Clear Sight Into Fragile Globe: New Byers Eye Institute at Stanford Combines High Technology with Advanced Knowledge

April 2011

Jennifer Thompson was feeling pretty good about her cataract surgery until shortly after it began, and she heard the surgeon say, “I can’t proceed. There is something very wrong.”

What he saw was blood where blood was not supposed to be. Thompson’s left eye was hemorrhaging, several layers of its delicate tissue torn open in a pre-operative procedure. Thompson had emergency surgery, but it was clear she needed the most advanced level of eye care possible. She was referred to the Byers Eye Institute at Stanford Hospital & Clinics to see eye surgeon Theodore Leng, MD, the Institute’s Director of Ophthalmic Diagnostics.

“I think he was pretty shocked by what he saw,” said Thompson. “He told me I was in danger of losing my vision and my eye.” Without quick action, that was a strong possibility.

"I think he was pretty shocked by what he saw. He told me I was in danger of losing my vision and my eye."
-Jennifer Thompson, patient at Byers Eye Institute at Stanford Hospital & Clinics


As frightening as that possibility was, she was thinking of something else that frightened her even more. Her husband had died eight years earlier of melanoma. Its first symptom was vision blurred by a detached retina.

Jennifer Thompson baking in her kitchen.
Jennifer Thompson was about to have cataracts removed from her left eye when the surgeon suddenly stopped the procedure. Her eye was hemorrhaging and the accumulating damage to fragile tissues inside the eye was an immediate, serious threat to Thompson's vision.

Delicate Architecture

Our eyes may be the most complex organs. Protected by our eyelids, which blink 14,000 times each day, each small globe is fronted by the stack of cornea, pupil, iris and lens that face forward; lining the interior of the globe is a thin layer of tissue called the retina, made up of several layers of neuronal cells. They have a biochemical response to light that sends information through the optic nerve to the brain.

Venturing into retinal territory requires infinitesimal precision. “The retina has the consistency of wet tissue paper,” said Leng. “Touch it with an instrument and you will rip it.”

By the time he saw Thompson, scar tissue was already forming on the retina’s surface, blocking her vision. The accumulating blood was seeping under the retina, like bubbles in wallpaper, lifting the retina off its contact with the interior of the eyeball and destroying the ability of her left eye to process light as coherent vision.

Thompson went into surgery with Leng, a retinal specialist, and other Eye Institute colleagues expert in the cornea. Two hours later, she was in recovery. “I had zero pain,” she said. But she did have to spend the next two weeks, asleep or awake, face down in the head cradle of a massage table. The goal: To hold all the repairs together long enough for them to be secure.

Jennifer Thompson during an eye exam
After a two-hour surgery at the Byers Eye Institute at Stanford, performed by Theodore Leng, MD, Thompson's vision is almost completely back to normal. Leng is keeping careful watch on her eye health, however. Thompson may yet need another surgery.
“It wasn’t easy,” she said, “but when you’re trying to save your vision, that’s what you do.” Her son set up a three-way mirror so she could watch television and her grandchildren could crawl under the table to look up at her and talk. “It was pretty hilarious,” she said.

History of Eye Care Innovation

Stanford’s Byers Eye Institute, where Thompson went for her care, opened this fall, bringing together a group of physicians and the latest in equipment for diagnosis and treatment. This new building is a natural progression of the groundbreaking work done in ophthalmology for decades at Stanford, said Byers’ Director Mark Blumenkranz, MD.

Stanford physicians have been instrumental in many of the major advances in eye care, Blumenkranz said, including the invention of many of the features of modern ophthalmic laser delivery systems for the retina. The initial system, developed in the 1960s, became the standard of care for eyes for decades, he said. In the last decade, new generations of scanning lasers have made treatments even more precise, quicker and less painful.

"The retina has the consistency of wet tissue paper. Touch it with an instrument and you will rip it."
-Theodore Leng, MD, Director of Ophthalmic Diagnostics, Byers Eye Institute at Stanford Hospital & Clinics

Jennifer Thompson knitting for her granddaughters.
Jennifer Thompson is an active grandmother who knits for her two granddaughters. She loves to bake, especially scones, a traditional tea time treat in her native New Zealand. If she had lost the vision in her left eye, she would now have a far different life, one marred by difficulties in reading, driving and other daily activities.

Stanford patients were among the first on the West Coast to benefit from another recent development, the use of monoclonal antibodies to stop leaking blood vessels that cause several types of blindness, especially in people with age-related macular degeneration, Blumenkranz said. The macula is the central portion of the retina; it can become clouded with material that obscures vision.

Current research at Stanford includes continuing development of microsurgical devices and lasers that operate in femtoseconds—that’s a millionth of a billionth second. Stanford physician-scientists are also investigating how semiconductor chips might be used to help patients whose retina is intact, but who, because of genetic disorders, have lost the rods and cones in the retina necessary to translate light into images.

More than 1,000 surgeries were performed at the Eye Institute last year; 40,000 patient visits covered treatment of cataracts, diabetic retinopathy, glaucoma, lid and orbital problems, corneal disease and vitrioretinal diseases such as age-related macular degeneration and diabetic retinopathy.

Protecting Your Eyes

- Our mothers weren’t joking about carrots being good for our eyes. So are leafy green vegetables. A balanced diet, said Theodore Leng, MD, of Stanford’s Byers Eye Institute, is an important part of healthy eyes.

- Wear a hat or sunglasses or both, Leng advises. Ultraviolet light can cause cancers on the surface of the eye, in addition to skin cancer on the eyelid.

- Ultraviolet light is also a likely impetus for cataract development and may also be a factor in macular degeneration. That condition, very often related to increasing age, is caused by cellular debris that accumulates between the retina and the choroid, another layer of tissue in the eye.

- Knowing the symptoms of retinal detachment can also prevent complete loss of vision. Those symptoms, which are painless, include the sudden appearance of floaters, debris that looks like bits of string or hair or spots. Sudden flashes of light in one or both eyes and a shadow over one area of vision can also mean trouble.

- Talk to your doctor if there is a family history of eye problems. Some diseases have a genetic component.

The Byers Eye Institute at Stanford is home to six specialized care centers. It offers the latest technologies for diagnosis and treatment. Its professional staff includes 25 eye care specialists in all services, including cataract evaluation and surgery, oculoplastic surgery, cornea and external eye disease, glaucoma, and neuro-ophthalmology. It opened in fall 2010 in a $26.3 million building  at 2452 Watson Court, Palo Alto.

The Architecture of Sight
Cornea: transparent protective tissue
Iris: muscular ring that controls amount of light entering the pupil
Pupil: allows light through to retina
Lens: changes shape to allow focus at various distances
Retina: thin layer of tissue whose photoreceptor cells transmit signals to optic nerve and visual process centers in the brain
Macula: central portion of the retina that processes central field of vision and enables vision acuity

Diagram of the human eye.
For more information about the Byers Eye Institute at Stanford, visit: stanfordhospital.org/eyeinstitute or call 650.723.6995. Join us at stanfordhospital.org/socialmedia.

The Institute has also been nationally recognized as a center for clinical studies in refractive surgery, including LASIK and PRK.

Complexity Overcome

With Thompson, the first challenge was diagnosis. At Stanford, physicians use specialized cameras and scanning equipment that produce a microscopic-level image of the eye’s structures--without having to remove any tissue from the eye. A low-intensity laser light beam allows information about the retina, even the optic nerve, to be gathered in ways previously not thought possible, said Blumenkranz. That data is then processed with software that constructs the image.

While repairing Thompson’s injury required great surgical skill, “she was very lucky,” Leng said. “It was a glancing injury which, fortunately and miraculously, did not cut the retina.”

The surgery was conducted with a raft of special devices designed to cope with the challenge of an organ that is 90 percent water and only about one inch long. “As a young medical student,” Leng said, “you have no idea of how complicated the eye is.” The complexity of the eye, he said, means there are more things that can go wrong.

"I feel nothing short of lucky, thanks to the skills, empathy, concern and knowledge of Dr. Leng and his team.'"
-Jennifer Thompson, patient at Byers Eye Institute at Stanford Hospital & Clinics

When he embarked upon his education in eye care, “they give you a set of books that stretches out three feet—and that’s the basic knowledge,” he said. “Then we specialize even more.”

“I feel nothing short of lucky,” Thompson said, “thanks to the skills, empathy, concern and knowledge of Dr. Leng and his team.” They even returned her calls on Christmas Eve and New Year’s Day, she said. “They made sure they were available. I was totally impressed.”

She may need to have more surgery. There is still some scar tissue that Leng may have to remove, but her vision in her left eye is currently 20/30, just 10 vision feet below normal. Because of the damage, however, even repaired, Thompson knows that left eye has some weakness. That hasn’t stopped her from being an active grandmother to her two granddaughters or from taking a long visit to back home to New Zealand. “I flew with no problem at all!” she said.

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