Groton — For Laurie Watson, things are looking up.

Dissatisfied with the outcome of cataract surgery on her right eye in March 2021, the 70-year-old Norwich woman sought a second opinion, opting to “take a chance,” as she put it, on Dr. Anthony Romania, an ophthalmologist who has been practicing in the area since 2000.

It turned out to be a fortuitous decision.

Romania recently had become the first — and is still the only — physician in the state certified to implant an artificial iris in a patient’s eye, a procedure granted U.S. Food and Drug Administration approval in 2018 and covered by Medicare since January 2020. After performing successful cataract surgery on Watson’s good, left eye last August, Romania operated nearly two months ago on her right eye, removing the damaged iris and inserting a custom-made prosthesis in its place.

Romania and Watson, interviewed together this past week at the Romania Eye Center at 82 Plaza Court, said the outpatient surgery at Pequot Health Center, 52 Hazelnut Hill Road, took 45 minutes.

Before operating, Romania numbed Watson’s eye with drops. Medication that relaxed her was administered intravenously. Then, looking through a microscope, Romania made a 2-millimeter incision in the surface of Watson's eye, removed scar tissue and injected the folded implant made of flexible silicone, positioning it in a sulcus, or furrow, where it self-sealed.

“No bandages, no stitches,” Romania said.

Having practiced a simulated version of the procedure for two months prior to the real thing, the Pequot Health surgical team performed flawlessly, Romania said, crediting Shauna Nocery, Kim Walsh, Fanny Desrosier, Mechelle Barber, Ashley Wildes, Michele Drayton and Scott Long.

Watson said the vision in her right eye was better the day after the March 25 operation, and has steadily improved since then. 

"It's an odd thing, it keeps getting better,” she said. "Before the operation, everything was blurry. It was like looking through a shower curtain with water droplets on it. ... My pupil was as wide open as it could be."

She had taken to wearing dark glasses.

"Every time I go back to Dr. Romania, I’m doing better on the eye chart," she said. "I have to move my head around so I can read, but I can go outside. My depth perception has improved a lot." 

'I just wanted to see'

Watson is an avid reader, as is her husband, Robert Smith, who works at the UConn Bookstore in Storrs. At some point, she said, she's going to try to drive again.

“When she’s fully recovered, she’ll have 20/40 vision (in her right eye) without glasses,” Romania said.

While a natural iris — the ring of muscle fibers that gives an eye its color — contracts and expands, changing the size of the pupil and controlling the amount of light that reaches the eye’s lens, Watson’s artificial iris permanently fixes the size of the pupil at an optimum “setting.” Compared to vision with a damaged iris, the artificial iris "improves contrast sensitivity, reduces glare and light sensitivity and eliminates transillumination defects," according to its U.S. distributor, VEO Ophthalmics.

Cosmetically, it’s an improvement, too, though Watson said she wasn't overly concerned about that.

“I wouldn’t have cared if it (the artificial iris) had to be green,” said the blue-eyed Watson, whose hand-painted implant was made to perfectly match the appearance of the natural iris in her left eye. “I just wanted to see. I garden, and I was having so much trouble with depth perception. ... In bright light, I couldn’t make out what I was doing. I was pulling out plants instead of weeds.

"There's chatter out there about it being a cosmetic thing, but it's geared for people with real problems," she said of the implant surgery. "It's not something you'd do just to change your eye color."

Few could afford it

A New Jersey native, Romania, 66, got his bachelor’s degree at Boston University and his medical degree at Northwestern. After completing a residency at the Cleveland Clinic, he spent a decade in private practice in Arizona before returning to the East Coast. He’s been in solo private practice in New London County for 22 years, first in New London and then Groton, and taught at Yale University for 17 years. He’s affiliated with Lawrence + Memorial Hospital in New London.

Romania said he started following the evolution of the artificial iris in 2010. At that time, the implants, which were developed by HumanOptics in Germany, had only been approved in the United States on a case-by-case basis under an FDA “compassionate use” exemption.

“I knew they were a vast improvement over what was available,” Romania said of the implants. "There weren't a lot of options previously. You would have to suture muscle back together, which never works well and not cosmetically. ... I went to medical conferences, stayed on top of things and waited for it to come to this country.”

In 2018, the FDA granted VEO Ophthalmics, an Ohio-based company, approval for the implantation of the devices in adults and children with an iris that was missing or damaged due to a congenital condition called aniridia or traumatic injury to the eye.

Romania said most candidates for an artificial iris implant have suffered an injury playing sports or in a motor vehicle accident, or, as in Watson’s case, because of complications of surgery.

Until 2020, when the U.S. Centers for Medicare & Medicaid Services approved VEO Ophthalmics’ artificial iris for payment status, few could afford it, Romania said. The implant itself can cost between $8,000 and $9,000.

And, with the Medicare-reimbursement approval coming down on the eve of the COVID-19 pandemic, the implant surgery’s availability may have gone largely unnoticed. Approved for anyone over 3 years of age, it’s available to virtually anyone who needs it.

b.hallenbeck@theday.com