Singh practices in Kansas.
By Raif Karerat
WASHINGTON, DC: David Jiang almost lost his eyesight after he contracted cancer and a series of complications ensued. However, thanks to the persistence and dedication of his eye doctor, Jiang’s vision was saved in an astounding fashion after it had deteriorated to a significant degree.
An Indian American eye specialist Ajay Singh is credited with completing the Hail Mary maneuver that saved Jiang’s eyesight per the Kansas City Star.
The root of the issues involving Jiang’s eyesight started when he was diagnosed with leukemia.
“I was shocked,” he said, when his doctor called him with the diagnosis and warned him that his life was in danger. Instead of heading out the door to lunch as he originally planned, Jiang immediately altered his destination to the University of Kansas Cancer Center, where he started chemotherapy the next morning.
Unfortunately, the chemo didn’t have the effect Jiang and his doctors had hoped for; it simply wasn’t doing enough to expunge the cancerous bone marrow and the malignant white blood cells they were producing.
Doctors decided Jiang would need a bone marrow transplant, a risky and arduous treatment, and Jiang underwent the procedure in April.
Prior to receiving a bone marrow transplant, patients must undergo a battery of intense chemotherapy treatments to eradicate the diseased bone marrow from their bones in order to make room for the new material. The new bone marrow is then injected into the blood stream, migrates to the patient’s bones, and start producing healthy white blood cells.
However, bone marrow is also the source of a body’s immune system, and between the destruction of their own bone marrow and a transplant, a patient is terribly vulnerable to infection.
According to the Kansas City Star, when kidneys, livers, or other organs are transplanted, the immune system of the new owner may recognize them as foreign objects and try to destroy it from the inside. But with bone marrow transplants, the bone marrow itself and the immune system housed within it see its new home as an alien threat and proceeds to attack the patient’s biological functions.
The phenomenon is known as “graft versus host disease,” and it is precisely what piled on to Jiang’s misery.
“After the transplant, I was exhausted,” he said. “I had one complication after another.”
To keep his graft versus host reaction at bay, Jiang was forced to take drugs that suppressed his immune system, which is what ultimately put his eyesight at risk:
Like most adults, Jiang is a carrier of cytomegalovirus, also called CMV. It’s scary-sounding, and the virus can be life-threatening. But people with healthy immune systems generally keep it in check and never know they carry it. But in people with compromised immune systems, such as those with AIDS or bone marrow transplants, cytomegalovirus can cause big trouble.
Depending on which organs CMV attacks, it can cause inflammation of the brain, seizures, coma, ulcers in the digestive tract, pneumonia or inflammation of the liver. The virus also can attack the eyes.
In Jiang’s case, CMV painfully began to accost the retina of his left eye, blurring his vision.
“We needed to stop this virus where it was or it was going to eat away the center of his vision,” said Singh, who serves as an eye specialist and assistant professor of ophthalmology at the University of Kansas Medical Center, according to the official KU website. To combat the onset of CMV, Singh began injecting an anti-viral drug twice a week directly into Jiang’s eyeball.
“I never thought you could put a needle in your eye,” Jiang said. “It sounded so scary. You see the needle coming in,” Jiang told The Star. Despite the searing pain the injections brought and the accompanied risk of infection, Singh couldn’t administer the drug to Jiang orally because it would damage his new bone marrow — his hands were tied without additional equipment.
Singh was aware of a tiny device that could be implanted directly into a patient’s eye and slowly release the drug to battle CMV from within. It had been developed during the height of the AIDS onslaught, when CMV eye infections became common.
However, when Singh attempted to locate one of the implants for his patient, he found that the device manufacturer had pulled it off the market within the last two years; AIDS treatment had advanced to the point that people afflicted with AIDS were no longer developing CMV eye infections.
Desperate, Singh started making calls to Singapore, India and Mexico City, searching for an implant. He even emailed the CEO of the company that discontinued the device but never received an answer, reported The Star.
After rounds of calls, Singh was eventually referred to an eye doctor in Kentucy who knew the original inventor of the implant and put the two in touch.
“Dr. Singh somehow rooted me out,” said Paul Ashton, CEO of Massachusetts-based pSivida. While pSivida had licensed its CMV implants to another company, it was still making other drug-dispensing eye implants.
After hearing about Jiang’s plight, Ashton offered to design a new version of his implant that was designed to hold enough of the anti-viral drug to treat CMV.
“It was a month of many sleepless nights. It was a race against time,” Ashton said. “You can’t keep injecting someone in the eye. Something bad is going to happen.”
The implant was finally ready by early November, at which point Singh called the FDA for emergency approval for the implant. “The FDA responded at lightning speed,” he said. “I got an answer in four hours,” which is leaps and bounds quicker than federal agencies generally get credit for.
Singh wasted no time and implanted the device into Jiang’s eye the very same day.
“Now his cancer doctors can keep working on getting his bone marrow up and running,” Singh told the Kansas City Star. The implant will continue delivering the drug to Jiang’s eye for nine months to a year. “By that time, his immune system can recover and get the virus under control again.”
Jiang told The Star that he is grateful for the perseverance of the eclectic team that rescued the vision in his left eye. “They all worked together. They worked so well together. I’m so fortunate.”
While Jiang’s vision is still a tad blurry, Singh has assured him that with new prescription glasses, he’ll be seeing straight again in just a few months. To date, the cancer has not returned and the graft versus host disease is being kept at bay and is under control.