as a 75% success rate. With older techniques, the failure rate was 90%, so this is a huge advance.

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 Dr. 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.