No one knows yet whether this hunch is right. Gouras and his Swedish colleagues have found that rejection of fetal RPE cells can occur months down the road. Moreover, slight differences in approach between Gouras' team and Ernest's may or may not prove to be significant. "It's an experiment," says surgeon Patel. "That's all it is. What we're trying to find out is whether there's a rationale for going to a larger study."

From the beginning, Ernest and his colleagues were also worried about the explosive ethical questions raised by the use of fetal tissue. Very early on, Ernest approached Dr. Mark Siegler, director of the University of Chicago's MacLean Center for Clinical Medical Ethics, for advice. As Siegler and many others saw it, there were no insurmountable barriers to the use of fetal tissue for medical purposes. After all, organs and tissue from brain-dead children and adults are donated for transplantation all the time. And while such deaths are tragic, they are caused not in order to obtain the organs but by events, such as automobile accidents, over which transplant teams have no control. Abortion, advised Siegler, could be viewed as another such tragic event.

Even more unsettling for Ernest has been the selection of appropriate patients. The first patient, of course, had to be someone in an advanced stage of the disease whom an experimental treatment could not harm and would perhaps help. "The problem is, patients with macular degeneration are desperate," Ernest observes, "and they are willing to let me do anything I want if I hold out any hope at all." Scanning his patient list, looking for people who were medically sophisticated enough to understand the trade-off of risks and benefits, Ernest almost immediately selected 80-year-old Pearl Van Vliet, a volunteer at the hospital for more than 20 years. Van Vliet, who is deeply religious and has always considered herself to be pro-life, sought advice from doctors in her own family as well as from her pastor and the congregation of the Calvin Christian Reformed Church of Oak Lawn, Ill. Everyone encouraged her to go ahead.

The operation on Van Vliet's eye went smoothly, but the aftermath was a bit rockier. A right-to-life group protested outside the University of Chicago Medical Center. Critical letters and phone calls flooded into Ernest's office. To one letter decrying his use of fetal tissue, Ernest responded, "I can only say I agree with you about the tragedy of abortion. [But] the use of human tissue obtained after death for transplantation has been a good thing in medicine, and I believe that with care and understanding, it will continue to be."

Conscientious and compassionate are words that colleagues use to describe Ernest--old-fashioned virtues that no doubt came from his youth in Sycamore, Ill., where his father was a postal carrier and he was a high school football star. His fascination with the eye, he says, began when he was a senior at Northwestern University and opted to do an honors paper on embryological development. "I went to the card catalog and opened up the file drawer, and the cards on embryology went the length of the drawer. In desperation, I narrowed the topic to the smallest part of the body I could think of, the eye."

As a research physician, Ernest straddles the twin worlds of biomedical research and clinical practice. His drive to explore new medical frontiers, he says, is rooted in a sense of urgency that comes from seeing 100 patients a week, many of them desperate and despondent. Indeed, when patients with macular degeneration complain about not being able to read, Ernest invariably thinks of his father and his love of reading. "My father was 93 when he died, and for the last 10 years of his life he was unable to read. We all take the ability to read for granted until it's gone."

Though macular degeneration has left an indelible mark on Ernest's life, there is no way of knowing whether it will be his team or some other group of researchers that will make the critical breakthroughs to alleviate the disease. When pioneering new treatments, observes Ernest, it is always prudent to expect the unexpected. "You often start out in one direction, but you end up going in another."