Introduction to Tooth-in-Eye Surgery
Brent Chapman can see again after doctors pulled out one of his teeth, flattened it, drilled a hole in it, placed a lens inside and implanted the tooth in one of his eyes. It seems bizarre, but the complex operation — informally known as tooth-in-eye surgery — can help restore vision in patients with the most severe forms of corneal blindness. “It kind of sounded a little science fictiony. I was like, ‘Who thought of this?’ Like this is so crazy,” Chapman, 34, who lives in North Vancouver, British Columbia, tells TODAY.com about his first impression of the concept. “Usually, the reaction is shock and surprise and frank disbelief that it even exists,” says Dr. Greg Moloney, his eye surgeon and an ophthalmologist at Providence Health Care’s Mount Saint Joseph Hospital in Vancouver.
The History and Development of Tooth-in-Eye Surgery
The technique was developed in the 1960s, and Moloney estimates several hundred people around the world have undergone the procedure. It’s for patients who have a healthy back of the eye, but have suffered severe damage to the front of the eye — the cornea — from a chemical burn, a fire or explosion, or an autoimmune reaction where the immune system attacks the eye. In those cases, doctors need a way to restore a clear window to the back of the eye — like changing a severely damaged windshield in a car, Moloney says. It turns out a tooth with a lens implanted in the eye is the solution.
Dr. Greg Moloney, left, and Brent Chapman talk before the second stage of his tooth-in-eye surgery. (Phil Chapman)
Sudden Vision Loss
Chapman was 13 years old when he lost his vision. He was playing in a high school basketball tournament, felt a little ill and took a couple of ibuprofen pain relievers. Healthy until then, Chapman had a life-threatening skin reaction to the medication known as Stevens-Johnson syndrome. In a coma for 27 days, Chapman recovered, but his eyes were forever impacted. His left eye is irreversibly blind, while his right eye suffered severe damage to the cornea. He spent the next 20 years traveling the world trying different procedures to preserve any vision he had left, including 10 cornea transplants. But they worked only for a short period of time. “It was very devastating when I would lose that vision again, so we couldn’t keep going down that road,” Chapman says. The damage to the surface of his eye was so severe that trying a cornea transplant was “like trying to plant a flower in a desert. It’s just not going to grow,” Moloney notes. Chapman needed a prosthetic cornea, and his tooth would do the job.
Why a Tooth is Used to Restore Vision
Humans have been trying for hundreds of years to figure out how to put an artificial cornea on the front of an eyeball — the biggest issue is getting it to stay in place so that the body doesn’t reject it, Moloney notes. A patient’s own tooth solves that problem. It’s a hard structure that can survive in this harsh environment, and the body understands it as part of itself, allowing it to grow into place, the doctor explains.
A patient’s eye after the procedure. (Dr. Greg Moloney)
“It’s a bridging tissue between the body and the plastic (lens) that focuses the light,” Moloney says. “This is like planting a cactus in the desert. This thing is going to survive and it’s going to grow.” The ideal candidate for tooth-in-eye surgery — officially known as osteo-odonto-keratoprosthesis — is blind in both eyes from a disease that has affected the surface of the eye, but still has a healthy optic nerve and retina.
Complex Surgery
The first stage of the two-step operation took place in February when Chapman had one of his teeth pulled. It had to be a healthy tooth that’s “bigger and then quite robust in order to hold the lens,” Dr. Ben Kang, his oral surgeon, tells TODAY.com. He extracted one of Chapman’s upper canine teeth, then shaped and flattened it down with a drill so that it became rectangular. A hole drilled in the middle of the structure allowed the lens to be installed inside. It would serve as the clear window to the back of Chapman’s eye, but more steps needed to be done.
The tooth with the lens. (Dr. Greg Moloney Providence Health Care)
The tooth was then put back into Chapman’s cheek and implanted in a fat pocket underneath his eye for three months so that the body could grow tissue around it. Moloney would use it to stitch and anchor the structure to the front of his patient’s right eye. That second stage of the surgery took place in June.
Life-Changing Results
After waking up, Chapman could see hand motions right away, but it took a couple of months for his eye to heal after the surgery and for his vision to sharpen. “We tried some glasses and had had this moment where I was like, wow, OK, I’m really seeing well now,” Chapman recalls. “Dr. Maloney and I made eye contact, and it was quite emotional. I hadn’t really made eye contact in 20 years. It felt really euphoric. It was really fantastic.” Chapman now has about 20/40 or 20/30 vision in that eye, Maloney says. He has some issues with glare so he wears sunglasses, but calls the surgery life-changing. Chapman can read, walk without a cane and is back to playing basketball.
From left to right, Moloney, Chapman and his father, Phil Chapman. "Before this surgery, the eye really consumed my life and my family’s life," Brent Chapman says. (Ann Gibbon)
Studies on people who’ve undergone tooth-in-eye surgery show the chance that the lens is functional and in place in 30 years is better than 90%, Maloney says. Chapman’s chance of retaining his current level of vision in 30 years is about 50%. Chapman is one of the first people in Canada to get the surgery. In the U.S., the first patient to undergo the procedure was a Mississippi woman in 2009. The Bascom Palmer Eye Institute in Miami says it’s the only center in the U.S. that performs the surgery. “It’s a big, big surgery and a big step,” Chapman says. “But it was right for me.”
Conclusion
Tooth-in-eye surgery is a complex and innovative procedure that can help restore vision in patients with severe corneal blindness. While it may seem like science fiction, the technique has been developed and refined over the years, with several hundred people around the world having undergone the procedure. The surgery involves using a patient’s own tooth as a prosthetic cornea, which is then implanted in the eye. The results can be life-changing, with patients regaining their vision and independence. However, the surgery is not without risks and challenges, and patients must carefully consider their options and consult with their doctors before making a decision.
FAQs
Q: What is tooth-in-eye surgery?
A: Tooth-in-eye surgery, also known as osteo-odonto-keratoprosthesis, is a complex procedure that involves using a patient’s own tooth as a prosthetic cornea to restore vision in patients with severe corneal blindness.
Q: Who is a good candidate for tooth-in-eye surgery?
A: The ideal candidate for tooth-in-eye surgery is blind in both eyes from a disease that has affected the surface of the eye, but still has a healthy optic nerve and retina.
Q: What are the risks and challenges associated with tooth-in-eye surgery?
A: The surgery is complex and carries risks such as infection, rejection, and vision loss. Patients must carefully consider their options and consult with their doctors before making a decision.
Q: How long does the surgery take to heal?
A: The surgery typically takes a few months to heal, and patients may need to undergo additional procedures to refine their vision.
Q: What is the success rate of tooth-in-eye surgery?
A: Studies have shown that the chance of the lens being functional and in place in 30 years is better than 90%, with patients retaining their current level of vision in 30 years being about 50%.
