“Wear something cute tomorrow because your husband might be able to see you for the very first time!” I said to Jackie Barnes, whose husband Brad had truly never seen her. From the start of their marriage several years earlier, Jackie had tirelessly cared for her blind husband and sought the best medical treatments available in America, all to no avail. Now, after two years of treatments at the Wang Foundation for Sight Restoration, she was hopeful that the man she loved so dearly would finally be able to see, and see her for the very first time.
I first met Brad and Jackie Barnes in the fall of 2004. Brad was in his early forties and had been blinded a dozen years earlier in an industrial accident. Behind his dark glasses were eyes so severely damaged that his eyelids looked like they had been melted shut. Ten years ago, just fifteen days before his thirty-second birthday, Brad’s life was altered in an instant as molten aluminum exploded from a container at the factory where he worked. Eleven hundred pounds of burning metal fluid, flowing at a blazing 1,550 degrees Fahrenheit blasted upward and splashed all over him, obliterating his protective goggles and severely scorching both of his eyes. He was left with near total blindness and could barely perceive light. Over the ensuing decade, he had undergone many extensive surgeries at major medical centers including Harvard, the Mayo Clinic, and Washington University, but all with no success.
Brad spent his time working with the God Squad, a group of men who performed feats of strength as a way of sharing their faith with young people. Being blind didn’t prevent Brad from smashing bricks, bending bars of metal, and tearing phone books in half. But it wasn’t just his physical strength that kept him going; he also had the love and strong support of his devoted wife, Jackie. Despite his condition, Brad fell in love and got married four years ago in 2000. His wife was dedicated to his care, and her faith inspired her to continue seeking medical help for her husband.
Four years later, Brad’s doctors at Washington University in St. Louis, Missouri referred him to the Wang Foundation for Sight Restoration. Word had spread about the work we were doing through the foundation, including the world’s first laser artificial cornea surgery I had performed on Joel Case. Brad’s doctors at Washington University had heard about the success of that surgery, which was why they referred Brad to us.
Despite our new laser technique, I feared that we still wouldn’t actually be able to help Brad, given how extreme the nature of his injury was. Although I specialized in difficult sight restoration surgeries, Brad’s case for me was at the farthest end of the spectrum. He had already been declared irreversibly blind, and his previous multiple failed surgeries made any subsequent procedure an impossibility.
His corneas were covered with flaps of skin and scar tissue so thick I couldn’t see his eyeballs at all. Additionally, his conjunctiva—the tissue that covers the surface of the eye and inner eyelid—was acutely inflamed due to severe dryness, because Brad’s tear glands had been completely destroyed in the accident. Without the tears normally secreted by these glands, there was no way the extremely dry eye would ever heal properly following any surgery. Additionally, Brad’s right eye was too damaged for any surgery. So his left eye, which could only barely see light, was our only hope.
“The artificial cornea implant requires a moist and stable ocular environment to support it after surgery,” I explained to Brad. “Unless we can somehow come up with a magical way for you to produce tears again, we’re unfortunately not going to be able to do any reconstructive surgery for your eye, as it would never heal after the surgery.”
Brad and Jackie had traveled a long way from St. Louis to Nashville, so the result of the consultation was very disappointing for all of us. What made the situation even worse was that Brad’s dry eyes were also causing him to be in a lot of pain. He said it felt like glass was constantly cutting his left eye. So if we couldn’t come up with a way to provide sustained lubrication to his left eye in order to substantially reduce his pain very soon, his only remaining left eye would have to be removed altogether, plunging him into irreversible total darkness for the rest of his life.
Since Brad’s tear-secreting glands were all dead, we immediately began a treatment to keep his eyes as hydrated and comfortable as possible using medication, tear drainage duct blocks, and around-the-clock artificial tear instillation.
“We need to somehow find a way to make your tear glands secrete tears themselves again,” I told them. “If we don’t, not only will we not be able to do any reconstructive surgery, but the left eye itself may also have to be removed.”
The winter of 2004 was especially cold in Nashville, with an ice storm that blocked the roads for days. But my heart felt even colder, and hopeless. Once again, the impending threat of total darkness over one of my patients deeply affected me. I was familiar with that darkness, one I felt as a teenager and almost didn’t escape. I reflected on what it was that had helped me pull out of that darkness and survive.
“Never give up.” My father’s voice once again rang in my ears. I realized I had survived the darkest days in my life through my own determination and through the constant support of others.
I did not want to give up on Brad. I would never give up.
For months, I spent many nights poring over scientific literature to find out if anything had ever been done in the past for a dry eye situation as severe as Brad’s, but I found nothing. I then called many colleagues from around the world including my mentor, Dr. Tseng, to ask for advice and help, but to no avail. I still did not want to give up, so I kept searching and praying to God to help me sustain hope, and to allow my efforts to eventually point me in the right direction.
In the spring of 2005, Brad called me one day with the exciting news that he himself might have found the answer we were looking for! He had found an ear, nose and throat (ENT) specialist at Washington University in St. Louis, the facility that had originally referred him to me. The pioneering ENT physician, Dr. Randal Paniello, had performed the world’s first procedure in which a saliva gland was taken from a patient’s jaw and re-routed to the temple area to lubricate the eye. Saliva has a similar chemical composition as tears, so if we could transplant Brad’s left saliva gland to lubricate his left eye, we might just have a chance to perform restoration surgery to bring back his sight!
I was fascinated by this idea. I called Dr. Paniello and asked him if he could evaluate Brad. Dr. Paniello agreed and called me after the evaluation to tell me that a saliva gland transposition on Brad would be very difficult, but he was willing to give it a try. The surgery was new, and there was no guarantee of success, but Brad had nearly nothing left to lose.
In March of 2005, Dr. Paniello performed the novel surgery. The thirteen-hour procedure was a success, and Brad became the second person in the world to undergo this saliva gland surgery. The funny thing about this procedure is that the saliva gland will still react to olfactory stimulation, rather than debris or dryness in the eye. So if Brad walked into McDonald’s, the French fries just might make his eye water!
When I saw Brad at his next appointment in Nashville, his left temple was swollen to the size of a golf ball. It would take some time for the swelling to recede and for the gland to produce moisture. If it didn’t work, we wouldn’t be able to proceed to the eye reconstruction surgery. We all waited nervously to see if the gland surgery was successful. Finally, after waiting for nearly a year, the glad reduced in size and started producing saliva again, which alleviated the pain in Brad’s eye significantly.
So by the summer of 2006, the stage was set for the eye reconstructive surgery portion of the world’s first combined saliva gland transposition and artificial cornea implantation surgery. My plan was to use the femtosecond laser to create the pocket in his left eye for the implant, just as I had done for Joel Case. Creating the corneal pocket and then put in the implant is like burying a treasure. We would leave the implant in the pocket for a few months, and then remove the corneal flap to reveal the treasure that will hopefully give Brad back his sight. Our goal was to bring him from nearly total blindness to enough vision that he could function more independently and take care of himself at home.
In reality, being part of such a ground-breaking surgery like this really isn’t result of confident masterminds meeting together to devise a plan. Such events tend to be the result of going step-by-step toward whatever options exist next to best help our patients. I really had no idea whether this combination surgical approach would work, and the stress of the uncertainty weighed on me from start to finish for that entire over two years process of helping Brad.
The first stage of the laser-assisted artificial cornea implantation surgery took four hours. Jackie was sitting patiently in the hospital waiting room when I came out of the operating room to give her the results. In the course of creating the corneal pocket and inserting the artificial cornea, I had located his pupil—which had been displaced during his accident—and I re-centered it.
“I rebuilt the front part of his eye, placed the artificial cornea into the pocket, and then sutured everything together,” I explained to Jackie.
She jumped up and hugged me tightly. “This is so cool! Thank you!”
“This has been a long process, but we’re off to a good start,” I said.
After many months of healing, Brad returned on March 28, 2007 for the second stage of the surgery. I opened the outer flap of the corneal pocket, which would allow him to see through the artificial cornea.
The next morning, Brad was back at Wang Vision Institute for the moment of truth. In cases this extreme, it is impossible to predict the outcome. After two years of surgeries through our foundation, Brad and his family weren’t the only ones anxious to know how it would all turn out. News teams in Nashville and St. Louis had documented the entire two-year process, and whole communities of people were on the edge of their seats to watch the results revealed live on television.
The presence of so many friends, colleagues, and news crews streaming results to thousands of people was nerve-wracking. My ritual is to pray with every patient who permits me to do so, but this time Brad himself was the initiator. He had brought his Bible, and he held it in his lap. He bowed his head to pray as Jackie and I stood on either side of him, each of us placing a hand on his shoulder.
I also said my own prayer to God in my heart. “God, I pray it is your plan to bring Brad out of darkness to see the world he has been missing for thirteen years. Will you please allow him to finally see his wife, Jackie, for the very first time? Amen.”
Brad tapped his thumbs nervously on the cover of his Bible.
“Are you ready?” I asked. He nodded.
I carefully removed the patch, cleaned out Brad’s left eye, and slowly pried open his swollen eyelids.
My entire office had shut down to witness this special moment. The staff joined Brad’s supporters, who were crowded around the door of the exam room and down the hallway. The room was completely silent, and the entire crowd seemed to collectively hold its breath in anticipation.
As I examined Brad’s left eye, it looked good but I couldn’t yet tell if he would be able to see or not. I turned to face the team and gave them a thumbs-up to indicate that at least the surgery itself had gone well. As I began to talk to my staff, Brad’s voice rang out unexpectedly behind me.
“I see a thumbs-up!” Brad exclaimed. “Yeah, I see it!”
The entire room gasped all at once.
“Yes!” Jackie shouted.
Amazed, I turned around to face Brad again.
“Hang on! Don’t move!” Brad requested excitedly. His right hand reached forward slowly, and eventually touched my face. “Is this your face? Yeah, I can see your face over there.”
We were all stunned.
But my face wasn’t the one I really wanted Brad to see. I stepped back and nudged Jackie forward. This was the moment we had all waited over two years to witness. Would Brad be able to see his wife finally for the very first time?
Jackie moved her face closer to Brad’s, looking at him intently. She seemed nervous.
“I can see you now!” Brad said, smiling broadly.
Brad and Jackie gazed at each other, their faces radiating happiness. Tears came to my eyes and I glanced around to see many others moved to tears as well.
I handed Brad a mirror so he could see his own face.
“Yeah, that’s me!” he exclaimed, seeing himself for the first time in thirteen years.
Brad was so enamored of his newfound sight that even simple things fascinated him. “This is incredible! I can’t even believe this!” Brad marveled at a piece of white tissue he had been holding in his hand … and everyone laughed with joy.
Few of us will ever personally know someone who has had sight restored after thirteen years of blindness. But even fewer will ever be present the very moment someone we know comes out of darkness and into sight. Everyone in the room with Brad felt privileged to be part of this powerful, once-in-a-lifetime opportunity. To me, such a moment is worth all these years of hard work, training and research, and all the sleepless nights that I have endured. Experiencing the joy that follows God’s miracles over and over again is what continually refuels my commitment to this work.
And it is a gift that keeps on giving, as Brad’s appreciation of his newfound sight wasn’t restricted to that one day in my office. For several weeks, I received reports from Jackie and other friends of theirs of his fascination with the things he was seeing now, big and small.
“Brad is having so much fun looking at everything!” Jackie wrote in an email. “TV is fun for him; and he seems to see two-dimensional images better than in person. Cars are so cool because he says he feels like he’s been propelled thirteen years into the future. Computers are cool too because they’re no longer just black screens with amber writing on them.”
I was taken aback by her words. Not only had Brad regained his sight, but he had essentially traveled through time, thirteen years in an instant! In Brad’s mind, the world around him—the people, city structures and technology—had remained frozen in time since 1994. So to come out of darkness after such a long time was to discover a world that’s not at all the same as the one he knew before. Brad’s thirteen-year time travel then led me to reflect on my earlier patient, Joel Case, who had actually time-traveled even further, four entire decades!
Jackie’s email continued. “He finds several new things to see every day. He loves looking at the sky, the clouds, the trees, green grass. It’s like having a kid who’s learning to walk or talk. I hate going to work now because I’m going to miss something.”
Coming out of blindness is, in a way, like a new birth. The patient sees the world again for the first time in a long while. Thanks to the Wang Foundation and all of Brad’s supporters, he is now rediscovering a life he had been missing for more than a dozen years, and the ability to actually see his beloved wife is what he considers his ultimate blessing.
“There is just no way to thank you for what you have done,” Jackie wrote at the end of her email. “Not only have you changed Brad’s life, through his testimony you have changed the lives of thousands. Now I’m crying again!”
Though taking care of charity patients is difficult and demanding on one’s time, our foundation has shown that it can in fact be done and done well. I believe this model of care should be an important part of our healthcare system. I’ve been inspired to treat charity patients as a way of giving back to America, and many other Nashville doctors have joined me in this important cause as well. The model practiced by the Wang Foundation attests to the effectiveness of embedding charity patients into the flow of patients in private clinics, fully utilizing the technology and service available at such clinics. Our hope is that the success we have experienced with embedded Charity care as such will spread to other medical specialties across the country, and will thus help reduce the nation’s financial burden to care for the poor.
An example of this need is the fact that the second part of Brad’s surgery almost didn’t happen. After the completion of his saliva gland surgery, we realized that the costs involved with his and Jackie’s travel and lodging, as well as hospital and operating room fees, was beyond their limited financial resources. Given how severe his damage was, even though I had waived all my surgeon’s fees, the other aspects of his care were going to be expensive. Furthermore, insurance does not typically cover new, experimental sight restoration procedures such as laser-assisted artificial cornea implantations. Cases like Brad’s were exactly the reason I had started the foundation in the first place, but now we needed to raise funds to cover the various costs beyond physician fees.
I came up with a plan to accomplish this goal. In the fall of 2005, I asked Brad and Jackie to be my special guests at the foundation’s first annual fundraising gala—called the EyeBall—at which ballroom dancing would serve as a symbolic source of exquisite beauty that the gift of sight allows us to fully appreciate. At the event, Brad shared his story with the gala’s attendees. In the end, it was the unique combination of modern technology, and the loving hearts and giving spirit of everyone involved, that ultimately gave Brad his sight back.