11 minute read
Hadassah Medicine
Dr. Itay Lavy, senior ophthalmologist and surgeon at HMO, examines patient Charlotte Goller.
Sight for Sore, Cloudy Eyes
Advertisement
Charlotte goller has had vision problems since her early teens. By her mid-30s, she had lost almost all sight in her left eye. Its dime-sized outer covering, the cornea, had bulged outward, the distorted cone-shape no longer able to bend the incoming rays of light into the orderly patterns essential for sight.
The condition is “called keratoconus, and I was born with it,” said the Connecticut-born Goller, a 75-year-old retired clinical psychologist. In the 1980s, she underwent a full corneal transplant in her left eye from a donor cornea at Mount Sinai Hospital in New York City, and a decade later, shortly before making aliyah in 1994, she had a corneal transplant in her other eye.
Whole corneas have been successfully implanted since 1905, making it the oldest and most successful type of human tissue transplantation. But, as Goller discovered, the transplant can come with an expiration date.
“A few years back, the donor cornea in my left eye began clouding,” she said. “Soon, the eye was virtually blind again. With repeat whole corneal transplants usually rejected, I didn’t know what to do.”
Enter Goller’s sister, who happens to be Barbara Sofer, Israel director of public relations and communications for Hadassah. In 2019, Sofer introduced Goller to Dr. Itay Lavy, a senior ophthalmologist and surgeon at the Hadassah Medical Organization.
Dr. lavy is a global expert in a cutting-edge method of partial corneal transplantation known as DMEK, Descemet’s membrane endothelial keratoplasty. His plan for Goller was to use DMEK to graft not a whole cornea, but a single microscopic layer of cornea tissue into her eye to restore her sight.
He had learned this innovative surgery during his fellowship at the Netherlands Institute for Innovative Ocular Surgery in Rotterdam with the creator of the procedure, Dutch ophthalmologist Dr. Gerrit Melles. When Dr. Lavy returned to Israel in 2017, he introduced it to Hadassah—making the medical center one of a handful of places worldwide to perform this advanced surgery.
“Hadassah has Israel’s highest-volume cornea clinic and has successfully implanted whole corneas to treat corneal trauma and disease for more than 50 years,” he said. “Now, the time limit on the implants is bringing many of these patients back with graft failure.”
In Goller’s case, as in many who need corneal transplants, “only one of the cornea’s five layers had failed, so only one needed replacing,” explained Dr. Lavy. The procedure takes about 30 minutes and is done under local anesthetic. Goller recalls being awake throughout, “feeling some pressure but no discomfort,” she said.
During the procedure, a surgeon gently dissects the cornea, separating the faulty tissue layer from the healthy ones and peeling it off. “We then inject a wisp of donor tissue,” Dr. Lavy said, “which we call a ‘megillah’ because it tends to scroll. With a virtually no-touch technique unique to Hadassah, we use air current to unscroll it and get it to the right place.”
This sounds simple until you realize that this is all taking place in the realm of the microscopic. The cornea is a half-millimeter thick at its densest, and the replacement layer a mere tenth of the thickness of a piece of paper. Not only that, but the donor
cells are implanted into the cornea’s innermost layer, atop supremely sensitive cells that, if damaged, will make the patient blind.
As a guide, Hadassah’s ophthalmic surgeons use Israel’s only intraoperative optical coherence tomography (OCT), a noninvasive imaging system that works on light waves rather than radiation and allows surgeons to map and measure each of the cornea’s distinct layers in real time.
Demanding as it is, the surgery’s advantages are significant.
“It has minimal rejection rates, fast visual recovery and good visual acuity,” said Dr. Lavy. “It doesn’t touch the cornea’s surface, so there’s no astigmatism. And without sutures, there’s little incidence of infection. Better yet, one donor provides sufficient tissue for two patients.”
As with hearts and lungs, the availability of donor tissue is the bottleneck of corneal grafting worldwide. Hadassah’s response to that need was to create a cornea bank 15 years ago at HMO. Supervised by Dr. Avi Solomon, Hadassah’s cornea service director and ophthalmic surgeon, the bank is run by Hadassah medical students. Sixth-year student Eden Amir has headed its three-member team for the past five years.
“We’re on call 24/7 to harvest corneas from deceased patients,” said Amir. “Medical center staff alert us to potential donors. We check their medical suitability and then approach
Medical student Eden Amir heads Hadassah’s cornea bank.
Podcast Alert! Real Stories. Amazing Breakthroughs.
PODCAST
Hadassah On Call takes listeners behind the scenes at Hadassah hospitals in Jerusalem. Meet the health care superheroes who save lives every day. Hear how Hadassah innovations are saving lives. And learn tips for staying healthy. From bone health to sleep disorders to women’s health, stay ahead of the curve with Hadassah On Call. Season 4 kicks off with our new host, American-Israeli journalist Maayan Hoffman, a third-generation Hadassah member. Tune in to Apple, Spotify or wherever you listen. Watch videos or listen to the podcast online at events.hadassah.org/oncall-hmag.
MAAYAN HOFFMAN HADASSAH’S NEW PODCAST HOST
their families. It’s hard. It needs sensitivity, focus, experience, awareness of the ethical and religious values of those involved, and a sense of when to persist and when to retreat and share the grief. I’ve had hundreds of conversations with hundreds of families. No two have ever been alike.”
He recalled going to the ICU after a Muslim father of nine children had just died. “There were dozens of sorrowing relatives there,” said Amir. “I waited and then approached two men who seemed senior. I explained, they listened and then consulted the family. One after another, they agreed to give the corneas, ‘no matter who they go to.’ ”
Once the family consents and the surgeons are informed, “we gently strip away the donor corneas in a relatively simple 30-minute procedure that leaves virtually no external trace,” said Amir. The tissue is then dispatched for immediate use or preservation.
When appropriate, the bank will bring together the family of the donor with the transplant recipient. “This closes the circle for all of them,” explained Amir, adding, “I’m uplifted by the work. I meet bereaved people who, even in their anguish, still see the other.”
MAAYAN HOFFMAN
A journalist passionate about Israel and Hadassah
When Israeli-American jour-
nalist Maayan Hoffman leaves her home in Jerusalem for her daily jog, she feels that with each step, she is running through Jewish history. “I brought my children to Israel because it is our Jewish home,” said Hoffman, who returned to Israel with her son and three daughters in 2015.
Born in Kansas City, Kan., Hoffman graduated from Washington University in St. Louis and first came to Israel in her 20s, after a short stint as managing editor of the Kansas City Jewish Chronicle. She received a master’s degree in Jewish civilizations from Hebrew University and returned to the United States in 2005, eventually moving to Baltimore and becoming editor-in-chief of the Baltimore Jewish Times—but, she said, “I never stopped hoping to move back to Israel.”
While history, heritage and family may have inspired her return to the Jewish state, the 44-year-old veteran reporter’s professional life has lately revolved around Israel as well, and specifically the areas of innovation and health care.
It is that interest and expertise that she is bringing to her role as the new host of Hadassah On Call: New Frontiers in Medicine, the monthly health and medicine podcast that features interviews with Hadassah Medical Organization physicians, researchers and nurses at the cutting edge of health care, at hadassah.org/podcasts.
This interview has been edited for brevity and clarity.
Maayan Hoffman
What are you looking to bring to the Hadassah On Call podcast?
I’m passionate about Hadassah. My two post-bat mitzvah daughters are fourth-generation life members, and I truly feel that Hadassah, and especially its medical organization, make a difference in the world. I have a very solid background and wide-ranging experience in both online and health care reporting.
I spent two years exhaustively covering the Covid pandemic for The Jerusalem Post, work that took me into Hadassah’s wards. I currently report for Health Policy Watch, a Geneva-based website, on world health trends and policy challenges.
I also ran The Jerusalem Post’s health podcast, discontinued when I left, and I’m a former head of strategy for The Jerusalem Post Group [which includes the internet portal Walla! and Hebrew daily Maariv]. I remain its head of conference planning for in-person and online events—although as an independent contractor through my own communications company.
You began hosting Hadassah On Call in September with an episode on monkeypox that featured an interview with infectious disease expert Dr. Allon Moses. Going forward, what changes might you make to the podcast?
I’m very aware that I’ve come to something very good, and that any changes must be for the better.
One major difference will be that I’m physically in Jerusalem, whereas previously the podcast was created remotely. Being here, I can be face-to-face inside the medical center, making the episodes both more personal and more timely [and it will now include video as well as audio interviews]. And I’ll be adding Jerusalem snippets—sharing stories from my neighborhood and my kids’ schools, local festivals, exhibitions, exciting restaurants and happenings.
Can you share the story of your return to Israel and remarriage seven years ago?
After my divorce in 2014, I started planning on bringing my four young children to Israel for the Jewish education and social circle I wanted for them. Around this time, I reconnected with longtime colleague and friend Gil Hoffman, then-Jerusalem Post political correspondent, who was also divorced with children. I’d first met Gil when we were reporters in Israel many years before. Our friendship quickly became personal, and when his two children gave me a card reading: “Please marry my Daddy,” that’s what I did! We married in December 2015. —Wendy Elliman
Cornea bank staff say they are proud that, despite limited resources, their educational and outreach efforts in the hospital and local community have seen increased donations and a vastly shortened waiting list.
Among the some 100 recipients of cornea tissue at Hadassah last year was a 53-year-old woman originally from Odessa who had made aliyah 25 years earlier. Born with congenital cataracts clouding both eyes, she had both faulty lenses replaced with artificial ones in the former Soviet Union when she was in her teens.
These old replacement lenses “unfortunately damaged her corneas, and vision deteriorated in both her eyes,” recounted Dr. Lavy. “So she underwent whole corneal transplant in one eye, but the graft became infected and the eye lost all vision. Some years ago, now in Israel, she began losing sight in her second eye. From being fully functional, she could no longer safely make herself a cup of coffee. It was heartbreaking.”
The Hadassah team operated first on the patient’s completely blind eye, replacing the old Soviet lens and restoring vision with transplanted cornea tissue. They then gave the partially sighted eye a new, more modern artificial lens, fully restoring her sight.
Another tissue recipient at Hadassah last year was a 23-year-old Ethiopian Jew who had been in a fight in a Tel Aviv bar.
“Glass from a broken bottle damaged his right eye so severely that the hospital where he was first taken wanted to remove the eye,” said Dr. Lavy.
A naval commando officer under whom the young man had served in the Israel Defense Forces contacted Hadassah.
“He’s hotheaded and gets into trouble, but he’s a good guy,” Dr. Lavy recalled the officer saying. “He pretty much grew up on the street, and he’s come a long way. He wants to go further. Please help him keep his eye.”
In a long and complex surgery, adapting operating techniques as they went, Dr. Lavy’s team rebuilt the patient’s eye, transplanting an iris and lens as well as a cornea. Today, the young man sees well enough to drive safely.
“I always try to see the person behind the eye and tailor treatment to suit him or her,” said Dr. Lavy. “I never give up. My patients know I’ll do anything to help them. I believe their trust contributes to the surgical success.”
Dr. Lavy notes that future advances in the field may reduce demand for corneal transplants or do away with them altogether. These innovations, he hopes, will include imaging that identifies cornea disease early enough to prevent it; injection rather than surgery to implant cornea cells; corneas created on 3D printers; healing with stem cells; and if surgery is still necessary, robotic surgeons to do precision work.
Until such advances are realized, Charlotte Goller has a plan.
“When the old transplant in my second eye wears out,” she said, looking up from one of the 100-plus books she reads each year, “I’m off to see Dr. Lavy.”
Wendy Elliman is a British-born science writer who has lived in Israel for more than four decades.
