In June 2021, Aaron James was in a horrific accident while working as an electrical lineman. The 46-year-old veteran from Arkansas lost most of the left side of his face, including his left eye, due to severe electrical burns, and he also lost his left arm.
Two years later, James underwent the first-ever partial face and full eye transplant, performed by surgeons at NYU Langone Health in New York City. And now, more than a year later, James is recovering well with no signs of tissue rejection, his medical team reported in a paper published Monday. In the way. Although the transplanted eye is still unable to see, the eye itself maintains its shape and blood flow, and there is evidence of electrical activity in the retina in response to light.
Other researchers say the findings mark a step toward successful whole-eye transplants, but also highlight the challenges of regenerating the optic nerve after severe injury.
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“We’re pleasantly surprised that the surgery went well, the patient was satisfied, and the aesthetic or cosmetic outcome was successful. The eye itself is viable and can remain in that space and continue to contribute to the overall success of the hemi-facial transplant,” said Jeffrey Goldberg, professor and chief of ophthalmology at Stanford University’s Byers Eye Institute. Goldberg was not involved in the study but is a co-author of the study in the same issue of The Journal of the American … JAMA.
The failure to restore vision was not unexpected, Goldberg says, because preclinical studies in animals have shown that optic nerve regeneration is difficult. The surgical team’s technique of injecting stem cells taken from James’ bone marrow into the tissue around the optic nerve has not been tested in animals and could pose a safety risk if the cells grow into a tumor, he notes. Fortunately, there is no evidence to date that this has happened. Another risk is that if the optic nerve from the donor eye regenerated, it could impair James’ vision in his other eye because of the way inputs from both eyes interact in the brain. But there are no signs of this complication either. This exciting first case helps lay the groundwork to push whole-eye transplants toward a reality of restoring vision, Goldberg says.
Whole-eye transplants have long been a dream for doctors and scientists working to treat people suffering from severe eye damage and blindness. The first corneal transplant was performed in 1905. But efforts to transplant whole eyes have been hampered by the extreme difficulty of regenerating the optic nerve, which carries signals from the eye’s light-sensitive retina to the brain’s visual center, where vision is perceived. While there has been limited success in efforts to regenerate the optic nerve in some animals, no one has ever successfully transplanted a whole eye into a human.
Aaron James (leftWe spoke with Eduardo Rodriguez, director of the Face Transplant Program and chief of the Department of Plastic Surgery at NYU Langone Health.
Haley Ricciardi/NYU Langone Health
“Aaron’s functional improvement is astounding, and the cosmetic results are remarkable,” says Eduardo Rodriguez, one of the many doctors involved in James’ treatment. “My ultimate goal was to save[the eye],” says Rodriguez, director of the Face Transplant Program and chair of the Department of Plastic Surgery at NYU Langone Health. “It’s remarkable that we were able to achieve that. Who knows what happens after that, because no one has ever done it before.”
The fact that James’ transplanted eye has maintained its shape and blood supply for more than a year, despite being blind, is remarkable, says Vaidehi Dedania, an associate professor of ophthalmology at NYU Grossman School of Medicine, who has followed eye health. The way the retinal cells respond to light is also remarkable, he added. “No eye has ever been transplanted from one human to another and survived and been maintained in that body for such a long period of time.”
Aaron James and his wife, Megan James, had visited New York City in August to meet with his medical team as part of his post-surgery follow-up. Scientific American We sat down with them to discuss Aaron James’ recovery and what this surgery means for his life.
(An edited transcript of the interview follows:)
It’s been a little over a year and a half since your transplant. How are you?
Aaron James: Everything’s going well. Like you said, it’s been a little over a year now, and I still have some movement in my face. I still have work to do. I’m still going to speech therapy. Just because I had the surgery doesn’t mean it’s over. I still have a lot of maintenance to do. But I’m feeling good. All my blood work is good. So, yeah, I’m just maintaining the status quo for now.
Your face looks totally improved.
Aaron James: It’s amazing how the body has the ability to regenerate. It’s amazing. A lot of people don’t even know that I had a face transplant.
I know there is no vision in the transplanted eye, but will there be any pain or discomfort?
Aaron James: No. It feels exactly like my own bones. There’s no pain. (The doctors) were worried at first that I’d be in a lot of pain, but it’s actually gone way beyond what they expected. I mean, almost a year and a half later, I’m still alive. Right after the surgery, they said, “Okay, you survived the surgery. Next up is 90 days.” And I made it past the 90 days. And I’m still alive. So we’re kind of in uncharted territory right now, just waiting to see what happens next.
How does it feel to be the first person to have this procedure?
Aaron James: It feels good. We’re just a normal family from Arkansas, so it feels kind of overwhelming to be a part of this. If I can be a part of sparking something, it feels good and I feel like I’ve helped millions of people in the future.
Since my accident, I’ve started thinking about things that I normally wouldn’t even think about. Right now I’m thinking about people who are visually impaired. There are a lot of people with visual impairments, and when I thought about that, I thought, “I can’t believe that there are so many people with eye problems and nothing has been done about it. It’s about time we did something.”
What has your life been like over the past year? Have you been able to go back to the same life you had before the accident?
Aaron James: At first, I had to be careful about what I did when I got home because of my white blood cell count. It was fluctuating a lot. But luckily, I think I’ve finally gotten over that issue. There are still some things I have to be careful about, like not being in the sun for too long (because immunosuppressants increase the risk of skin cancer), but it’s really not a big deal.
Have you experienced immune rejection of the face or eyes or other complications?
Aaron James: No.
Has your vision in your non-implanted right eye changed since the accident?
Aaron James: Yeah, first I got cataracts and had to have them removed, and now I wear contact lenses and reading glasses when I need to see things up close.
Haley Ricciardi/NYU Langone Health
What are some of the emotional challenges you guys have experienced?
Aaron James: We live about two and a half hours away from my family. My mom had a stroke and is in a nursing home. They’re constantly seeing COVID-19 cases in nursing homes, so it’s hard for me to go there. I can’t be around those people.
Megan James: From the beginning of the accident and everything that it entails. Aaron told me that his mother had a stroke. And then a few months after that, I actually lost my mother. And then a few months ago, I lost my sister to breast cancer after battling it for five years. So the mental toll is just on top of that. We’ve definitely grown closer through all of this.
Aaron James: Yeah, absolutely. And now my daughter is going to college, so now I can just focus on real life, the normal stuff. I’m finally getting back on track.
Have you found any helpful strategies for dealing with recovery?
Aaron James: One way to deal with it is to have a sense of humor. Tell a joke.
Megan James: If you listened to our everyday conversations you probably wouldn’t believe anything. We’re just mean to each other, but I think that’s how we cope. We have fun, we joke and we laugh.
Aaron James and Megan (left) and Aaron James with his family (right).
Megan, is there anything you’d like to say about your experience caring for Aaron?
Megan James: I always said I would be famous one day, but I never thought I’d be a part of something like this. And it’s really amazing that I got a small role. They just put me in the first implant and sent me home and said, “Take care of yourself.” I was like, “Who could I be a part of this?”
Aaron, how has this face and eye transplant changed you?
Aaron James: It’s definitely something I still think about every day. I think about everything that’s happened in the past. And now, to be honest, when I look at old photos of myself, I look kind of weird. I look familiar. I know who it is, I know it’s me. But I don’t know. It’s hard to explain.
