Ryan in April 2016, before the corneal transplant.
By Kristen Mulvihill
Scheie Vision Annual Report 2018
The expression "age is just a number" may have some tangible truth after all, at least for Ryan Cochran and Lloyd Patton. In 2016, the three-year-old and 71-year-old, respectively, underwent the same transformative surgery to improve their vision: a corneal transplant.
Ryan Cochran was born with congenital glaucoma, a rare condition occurring in infants and young children that causes increased intraocular pressure, which damages the optic nerve. His glaucoma caused corneal edema, or swelling of the cornea. Ryan was blind until he was 18 months old.
At only 10 days old, Ryan had his first surgery at the Children's Hospital of Philadelphia (CHOP). By the time he reached his first birthday, he had undergone multiple operations.
After receiving tube implants in both of his eyes, Ryan's right eye started to respond well to the treatments and eye drops. However, the vision in his left eye remained cloudy.
"He couldn't do anything. It was a challenge to get him to try anything," recalled Ryan's mother, Erin Cochran. "He had no interest in trying new foods, no interest in walking, no interest in crawling."
Erin and her husband Nick Cochran enrolled their son in Pennsylvania's Early Intervention program, which offers services to support families raising young children with developmental disabilities and delays. Ryan received a variety of therapies, including occupational, speech, physical, and vision therapy.
As Ryan's limited vision continued to pose challenges to his development, Nick and Erin considered the possibility of a corneal transplant for their son. The operation requires the removal of all or part of the damaged or diseased layers of the cornea. The layers are then replaced with healthy corneal tissue from a donor.
Monte Mills, MD, a pediatric ophthalmology and glaucoma specialist at CHOP, referred the Cochrans to Stephen Orlin, MD, a cornea specialist at the Scheie Eye Institute.
"We definitely get funny looks when we go see Dr. Orlin because everyone in the waiting room is much older than Ryan," Erin said. "It's such an unusual and rare instance that a child this young would require a transplant."
At the age of one, Ryan received a partial corneal transplant in his left eye. However, due to the complexity of Ryan's condition and his age, the partial transplant operation was not successful.
Two weeks later, Dr. Orlin performed a full corneal transplant on Ryan's left eye at CHOP. The results were striking.
"In the year and a half that we've had since the surgery, he's grown leaps and bounds. Now, he can walk, crawl, climb, eat just about anything, and grab a pen. I mean, you take a lot of those things for granted," Erin explained. "Without that transplant, there would've been no way for him to learn at that pace."
Ryan is not the only patient who benefited from a corneal transplant. During the summer of 2016, Lloyd Patton's right eye suddenly became severely inflamed, causing him pain and irritation. "I basically just stayed indoors and sat in my darkened living room and listened to the TV, not really watching it," he recalled. "It was a tough summer."
Lloyd had glaucoma and was seeing Prithvi Sankar, MD, a glaucoma specialist at Scheie, for treatment. After a glaucoma surgery, Lloyd developed corneal complications. Like Ryan, Lloyd's condition resulted in corneal edema, the source of his discomfort. He required a corneal transplant in his right eye.
However, Lloyd had very low pressure in his eye, making the transplant more complicated. Before he could receive the transplant, Lloyd had to wait for his eye pressure to normalize.
When Lloyd's eye pressure finally stabilized, he was immediately matched with a suitable donor and prepped for surgery. Along with cataract surgery, Dr. Orlin performed the corneal transplant in September 2016.
Following their operations, both Ryan and Lloyd endured extensive recovery processes. Ryan required both treatment for his glaucoma and for his transplant. He also struggled to comprehend the reasons behind the numerous doctor visits and treatments.
"I can't rationalize what we're doing to him because he's so young. So he doesn't understand why people are looking at his eyes, or why he has to do eye drops ten times a day, or why he would require going to the doctor's office maybe more than most children his age," Erin explained. "So, it was difficult getting him acclimated to a schedule and getting him to understand that this is what we're doing, even if it's something he doesn't want to do."
Packed with doctor appointments and eye drops, the beginning weeks of Lloyd's recovery were also draining. "I was using 25 to 26 eye drops a day in the beginning," he said. "There was a point in time where I was seeing Dr. Orlin on Monday, Wednesday, and Friday, and Dr. Sankar on maybe Tuesdays and Thursdays."
Since then, the number of required eye drops has vastly diminished and Lloyd only goes in for appointments every couple of months.
Lloyd was thrilled with the transplant's success. "My eyesight has definitely improved. I believe my vision is around 20/40 or 20/60 now," he remarked. "When I go in for an eye test, I'm doing a lot better than I was in the past."
Amidst her child's ongoing health obstacles, Erin remains optimistic and grateful. "My husband and I have been married almost four years and this is our only child. You would do anything for your kids," she said. "Dr. Orlin has been fantastic. And that's why I do believe we have been able to sustain Ryan's cornea for this long, because we really are in the best possible care."