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Indianapolis eye surgeon popularizes new transplant technique

November 10, 2008
Almost imperceptibly, Dr. Francis Price Jr.'s fingers, gloved in brown latex, move a metal blade over the eyeball of an elderly woman.

After making small incisions, Price, peering through a special microscope, slips what looks like a contact lens under the eye's membrane. It's a donated cornea, meant to replace the woman's old one that has malfunctioned and caused blurry vision.

As Price pumps a syringe full of air into the woman's eye to push the new cornea into place, visiting eye surgeons stare at the microscope's view of the action on a TV monitor over his head.

These surgeons are the latest of more than 500 Price has brought to Indianapolis to learn a new transplant technique that has swept the ophthalmology field.

The technique Price uses is called DSEK, which stands for Descemet's stripping endothelial keratoplasty. Compared with older cornea transplant techniques, DSEK requires much less cutting of the patient's eye and no sutures, and yields recovery times of a couple of months instead of a year or two.

Less cutting and no sutures should mean stronger eyes and fewer patients that experience a rupture years after the transplant.

"I literally got tired of my patients losing their eyes," Price said of the more than 5,000 cornea transplants he did using the older technique. He added, "Is this good? Oh, it's fantastic for patients."

Price, 57, neither invented the technique nor came up with the automated cutting procedure that made it feasible for most every eye surgeon to do. But his enthusiasm for the latest and greatest led him to the Netherlands to learn the technique in 2001 and helped him make the technique nearly ubiquitous in just the last four years.

Price passed on his knowledge, bringing surgeons from 45 states and 16 countries to Indianapolis for his course on DSEK. He has also made presentations at conferences around the country. He and his wife, Marianne, have edited a book about the technique, which is due out in February.

"He's pretty well-known nationally, being a pioneer in DSEK," said Dr. Marty Arkin, a cornea surgeon in Traverse City, Mich. Arkin paid $3,000 to take Price's course two years ago and started doing the DSEK procedure himself.

"This new technique came about where the results were better and faster and safer. I wanted to stay on the cutting edge of medicine," Arkin said.

Transplant boom

The new procedure has led to a surge in cornea transplants, according to statistics from the Eye Bank Association of America.

The total number of cornea transplants performed in the United States had declined every year since 2000 before jumping 16 percent last year, to an all-time record of 39,391.

The numbers are up because the easier recovery process means more patients are getting cornea transplants in a second eye. Or, whereas patients used to put off a transplant until they were legally blind in one eye, patients are now coming in just because they're having trouble driving at night, Price said.

That higher volume is nice for Price and other eye surgeons, because cornea transplants aren't very lucrative procedures — certainly not compared with the LASIK refractive surgery for which Price is best known locally.

Cornea transplants are covered by Medicare and most health insurance policies, which pay anywhere from $6,000 to $10,000.

But the donated cornea alone costs about $3,000. And after other costs, an eye surgeon brings home about $900 to $950 from each transplant, said Tim Fischer, CEO of the Indiana Lions Eye and Tissue Transplant Bank.

Price keeps this in mind when teaching his courses. He gathers his students to examine video of past cases where he's had to trouble-shoot through problems.

In one case, where the donated cornea got stuck to a piece of equipment and wadded up, one student suggested just abandoning the entire procedure.

"Who pays for the [donated] tissue?" Price asked, noting in this case it cost as much as $3,500. "It'll probably take you 30 to 40 grafts to make that up."

Pushing envelope

With margins that thin, what has motivated Price to preach this new technique so heavily? He said he just likes to push the envelope.

Indeed, Price has a history of that. His resume runs 24 pages long, largely because it lists 25 years' worth of clinical trials in which he participated.

Even now, Price is conducting clinical trials for such companies as Allergan and Advanced Medical Optics.

"He has probably done more than most doctors in private practice," said Dr. Louis Cantor, a professor in the Ophthalmology Department of the Indiana University School of Medicine, who has known Price since they were at medical school together.

"It's not uncommon, in today's environment, for private practices to be involved [in clinical trials]," Cantor added. "It provides a certain degree of stimulation and interest. It can also bring in extra revenue and patients."

Shortly after launching his private practice in 1983, Price got into cryolathing, a precursor to LASIK surgery that required shaving off and freezing some eye tissue, reshaping it using a lathe-like cutting tool, then reinserting it into a patient's eye.

LASIK got going in the early- to mid-1990s and Price participated in multiple clinical trials that demonstrated the safety of using lasers to reshape two eyes at the same time.

The LASIK market has now grown to $3 billion nationally, according to Kalorama Information, a market research company with offices in Maryland and New York.

Profits from LASIK provide much of the money Price uses to conduct research projects through his not-for-profit organization, the Cornea Research Foundation of America.

The group, run by Marianne Price, conducts research projects, data analysis and presentations related to corneal treatments. It has an annual budget topping $300,000.

Price even has biblical reasons for pushing research. He points to Jesus' parable of the talents.

Before embarking on a journey, a man leaves money in the hands of three servants. The first two servants put the money into trade and double it by the time of their master's return. The third servant buries the money he's given and returns it with no profit to the master.

"I don't want to be the last guy. I want to be the middle one — or even the first one," Price said. "So I'm always trying to find a better way to do things."
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