Benefactors See a Way to Give Gift of Sight

On a gray April morning, a Mexican boy and his mother sit in a doctor’s office in San Diego. A bandage covers the boy’s left eye. His right eye, as blue as the deep ocean, has a vacant look.

A birth defect left the 16-year-old unable to see much beyond a few inches. His corneas, the clear tissue at the front of his eyes, are clouded over. It’s as though Israel Cortez Guzman always looks at the world through a dirty, frosted window pane.

Today, the doctor tells him, that may change. Just 24 hours earlier, surgeons removed the diseased cornea in Israel’s left eye and replaced it with a healthy, donated cornea. There’s a small chance that the procedure will improve his vision significantly. If it works, the doctor will peel back the bandage and, for the first time, Israel may see beyond a few inches.

It’s a day that Israel and his mother, 46-year-old Francisca Guzman, have long prayed for. The shy boy with coffee-colored skin and a warm, toothy smile wants to be able to work and help his mother, who has raised Israel on her own. He loves machines, and dreams of working with computers.

“I want to do what other people can do,” Israel says.

Had Israel been born in the United States, his defect likely would have been quickly identified and corrected. But he was born in rural Mexico, and his defect has cost him much more than sight.

Israel’s eyes clouded over at birth, giving them an unearthly blue hue. His father, who owned land in the poor southern state of Oaxaca, thought there was only one way that a blue-eyed child could come from two brown-eyed parents.

“This isn’t my son,” Francisca says he told her.

He accused her of infidelity. Francisca says he beat her. When Israel was a year old, he kicked her out of the house. She had no money and no job--and Israel and his 5-year-old brother, Angel, to support.

“We had nothing,” Francisca says. “Only a change of clothing.”

She left Angel with her parents in Oaxaca and headed north with Israel to the Pacific port town of Ensenada. She rented a room, awoke at 4 a.m. each day to make tamales and tortillas, strapped Israel to her back and walked door to door peddling the goods to her neighbors. She barely earned enough to eat.

Francisca first noticed there was something wrong with her son’s eyes after his third birthday. When she dropped an object, Israel had trouble finding it. The boy was sensitive to light, his mother said, so much so that tears would flow from his eyes and stain his shirt.

He could see his hand held close to his face, but everything around it was a blur. In school, he struggled to read, holding books inches from his eyes. His classmates teased him mercilessly.

“I’m never going to see,” he would tell his mother, crying. “I don’t want to live this way for the rest of my life.”

Doctors call it congenital hereditary endothelial dystrophy. The endothelial cells that pump out fluid from the cornea don’t work properly. Fluid backs up in the corneas, like a clogged drain, and they sometimes grow painfully swollen.

The condition is so rare that a review of medical literature doesn’t spell out how often it occurs, said Dr. Janine Smith of the National Eye Institute in Bethesda, Md. “The really horrifying thing about this disease is it’s completely treatable with corneal transplants,” Smith said.

But if it’s not caught before age 9, the child’s brain-eye connections don’t develop properly, and even a transplant is unlikely to fully restore vision.

Francisca desperately wanted her son to see. Doctors in Ensenada told her a corneal transplant would cost $6,000--far beyond her means.

She had given up hope, she said, but then Israel came home one day last year with an exciting story. Doctors from the local child welfare agency had visited his school and examined him. They told him his eyes could be fixed.

In December, Mexican doctors brought Israel to an eye clinic in the border city of Tecate, run one weekend a month by volunteer physicians, nurses and others from San Diego.

Israel’s exam revealed that his eyes were relatively healthy and might respond well to a corneal transplant--a procedure done about 45,000 times a year in the United States. At the clinic, Israel won over a strong ally: nurse Cindy Fulton. A 12-year veteran of humanitarian medicine, Fulton said she noticed Israel waiting patiently for his turn to be examined, staring at nothing. Taken with the sweet, shy teen-ager, she put her connections to use to help him.

Things came together quickly. The doctor she works for, Tommy Korn, agreed to do the surgery at no charge. Fresh Start, a charity that provides cosmetic surgery for deformed children, offered its operating facility. Another doctor lined up the powerful microscopes and surgical tools needed.

During the surgery in the San Diego suburb of Encinitas, Korn uses a trephine, an instrument like a cookie cutter, to remove Israel’s cloudy cornea. It’s replaced with a healthy one donated by the San Diego Eye Bank. Korn sews it in place with fine thread, thinner than a human hair. The whole procedure, which goes flawlessly, takes about 90 minutes.

No surgery is without risk. A small number of eye surgery patients develop complications such as glaucoma, infection, a damaged retina or bleeding. A bigger concern, however, is whether Israel is too old. His brain may not be able to process the clearer images his improved eye will send it.

Korn gives the operation a 20% chance of success. He allows Israel’s eye one day to recover before checking the results. It’s like opening presents on Christmas Day, he says. You don’t know what to expect.

The next morning, Israel arrives early in Korn’s aseptic waiting room.

Korn walks into the waiting room and greets Israel. With little delay, he peels away the bandage over the boy’s eye.

“Open a little,” the doctor tells Israel.

The boy peers out through his new cornea. Tears stream from his left eye as the lid blinks over a cornea encircled with sutures. The eye is no longer blue.

Israel’s face lights up.

“Much better?” Korn asks.

“Yes,” Israel says.

Korn runs some tests. For the first time, Israel sees the world in crisp detail. The vision in his left eye improved more than twofold, and he is no longer considered legally blind. Korn is very satisfied. “I’m very optimistic he should lead a normal, healthy life,” Korn says.

As Korn makes plans to operate on the other eye in a few months, Israel starts crying again, this time, from emotion.

Fulton shakes her head in amazement.

“The boy can see,” she says.