Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.
Issue link: http://digital.ophthalmologybusiness.org/i/138484
continued from page 9 "I finally found that paper, which wasn't available digitally, and I thought, 'Now that we've done so much work with lasers on dermal pigment, it should be fairly easy to remove that iris pigment safely, which should, in turn, reveal a blue eye,'" Dr. Homer said. "Around '01, I personally funded a small study at Cedars-Sinai Eye Institute in Los Angeles. We took brown-eyed rabbits and proved the concept, showing that we could change an eye's color. These rabbits don't have blue eyes, but what we showed is we could remove the pigment." The study has now moved into the human realm: 17 irides have been treated in Mexico. The laser has been used on a small spot at the 12 o'clock position of the iris, covered by the upper lid. The next stage of research will be performing the procedure on an entire iris. Perry S. Binder, MD, clinical professor, Department of Ophthalmology, University of California, Irvine, and a member of the Strōma MAB, said earlier investigations into changing eye colors have involved the anterior chamber, which proved risky. This new technique on the surface of the eye appears much safer, he said. It is noninvasive, painless, and takes only 10 seconds to perform. However, the procedure could still face some opposition because it is a new idea, he said. "We will see a lot of resistance, rightfully so I think, because the color of the eye is not inhibiting people's ability to function," Dr. Binder said. "There will be a lot of controversy, but as long as the company does the proper research and publishes its research and everything's good, I think it will become a marketable procedure." Concern of pigmentary glaucoma prompted examination of that issue, but thus far, no evidence of it has been found. Dr. Binder said IOP has also been carefully measured throughout testing, but no rise has been seen. 10 How it works Marguerite B. McDonald, MD, professor of ophthalmology, New York University Langone Medical Center, New York; adjunct clinical professor of ophthalmology, Tulane University Health Sciences Center, New Orleans; and Ophthalmic Consultants of Long Island, N.Y., is on the Strōma MAB. She described how the laser works. "This is a Qswitch neodymium YAG laser, which produces a very highly discriminatory photo-absorbed frequency. The laser fires a series of small, computer-guided pulses, right across the iris, to photo-disrupt the stromal melanocytes," she said. "Because of the photo-absorption properties of this laser, the energy passes through the clear cornea, and it very selectively hits the brown melanocytes, leaving the cornea and the posterior iris stroma totally undisturbed. The photo-disrupted melanocytes release cytokine protein molecules into the anterior chamber and the cytokine signal recruits macrophages. If you break down 'macrophage' into its Greek origins, it means 'big eaters' because these are huge cells that eat garbage, they eat debris," said Dr. McDonald. "The macrophages arrive after they get the cytokine signal, and they engulf and digest the photodisrupted melanocytes as cellular debris. The complete elimination of the melanocytes takes one to four weeks. The final outcome is the removal of the brown stromal pigment and the emergence of the underlying natural blue stroma," she said. Potential Many people are excited by the prospect of permanently changing their eye color, Dr. Homer said. The procedure would likely cost about $5,000 for both eyes, although physicians would set the price, not the company itself, and it would vary depending upon territorial demand curves. Ophthalmology Business • July 2013 Dr. Homer, whose doctorate is in evolutionary neurology, said from a biological standpoint, there are many reasons that people might want lighter eyes: the clearness of the eye possibly revealing more genetic defects and disease, and the fact that people often show their attraction to another with an enlarged pupil, which is easier to see in a lighter eye. He was quick to point out, however, that eye color is purely a matter of personal preference. "We are not proposing that some qualitative difference exists between dark and light eyes. Our goal is simply to provide consumers with a choice." Dr. McDonald said blue eyes are exotic in many places, which could be part of the procedure's appeal. "It is unique, it is a first of its kind, and they've done a lot of studies indicating that the potential market is huge. I am behind them all the way because I appreciate the deliberate approach," Dr. McDonald said. "They've got the best people on their team, the best scientists, the best pathologists, and they're going to make sure that people are not harmed by this. Each step moves forward hinged on the last one, the top concern being safety." For more information, visit the company's website, www.stromamedical.com. OB Reference 1. Eagle RC Jr. Iris pigmentation and pigmented lesions: an ultrastructural study. Trans Am Ophthalmol Soc. 1988;86:581-687. Editors' note: Drs. Ahmed, Binder, and McDonald have financial interests with Strōma Medical Corporation. Dr. Homer is chairman and chief scientific officer, Strōma Medical Corporation. Contact information Ahmed: 905-820-3937, firstname.lastname@example.org Binder: 858-922-8699, email@example.com Homer: firstname.lastname@example.org McDonald: email@example.com