Often called the window to the soul, the eyes are more sacred than other body parts, at least for some.
Eye transplants are desperately needed, but they're nowhere in sight. About 12.7 million people worldwide need a corneal transplant, which means that only one in 70 people who require them, get them. The gaps are international. Eye banks in the United Kingdom are around 20 percent below the level needed to supply hospitals, while Indian eye banks, which need at least 250,000 corneas per year, collect only around 45 to 50 thousand donor corneas (and of those 60 to 70 percent are successfully transplanted).
As for retinas, it's impossible currently to put one into the eye of another person. Artificial devices can be implanted to restore the sight of patients suffering from severe retinal diseases, but the number of people around the world with such “bionic eyes” is less than 600, while in America alone 11 million people have some type of retinal disease leading to severe vision loss. Add to this an increasingly aging population, commonly facing various vision impairments, and you have a recipe for heavy burdens on individuals, the economy and society. In the U.S. alone, the total annual economic impact of vision problems was $51.4 billion in 2017.
Even if you try growing tissues in the petri dish route into organoids mimicking the function of the human eye, you will not get the physiological complexity of the structure and metabolism of the real thing, according to Cosma. She is a member of a scientific consortium that includes researchers from major institutions from Spain, the U.K., Portugal, Italy and Israel. The consortium has received about $3.8 million from the European Union to pursue innovative eye research. Her team’s goal is to give hope to at least 2.2 billion people across the world afflicted with a vision impairment and 33 million who go through life with avoidable blindness.
Their method? Resuscitating cadaveric eyes for at least a month.
If we succeed, it will be the first intact human model of the eye capable of exploring and analyzing regenerative processes ex vivo. -- Maria Pia Cosma.
“We proposed to resuscitate eyes, that is to restore the global physiology and function of human explanted tissues,” Cosma said, referring to living tissues extracted from the eye and placed in a medium for culture. Their ECaBox is an ex vivo biological system, in which eyes taken from dead donors are placed in an artificial environment, designed to preserve the eye’s temperature and pH levels, deter blood clots, and remove the metabolic waste and toxins that would otherwise spell their demise.
Scientists work on resuscitating eyes in the lab of Maria Pia Cosma.
Courtesy of Maria Pia Cosma.
“One of the great challenges is the passage of the blood in the capillary branches of the eye, what we call long-term perfusion,” Cosma said. Capillaries are an intricate network of very thin blood vessels that transport blood, nutrients and oxygen to cells in the body’s organs and systems. To maintain the garland-shaped structure of this network, sufficient amounts of oxygen and nutrients must be provided through the eye circulation and microcirculation. “Our ambition is to combine perfusion of the vessels with artificial blood," along with using a synthetic form of vitreous, or the gel-like fluid that lets in light and supports the the eye's round shape, Cosma said.
The scientists use this novel setup with the eye submersed in its medium to keep the organ viable, so they can test retinal function. “If we succeed, we will ensure full functionality of a human organ ex vivo. It will be the first intact human model of the eye capable of exploring and analyzing regenerative processes ex vivo,” Cosma added.
A rapidly developing field of regenerative medicine aims to stimulate the body's natural healing processes and restore or replace damaged tissues and organs. But for people with retinal diseases, regenerative medicine progress has been painfully slow. “Experiments on rodents show progress, but the risks for humans are unacceptable,” Cosma said.
The ECaBox could boost progress with regenerative medicine for people with retinal diseases, which has been painfully slow because human experiments involving their eyes are too risky. “We will test emerging treatments while reducing animal research, and greatly accelerate the discovery and preclinical research phase of new possible treatments for vision loss at significantly reduced costs,” Cosma explained. Much less time and money would be wasted during the drug discovery process. Their work may even make it possible to transplant the entire eyeball for those who need it.
“It is a very exciting project,” said Sanjay Sharma, a professor of ophthalmology and epidemiology at Queen's University, in Kingston, Canada. “The ability to explore and monitor regenerative interventions will increasingly be of importance as we develop therapies that can regenerate ocular tissues, including the retina.”
Seemingly, there's no sacred religious text or a holy book prohibiting the practice of eye donation.
But is the world ready for eye transplants? “People are a bit weird or very emotional about donating their eyes as compared to other organs,” Cosma said. And much can be said about the problem of eye donor shortage. Concerns include disfigurement and healthcare professionals’ fear that the conversation about eye donation will upset the departed person’s relatives because of cultural or religious considerations. As just one example, Sharma noted the paucity of eye donations in his home country, Canada.
Yet, experts like Sharma stress the importance of these donations for both the recipients and their family members. “It allows them some psychological benefit in a very difficult time,” he said. So why are global eye banks suffering? Is it because the eyes are the windows to the soul?
Seemingly, there's no sacred religious text or a holy book prohibiting the practice of eye donation. In fact, most major religions of the world permit and support organ transplantation and donation, and by extension eye donation, because they unequivocally see it as an “act of neighborly love and charity.” In Hinduism, the concept of eye donation aligns with the Hindu principle of daan or selfless giving, where individuals donate their organs or body after death to benefit others and contribute to society. In Islam, eye donation is a form of sadaqah jariyah, a perpetual charity, as it can continue to benefit others even after the donor's death.
Meanwhile, Buddhist masters teach that donating an organ gives another person the chance to live longer and practice dharma, the universal law and order, more meaningfully; they also dismiss misunderstandings of the type “if you donate an eye, you’ll be born without an eye in the next birth.” And Christian teachings emphasize the values of love, compassion, and selflessness, all compatible with organ donation, eye donation notwithstanding; besides, those that will have a house in heaven, will get a whole new body without imperfections and limitations.
The explanation for people’s resistance may lie in what Deepak Sarma, a professor of Indian religions and philosophy at Case Western Reserve University in Cleveland, calls “street interpretation” of religious or spiritual dogmas. Consider the mechanism of karma, which is about the causal relation between previous and current actions. “Maybe some Hindus believe there is karma in the eyes and, if the eye gets transplanted into another person, they will have to have that karmic card from now on,” Sarma said. “Even if there is peculiar karma due to an untimely death–which might be interpreted by some as bad karma–then you have the karma of the recipient, which is tremendously good karma, because they have access to these body parts, a tremendous gift,” Sarma said. The overall accumulation is that of good karma: “It’s a beautiful kind of balance,” Sarma said.
For the Jews, Christians, and Muslims who believe in the physical resurrection of the body that will be made new in an afterlife, the already existing body is sacred since it will be the basis of a new refashioned body in an afterlife.---Omar Sultan Haque.
With that said, Sarma believes it is a fallacy to personify or anthropomorphize the eye, which doesn’t have a soul, and stresses that the karma attaches itself to the soul and not the body parts. But for scholars like Omar Sultan Haque—a psychiatrist and social scientist at Harvard Medical School, investigating questions across global health, anthropology, social psychology, and bioethics—the hierarchy of sacredness of body parts is entrenched in human psychology. You cannot equate the pinky toe with the face, he explained.
“The eyes are the window to the soul,” Haque said. “People have a hierarchy of body parts that are considered more sacred or essential to the self or soul, such as the eyes, face, and brain.” In his view, the techno-utopian transhumanist communities (especially those in Silicon Valley) have reduced the totality of a person to a mere material object, a “wet robot” that knows no sacredness or hierarchy of human body parts. “But for the Jews, Christians, and Muslims who believe in the physical resurrection of the body that will be made new in an afterlife, the [already existing] body is sacred since it will be the basis of a new refashioned body in an afterlife,” Haque said. “You cannot treat the body like any old material artifact, or old chair or ragged cloth, just because materialistic, secular ideologies want so,” he continued.
For Cosma and her peers, however, the very definition of what is alive or not is a bit semantic. “As soon as we die, the electrophysiological activity in the eye stops,” she said. “The goal of the project is to restore this activity as soon as possible before the highly complex tissue of the eye starts degrading.” Cosma’s group doesn’t yet know when they will be able to keep the eyes alive and well in the ECaBox, but the consensus is that the sooner the better. Hopefully, the taboos and fears around the eye donations will dissipate around the same time.
The Dock to Dish model has expanded across North and Central America. Above, artisanal fishermen on the Pacific coast of Costa Rica head out to sea seeking schools of abundant forage fish to supply the program.
In 2012, entrepreneur Sean Barrett founded Dock to Dish in Montauk, New York. It connected local fishermen and women with local chefs, enabling the chefs to serve hyper-fresh seafood – with the caveat that they didn't know what would be on their menus until it arrived in their kitchens the night before.
"Since we're not a seafood-centric culture, people don't know what's what, where fish are from, and when they're in season, making them easy to dupe."
In June of 2017, The United Nations Foundation designated Dock to Dish as one of the top breakthrough innovations that can scale to solve the ocean's grand challenges. His company has since expanded across the Americas and has just opened up shop in Fiji. Leapsmag recently chatted with Barrett about his inspirations and ideas for how to overcome the hurdles of farming wild seafood. This interview has been edited and condensed for clarity.
What inspired you to start Dock to Dish?
The short story is "A Tale of Two Hills."
The first is Quail Hill Farm in Amagansett. I grew up in the commercial fishing port of Chinicock in the 1980's and 90's, working on my family's dock from an early age and in the restaurant industry in my teens. By my thirties, I had accrued my 10,000 hours of experience in both dock and dish. I watched the food system shift from local to global, especially in seafood. By the early 2000's, over 90 percent of seafood in the U.S. was imported. It was bad.
Quail Hill was the first CSA [Community Supported Agriculture, in which customers pay up front for a share in whatever crops grow (or don't) on the farm that season] in the U.S., founded in 1990. So people in the area were accustomed to getting their produce that way. Scott Chaskey, the poet farmer at Quail Hill, really helped crystallize the philosophy for me and inspired me to apply it to seafood. Fishermen had always been bringing a share of their day's catch to their neighbors; now we were just doing it in a more formalized way.
The second is Blue Hill at Stone Barns. [Executive chef and co-owner] Dan Barber literally trademarked the phrase "Know Thy Farmer"; we just expanded it to Know Thy Fisherman and it took off like a rocket ship. His connections in the restaurant world were also indispensable.
17th generation Montauk fisherman Captain Bruce Beckwith (above left) with crew Charlie Etzel (Center) and Jeremy Gould (right).
Do you have any issues that are unique to seafood that a CSA or meat co-op wouldn't face?
This food is WILD. People are totally disconnected from what that word means, and it makes seafood different from everything else. Everything changes when viewed through the prism of that word.
This is the last wild food we eat. It is unpredictable, and subject to variables ranging from currents and tides to which way the wind is blowing. But it is what makes our model so much more impactful and beneficial than the industrialized, demand-driven marketplace that surrounds us. The ocean and its ecosystem are the boss, not chefs and consumers.
There has a been a lot of press about seafood being mislabeled. How and why does that happen? Can Dock to Dish fix it?
Imported, farmed seafood is cheap. Wild, sustainable seafood is not. People are buying low and selling high to make a buck; and while fisheries are extraordinarily regulated, the marketplace isn't. There is no punishment for mislabeling, and no means to correct it. Since we're not a seafood-centric culture, people don't know what's what, where fish are from, and when they're in season, making them easy to dupe. But technology is poised to fix that; DNA testing can test what a fish sample is and where it's from, and SciO handheld spectrometers – soon to be incorporated into smartphones – can analyze the molecular makeup of anything on your plate.
We've created the first ever live tracking system and database for wild fisheries. It is similar to the electronic system used to monitor commercial fisheries, thanks to which the resurgence of wild seafood in U.S. waters is a model for the rest of the world. We have vessel tracking devices on our fishing boats and delivery vans, so the path of each fish is publicly available in real time.
In 2017, Dock to Dish launched the world's first live "end-to-end" tracking system for wild seafood, which provides full chain transparency and next-generation traceability for members.
People are increasingly looking to seafood as a healthier, possibly more sustainable protein option than meat. Can Dock to Dish scale up to accommodate this potentially growing market?
Nope. We can't scale; the supply is finite. That's why the price keeps going up. To avoid becoming "fish for the rich" we are working closely with Greenwave.org to create a network of 3D restorative ocean farms growing kelp and shellfish, which sequester carbon and nitrogen out of the air and soil. Restorative, because sustainable is no longer an option. In fifty years, a plate of seafood will be mostly ocean vegetables with a small amount of finfish as a garnish.
