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• W4386020137 abstract "Corneal transplantation is one of the viable options for visual rehabilitation for corneal blind people, and keratoplasty, in any form, is considered to be the most frequent type of transplantation in the world. Conclusive data in India, which is essential in defining local or national strategies to fight corneal blindness, is lacking. In fact, there is a significant data gap. Since 2000, Indian ophthalmologists have often come across a statement that places India’s demands at 100,000 corneal transplants every year to treat corneal blindness as per the vision 2020 program. To meet this demand, 200,000 donor corneas with a utilization rate of 50% or so are required.[1] However, the exact number of corneal blind people among India’s 1.42 billion population remains unclear, as is the number of individuals who could benefit from corneal transplantation. The recent rapid assessment of avoidable blindness (RAAB) survey (2015–2019) by the National Program for Control of Blindness and Visual Impairment (NPCBVI), Govt of India, reveals that corneal blindness is the second most common cause of blindness (8.2%) in the population aged 50 years or above, and at the same time, it is the leading cause of blindness (37.5%) in those between 0 and 49 years of age.[2] When discussing blindness, we refer to the condition where visual acuity in the better eye is <3/60 with available correction, signifying bilateral blindness. Extrapolating these figures with India’s current population, the approximate number of corneally blind individuals would be around 420,000. The critical question that then arises is, “How many among these could benefit from keratoplasty?” Much speculation has gone into the discussion on the number of new corneal blind patients added in the list every year. Old data suggests that it is between 25,000 and 30,000 every year, and this figure has remained unchanged for over 25 years. Unilateral corneal blindness was not captured in the NPCBVI-RAAB survey, but it was estimated that prevalence of unilateral corneal blindness was 0.56% (blindness was defined as presenting visual acuity of <6/60 in the better eye in those days).[3] The most common cause of unilateral blindness was keratitis, followed by post-cataract surgery corneal edema/bullous keratopathy.[3,4] Even today, these remain the two most common indications for corneal transplantation in India, mostly addressing unilateral corneal blindness. The outcome of optical penetrating keratoplasty in patients with bilaterally blinding corneal disease is poorer than in those who are unilaterally blind.[5] On the other hand, the visual outcomes of bilateral lamellar keratoplasty are much better, which is compatible with day-to-day functioning.[6] The statistics webpage of NPCBVI provides figures only for cornea/eye ball collection, with the annual target set between 50,000 and 72,000 on a year-to-year basis. The pre-coronavirus disease (pre-COVID) 3-year figures were 71,709, 68,409, and 65,417, respectively, whereas the 3-year figures in the coronavirus disease (COVID) era (2020–2021 and 2022–2023) were 17,402, 45,294, and 32,414 respectively.[7] The data from 2022 to 2023 is probably incomplete. However, information on utilization data, which is more crucial in the context of corneal transplant to address corneal blindness, is lacking. Analyzing the data from the Eye Bank Association of India (EBAI), we obtain information on both collection and utilization.[8] It also provides data on the different types of keratoplasty performed, giving a fair idea of the adoption and performance of various corneal transplant procedures in India. Over the last 6 years, therapeutic penetrating keratoplasty has remained between 27% and 34% of all transplants, and the purpose is to treat active keratitis and to save the integrity of the eyeball. Optical penetrating keratoplasty remains between 45% and 50%, and endothelial keratoplasty is steadily increasing from 13% to 17% in the last 6 years. Other challenging procedures, such as deep anterior lamellar keratoplasty (DALK) and keratoprosthesis, also feature in the list [Table 1]. These figures, however, might be incomplete, as of today, not all eye banks share their annual numbers with EBAI, which, in turn, leads to discrepancies between NPCBVI data and EBAI data [Table 2].Table 1: Number and percentage of different types of keratoplasty as per the EBAI record (Apr 2017–Mar 2023)[ 8 ]Table 2: Pre-COVID and COVID-era cornea collection and utilizationThe encouraging aspect of these figures is that despite the challenges associated with COVID-19, the number of corneal transplants in 2022–2023 reached an all-time high in the country. This achievement occurred even though the collection numbers were significantly lower than in the pre-COVID era. Much of this progress can be attributed to improvements in the cornea retrieval program, the introduction of new storage mediums, and the implementation of specular microscopy in every eye bank. Furthermore, there has been a noticeable increase in the number of trained corneal surgeons over the years, alongside the gradual adoption of the lamellar keratoplasty procedure. Interestingly, in many cases, one cornea has been used for two different types of lamellar keratoplasties in two separate recipients. Nevertheless, we have only achieved only about one-fourth of our target. However, considering the utilization trend over the last 3 years, it appears we are poised to tackle this uphill task. The significant increase in donor cornea utilization is largely attributed to the nationwide implementation of the Hospital-based Cornea Retrieval Program (HCRP). This initiative enabled eye donation counselors and recovery technicians to proactively procure transplantable corneas, a factor which proved to be more critical than mere collection. A significant shift occurred in many eye banks when, with the availability of McCarey-Kaufman (MK) medium and Cornisol medium, the practice changed from whole globe enucleation to in situ excision of the corneoscleral button. In addition, the national distribution of suitable donor corneas via a central distribution system has greatly contributed to their immediate availability and improved quality across the country.[9] Surgical interventions for corneal blindness will only be successful if we have well-established specialty clinical services for long-term follow-up and treatment of graft rejections and other post-keratoplasty complications. Owing to the nonequitable distribution of such specialized corneal services in India, timely management may not be available to people in rural and underserved regions, where the magnitude of corneal blindness may be the greatest. Another crucial aspect is the number of well-trained corneal surgeons. If we consider an annual target of 100 transplants per surgeon, India needs 1000 trained specialists. The Cornea Society of India has over 1000 members, but the exact number of corneal surgeons performing keratoplasty regularly and their annual average remain unknown. There are also non-member cornea surgeons who significantly contribute to the annual keratoplasty procedures. In addition, more than 50 budding ophthalmologists are currently undergoing cornea fellowship programs across the country. These factors are all crucial for the long-term results of any form of keratoplasty. In the global survey of cornea transplantation and eye banking, India ranks as “almost sufficient” – coming second only to the USA in the number of corneal procurements and transplantations. However, several remaining gaps must be addressed to further improve and build upon this success. These gaps include the following: Determining an accurate figure for the number of individuals with corneal blindness that can be treated by keratoplasty Identifying the number of individuals who have been transplanted for visual rehabilitation Understanding and optimizing the process of collecting transplantable corneas within Indian eye banking Establishing a national registry for individuals with corneal blindness who are treatable by corneal transplantationThis should include a national transplant registry with a unique number linked to either the Aadhar identification number or the mobile number, facilitating effective follow-up care nationwide and allowing for the analysis of long-term outcomes associated with different keratoplasty procedures.Calculating the number of corneal surgeons needed to clear the existing backlog of cases Exploring the different types of keratoplasty performed by individual surgeons, and implementing need-based training for advanced keratoplasty procedures. Tackling the challenge of corneal blindness requires a united and data-driven approach. A comprehensive strategy involving enhanced data collection and sharing mechanisms, establishment of a national corneal blind and transplant registry, and investments in training programs for corneal surgeons is indispensable. By bridging the data gap and implementing evidence-based practices, India can make substantial progress in the fight against corneal blindness, ensuring improved vision and quality of life for treatable corneal blind people. A long road ahead… About the AuthorDr. Samar Basak Dr. Samar Basak is the Director and one of the founder members of Disha Eye Hospitals which is the largest Private hospital chain in Eastern India with 18 branches in the state of West Bengal. He also serves as the Director of Cornea services for the hospital and is the medical director of Prova eye Bank, the region’s premier Eye Bank that retrieves around 1900 eyes and utilizes 1400 corneas annually. Dr. Basak has authored over 50 peer-reviewed publications and 7 books in Ophthalmology. He was the past President of the Eye Bank Association of India and the Cornea Society of India. An active member of the All India Ophthalmological Society, he is currently serving as the President-Elect. He is a high volume keratoplasty surgeon performing around 250 procedures per year. He is involved with teaching and training program on eye banking and keratoplasty skill transfer courses both individually and in collaboration with SightLife and Visionaries-International, in India and abroad." @default.
• W4386020137 created "2023-08-22" @default.
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• W4386020137 date "2023-08-21" @default.
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• W4386020137 title "Data gap: Transplantable corneal blindness, current transplantation, and eye banking in India" @default.
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• W4386020137 doi "https://doi.org/10.4103/ijo.ijo_2096_23" @default.
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