Dressed in a teal, sterile surgeon uniform, Dr. Thiran Jayasundera holds micro scissors with latex gloves. Sitting, he leans in to stare through a microscope-like lenses aimed straight down over a patient’s eye. Back aches. Bright lights. At any moment in the four-hour surgery, one accidental twitch of his hand could make him brush one of the tiny, fragile wires he just implanted, ruining the surgery and the prize—a $150,000 square, metal implant. And everyone would know; this surgery, unlike others, broadcasts onto a TV screen just outside of his Kellogg Eye Center operating room and is recorded so that surgeons near and far can learn from it. In the end, all wires were left unscathed.On January 16 and January 22, Dr. Jayasundera—a retina researcher, clinician, and surgeon—and his medical team performed the first two “bionic eye” surgeries ever performed in the United States since the FDA approved the procedure this past summer. The surgery propels Dr. Jayasundera from a new, unknown ophthalmologist into American eye surgery fame and marks the first significant progress in history towards treating patients who have severe stages of an eye disease called retinitis pigmentosa.
Over time, retinitis pigmentosa causes increasing blindness in the 100,000 Americans it affects. Because extreme patients have no useful vision, they need the “Argus II” implant to sense images for them. The implant is a square patch of tiny electric wires put on the retina—the part in the back of the eye that senses images. It receives images wirelessly from a camera on a pair of sunglasses. Second Sight, the company that makes the “Argus II” implant, chose only 12 centers in the country to receive the device. Because Dr. Jayasundera pushed his team to connect with Second Sight for the selection process, the Kellogg Eye Center is one of them. According to Dr. Jayasundera, Kellogg is a “well-oiled machine for retinal dystrophies” because, in one team-oriented location, it harbors doctors with diverse specialties—like Dr. Jayasundera himself.
Retinal dystrophy doctors usually see patients or perform surgeries—one or the other. Dr. Jayasundera does both. “There are maybe two other people in the country that do what I do—both retinal dystrophies and retinal surgery,” said Dr. Jayasundera.Dr Jayasundera’s personal goal explains the initiative he took to perform the surgery.
“My philosophy is you really do want to change the world. You do want to change the way we practice medicine somehow,” said Dr. Jayasundera.
Change the practice of medicine he does. The surgery allows patients who formerly have no useable vision to see shapes and motion.
“The fact that he can see …where we need to take the field is really forward-thinking,” said Dr. Jillian Huang, a Genetic Counselor and the coordinator for Dr. Jayasundera’s many research projects.
Dr. Jayasundera “is very innovative, dedicated, and has the gift of being able to take an idea—take something from a concept or an idea to making it happen,” said Dr. Dr Paul Lee, Director of the Kellogg Eye Center.
Dr. Jayasundera, 38, grew up Colombo, the capitol of the island Sri Lanka. When he was 13, his family moved to to Auckland, New Zealand, the largest city in the country. As he was finishing his residency at the University of Auckland in New Zealand, he met Shalini Gunawardane at a wedding in California. They eventually married and moved back to New Zealand until a year-and-a-half-long retinal dystrophy research fellowship at the University of Michigan brought them to Ann Arbor. Next was Canada for two years of medical fellowship at McGill before Dr. Jayasundera finally settled back down in Ann Arbor as faculty member at Kellogg in 2011. The Jayasunderas have a three-year old son and a second child due in June.
Jayasundera set his sights on retinal dystrophy care because, when he was becoming a doctor, there was no help for such patients. “Things need to be done for them” he said.
His family has helped him cope with the pressure of the landmark surgery.
“Whatever free time he has… is family time the three of us,” Gunawardane says. “My son’s favorite thing to do is to go to Zingerman’s deli and eat gelato, so we’ve been doing that on a weekly basis every Sunday,” Gunawardane said earlier.
Good food and the television show, Top Chef, are, in fact, two of Dr. Jayasundera’s passions after the operating room and his family.
“Despite the fact that his parents are so far away in New Zealand, …he’s always checking up on them, calling them everyday …If there’s one thing about him aside from his job as a doctor it’s just that he really treasures that time with his family… Thiran is the ultimate family man,” said Gunawardane. Earlier she said, “That’s who he is in his core…Laying on the floor with my son doing Legos and building castles and blocks, he’s just the happiest then.”
And then there’s the Argus surgery, like doing tiny Legos in its own way.
The Argus II restores vision for motion and shapes, but future versions of the implant, one day, will be able to identify between faces and colors. With technology moving at an exponential rate, Jayasundera and other surgeons may be even quicker to do for blindness what cochlear implant surgeons did for deafness: approximately 70,000 patients have received implants in the thirty-years since FDA approval and up to one in three deaf children receive treatment.
“For patients who have no vision, being able to have some vision is a great gift,” said Jayasundera.
See more on the Argus II implant and Dr. Jayasundera at http://2-sight.eu/en/landing-first-implants-us and http://www.kellogg.umich.edu/news/14/first-retinal-prosthesis-implant.html