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Making meaningful eye contact(s):

8 min read

Many suffering from corneal blindness given new lease on sight

Perry Rosenthal, Randy
Perry Rosenthal is pictured in his Chestnut Hill office with Randy Hirsekorn, a hog farmer from Alberta who had his sight restored after eight years of blindness. (Staff photo by Stephanie Mitchell)

Perry Rosenthal considers himself an agnostic, but recently he has had the disquieting sense that his life may be shaped by some higher purpose.

“Everyone has a role to play in life, and I feel I’ve been one of the really lucky ones,” he said.

Rosenthal, who has a part-time appointment as assistant clinical professor of ophthalmology at the Medical School, is the developer of the Boston Scleral Lens, which literally allows the blind to see.

Rosenthal’s lenses can’t cure all blind people, only those whose blindness is caused by certain diseases of the cornea, the clear lens that focuses light onto the retina. There are about 50,000 people in the United States affected by such diseases, possibly more. But the way Rosenthal’s lenses have transformed the lives of these people is nothing short of miraculous.

Darkness and pain

Take Randy Hirsekorn, for example. A farmer in Alberta, Canada, Hirsekorn enjoyed good health until he took the common, over-the-counter pain medication ibuprofen and had a very uncommon and extreme allergic reaction known as Stevens Johnson syndrome. The disease attacked the entire surface of Hirsekorn’s body, causing 98 percent of his skin to blister and slough off.

Treatment at a burn unit saved his life, but his corneas were also affected, becoming permanently scarred and distorted. Hirsekorn lost most of his sight, which made it impossible for him to carry out his normal tasks on the farm, but what was worse, his eyes became so sensitive to light that he could stand to be outdoors only at night. Blinking was so painful that at one point his doctors tried suturing his eyelids shut to give him some relief.

Then he heard about Rosenthal’s clinic on a radio talk show and came to Boston to see if Scleral Lenses could help. Now, after only a few days of wearing the lenses, Hirsekorn is able to see clearly in daylight.

“This is the best I’ve seen in years,” he said. “Last night I watched TV, and for the first time I could see the faces that went along with the voices. I’m looking forward to going back home to the farm and seeding the crops and caring for the animals again.”

Donna Pugh is another of Rosenthal’s success stories. A former flight attendant, Pugh developed keratonconus, a disease in which the cornea thins out and becomes distorted, resulting in a gradual loss of sight. Pugh’s vision had diminished to less than 20/400 despite several corneal transplants. The expense of treating her disease caused her to lose her house.

Within minutes of being fitted with Rosenthal’s lenses, Pugh was able to read the 20/20 line on an eye chart and later that day drove a car for the first time in 10 years.

This past Monday (Feb. 3), Pugh appeared with Rosenthal on the “Oprah Winfrey Show” in a program highlighting medical miracles. The appearance seems likely to bring Rosenthal’s work to the attention of many more potential patients. He said that since the show aired, more than 10,000 people have visited the Web site of the nonprofit organization he founded, the Boston Foundation for Sight.

Man on a mission

Rosenthal has specialized in contact lenses ever since he began his residency at the Massachusetts Eye and Ear Infirmary in 1960. He has taught contact lens fitting at the Mass. Eye and Ear Infirmary for many years, and from the beginning, he was struck by the way hard contacts could correct corneal distortions and dramatically improve the vision of those afflicted by this class of eye diseases.

But he was also disappointed by the technical limitations of the contacts in use at that time. The plastic of which they were made blocked out the air, and since the cornea, alone of all the tissues of the human body, extracts oxygen from the atmosphere rather than from the blood, this impermeability meant that many people could not wear contact lenses for more than a few minutes.

This situation changed in 1986 when Rosenthal became the first person to successfully use the newly developed gas-permeable plastics to make contact lenses. The lens he developed, known as the Boston Lens, has since become the standard in the industry.

The Boston Lens, however, could not help people afflicted by corneal diseases. This is because the cornea is also the most sensitive tissue in the body, containing the highest concentration of nerve endings. Because normal lenses do not fit smoothly on the distorted and fragile surface of diseased corneas, they cause almost unbearable pain.

As Rosenthal contemplated this problem, he thought about the design of the earliest contact lenses, developed in Germany in the 1880s. These were larger than today’s lenses, about the size of a quarter, and rested on the white part of the eye, or sclera, rather than on the cornea. Since the sclera is relatively insensitive, such a lens design would work well for patients with damaged corneas.

Thus, the Boston Scleral Lens was born. Floating on a layer of artificial tears, the lens both protects the distorted cornea and accurately focuses incoming light rays, radically improving vision. But there were many kinks to work out before lens performance was optimized.

Each lens had to be very carefully fitted to the individual wearer, resulting in a shape that was more complex than normal contact lenses. To fabricate this lens, Rosenthal and his associates developed a special computer program, based on an advanced type of mathematics called spline theory. The program runs a highly sophisticated lathe, donated to Rosenthal’s clinic by Bausch and Lomb, which turns the delicate lenses from a solid piece of acrylic plastic.

Another problem with Rosenthal’s early efforts was that the fluid tended to get forced out, resulting in the lens being sucked onto the cornea. Rosenthal solved this difficulty by creating a series of tiny radial channels in the underside of the lens that allows the wearer’s natural tears to be pulled into the center.

Getting the word out

The Boston Scleral Lens, which received FDA approval in 1994, has now achieved an 80 percent success rate, but the cost is still high – $5,500 for each pair of lenses. Rosenthal’s clinic, backed by its parent organization, the Boston Foundation for Sight, subsidizes its operations through fundraising, managing to treat about half its patients free of charge.

David Walton, an associate clinical professor of ophthalmology and Rosenthal’s colleague at the Eye and Ear Infirmary, has sent two of his patients to Rosenthal for treatment. Both suffer from a rare condition in which the soft surface of the cornea cannot repair itself normally.

“Both of them have benefited greatly,” he said. “They’ve had real vision breakthroughs. Dr. Rosenthal is a wonderful personality who has helped a lot of people.”

Rosenthal wishes that he could furnish lenses for everyone suffering from corneal eye diseases, many of whom develop the condition in early childhood and are condemned to lives of pain and isolation. But so far his clinic is the only one in the country offering such services, a situation that he is trying to change.

“Ophthalmologists should be sending us their patients, but these conditions are so uncommon that they forget about us. I decided six months ago that I’ve got to stop doing this thing quietly and get the word out.”

Hence the “Oprah” appearance, which Rosenthal hopes will bring his work to national attention. He also hopes it will help to change the policies of health insurers, which either refuse to pay for the lenses or reimburse only a small fraction of the actual cost.

Meanwhile, Rosenthal has started a program to train other doctors in his procedures, financed by a $240,000 grant from Johnson & Johnson. Recently, the first affiliated clinic was set up in Tokyo, Japan.

Rosenthal, who says he is driven by a lifelong “passion for lenses,” finds these developments encouraging but feels there is much improvement to be made.

“The ones you can’t help – those are the ones you remember.”

Still, as more people learn of his work, and more minds apply themselves to the problems still to be solved, there is bound to be progress on all fronts. Rosenthal, the agnostic who believes that someone or something placed him in the right place at the right time, is counting on it.

“When teaching and research is nurtured, miracles happen.”