Transcriber: Vy Dinh Reviewer: Keira White
Can you imagine waking up in the morning to nothing but darkness or shadows?
This is the reality for people who are born blind or who become blind
because of disease or damage to the corneas.
I encountered my first blind patient when I was six years old.
At the time,
my family was living in Malaysia and one of my father's jobs was to go into
the jungles to vaccinate the villagers in the remote areas.
So this one time I insisted on going with him.
And while the medical personnel were doing the vaccinations,
I stayed in the jeep.
When I was in the jeep,
I saw a child very much like this one, peeking into the windows.
This child had one white eye.
I was really scared because I'd never seen a person whose eyes were white.
So I dove under the seat and I hid until my father got back.
When my father got back, he explained to me that this person was blind.
This child had a scar or an ulcer on the cornea,
which is the transparent window of the eye.
And normally that transparent window lets the light in.
But with the ulcer or the scar, there’s no light going in through this milky fog.
This child was mostly blind, probably because of malnourishment.
I love colors, I love the pretty colors of the flowers,
the blue of the sky, green in the grass, sunrises, sunsets, and I thought,
this is horrible and I need to do something about it when I grow up.
Well, nowadays, we can actually cure people with corneal blindness.
And this is done by transplantation using donor human corneas.
But there is a problem.
If you look at this map,
it represents the number of cornea blind people in the world.
So the bigger the country on the map, the more people there are.
Also, look at the colors.
The colors represent how well we’re able to deal
with cornea blind patients, so North America, for example,
it's tiny on this map, but it's also in purple,
which means there are few patients, but we can handle those patients.
Look at India. It's huge. There are millions of patients,
but it's also purple, which means that they can handle those patients.
Now have a look at the countries which are in yellow,
these countries have no means whatsoever of dealing with cornea blind patients.
And then there are countries in green.
So in green, are the countries where they can deal with some cornea blind patients,
mostly in the cities, but then there are lots of rural remote areas where they
have no capacity.
Right now, there are 12.7 million people on waiting lists,
and these are in the countries that are able to deal with cornea blind patients,
but the countries with no capacity make up about 53 percent of all countries
in the world.
So we have a problem. We need a different solution.
Have you seen the movie by Kevin Costner, Field of Dreams?
In this movie,
Kevin Costner hears a voice that tells him if you build it, he will come.
This refers to him building a baseball diamond.
And the people who will come would be the baseball players,
so this is sort of along the same lines, my colleagues and I decided to build
a cell free implant to mimic the natural architecture and structure of
the human cornea.
So the human cornea is made of mostly collagen and water.
Fine, we would use collagen, but what collagen?
We tried medical grade, bovine collagen from cow skin,
that was great until CJD or Mad Cow Disease, so poof!
My cornea implants just went away
because we can't use anything that could be contaminated.
Then we decided on porcine collagen.
And of course, we had swine flu, H1N1, so poof, that disappeared again.
Then came marine collagen, we thought this would be safe
because we don't know of too many things being transmitted from fish to humans,
but then we had the nuclear reactor meltdown in Fukushima
and we had radioactive fish.
So we decided that's it, we needed a synthetic solution.
So what we did was to build our baseball diamond
or cell free corneal implant that you see out of recombinant human collagen.
So this is collagen made by yeast in the lab.
And this implant was sutured into a patient cornea after
the diseased cornea was removed.
Now, if we take a look at what's happening in the patient's cornea.
This artificial cornea, or baseball diamond,
attracts the cells from the patients.
These come out of the patient’s own damaged eye,
just like the baseball players came out of the corn.
They go in to the implant,
they multiply and they differentiate to regrow a new cornea.
And that is the regenerated cornea that you see in the screen.
So we did a lot of experimentation, mostly in the lab,
and then we did animal studies, and finally,
after all the regulatory and ethics approvals,
we did our first clinical trial.
And this was the first time that we showed that
the human cornea can regrow itself.
This was the first-in-human demonstration of regeneration in adult corneas.
And what you see, are two-year post-op and four-year post-operation photos
of the 10 patients that were operated on by my colleague,
cornea surgeon Per Fagerholm in Sweden.
So there were 10 patients altogether
and all 10 patients regenerated their corneas.
The same patients you can see at four years post-operative.
All the corneas were stable, we had no rejections.
We were very, very thankful for that.
In our control group,
which were patients that actually received a human donor cornea,
we actually had one instance of a rejection reaction.
So basically, we show that if you build it, they will come in.
We did a second clinical trial in high risk patients.
So these are patients that are not able to receive a conventional donor cornea.
They had a very high risk of rejection.
Like about 50 percent or more of them would actually reject the donor cornea.
Some of the patients did better than others.
And what I’m showing you are the patients with ulcers and scars
after a severe infection.
And you can see the before and after pictures,
you can see the ulcer in the patient with keratitis.
And the fungal keratitis patient had a scar.
After the surgery, these patients had clear corneas and
some of them had restoration of vision.
So this was very good.
The problem, of course, is that these patients had implants that needed
a surgical theater for the operation.
And the surgical theaters cost thirty eight dollars a minute.
It's not going to happen in countries where there are no resources.
So we needed a solution for that.
A few years ago,
I was passing through London on my way home to Canada for Christmas vacation,
and I stopped by and visited with my friend Bruce Allen,
who’s a cornea surgeon at Moorfields Hospital in London.
What else would you talk to a cornea surgeon about at lunch? Corneas!
So we decided that we needed a new solution.
Our artificial implants were working,
but it was not going to be able to cure 12.7 million people
who are waiting for corneas.
We also know that vaccinations are very, very effective,
where each person would get a syringe full of vaccine.
So we thought we need something liquid that could fill a hole very much like
a dentist's filling the cavity of a patient.
And this was the start of our liquid cornea
or Liqd Khan Dispensé Cornea.
We've now tested our liquid cornea,
in vitro in the lab and in a number of different animal models.
What is left for us is to do formal toxicology essays.
Also, we need to redo some animal transplantations and of course,
there's a whole pile of paperwork that needs to go in to
the regulatory agencies before we get our approval
for human corneal transplantations.
So there is a long road ahead of us and there are a few bumps.
But with a team of very dedicated collaborators from all over the world,
which includes surgeons, other medical professionals, engineers,
scientists and just people who are interested in helping the cause.
We will get there.
There is a light at the end of that road.
It’s long, but we should make it.
So there is hope and not hype that we will get there.
Thank you, Merci.