Countries Make Push To Increase Eye Donors

Original Source By BINA VENKATARAMAN Eye donation recently got a new public face in Syria, where the Grand Mufti, the highest official of religious law, pledged to donate his corneas upon death to help one of the thousands of people waiting for transplants there. In India, it is Bollywood film stars like Aishwarya Rai Bachchan, the former Miss World, who have pledged their eye tissue for transplant. The hope in both places is to overcome cultural norms about how to treat the body that have fettered the growth of national eye banks. Armed with new ranks of eye doctors and better medical facilities, these countries and many others in the Middle East and Asia are making a push to increase the number of eye donors among their populations. To some degree, necessity is breeding invention. Supply from the United States, the leading exporter of corneas, has dropped significantly in recent years as a new surgical procedure for transplants has gained in popularity here. The shortage explains why, in Syria, when the Grand Mufti made his pledge three weeks ago, Dr. Rida Said of the Syrian Ministry of Health was watching closely. Doctors in Syria perform hundreds of transplants a year, said Dr. Said, director of the National Program for Blindness Control. But the supply of tissue from the United States has been dropping, and the corneas the country does get go only to wealthy people who will pay $1,000 or more per eye. A new eye bank in Syria is part of a regional effort to drum up corneal tissue in the Middle East and parts of northern Africa. If the tissue is available, we can definitely solve this problem, he said. It’s a social mentality that we have total respect to the dead and to the body. Dr. Alfred Sommer, a professor of ophthalmology and epidemiology at Johns Hopkins University who has worked on blindness prevention programs in the developing world for more than 35 years, said the spread of surgical expertise had outstripped the supply of eye donors. The gap between how many corneas could be used and the number that are available has definitely grown, Dr. Sommer said. Organizations that work to prevent blindness say it is nearly impossible to quantify the global disparity between the number of corneas available, the number of surgeons trained to perform transplants and the number of people who need them. But the situation in individual countries suggests the depth of the problem. India’s eye banking system now collects about 10,000 corneas suitable for transplant each year, said Dr. Nag Rao, founder of the L. V. Prasad Eye Institute in Hyderabad and president of the International Agency for the Prevention of Blindness. He estimates that more than 100,000 corneas are needed annually in India and that its growing cadre of well-trained surgeons could safely perform at least 30,000 transplants per year. Government and health agencies are developing a system of 50 eye banks to address the shortage. My expectation is that in 10 years time we’ll be able to tackle the problem more effectively, Dr. Rao said. In Japan, about 5,000 people are on waiting lists for corneas, said Dr. Naoshi Shinozaki, executive director of the Cornea Center and Eye Bank in Ichikawa, adding that the current rate of transplants, about 2,500 per year, falls far short of the country’s estimated need for 15,000 per year. Even countries with marginal ability to perform cornea transplants are affected by the shortage. Dr. Dan Kiage, the head of the ophthalmology department at the Aga Khan University Hospital in Nairobi and the president of the Ophthalmological Society of Eastern Africa, said that Kenya’s two major eye hospitals together used to do about 50 cornea transplants a year, almost all with corneas from eye banks in the United States. The transplant rate is now 10 a year, he said, with about 20,000 people in need of transplants. To safely use a cornea for transplant, it must be removed from a body within hours of the death, kept in tissue culture or refrigerated, and used in 7 to 12 days. The cornea, a clear, dome-shaped window covering the pupil and iris that admits light into the eye, relies on a thin layer of endothelial cells that pump fluid out of it to keep it from clouding over. As corneal transplants become more and more successful, there are more and more candidates for the procedure, said Dr. Hunter Cherwek, medical director of the Flying Eye Hospital, a DC-10 airplane run by the nonprofit group Orbis that flies to various countries to train eye surgeons. It truly becomes a supply and demand issue, where the techniques are expanding the demand. Orbis is working with a government agency to increase eye donations in Vietnam, where Dr. Cherwek estimates that thousands, likely tens of thousands could benefit from corneal transplantation. Monty Montoya, president of the Northwest Lions Foundation for Sight & Hearing, part of a network of 18 eye banks in the United States, said that in other countries, there is almost an insatiable demand for corneas for transplant. From 2003 to 2007, the number of corneas sent to other countries from the United States dropped to 10,731 from 14,196, according to the Eye Bank Association of America, a decline to 21 percent of the total corneas donated from 31 percent. Eye banks attribute the drop to the increase in corneas used in the United States for endothelial keratoplasty, a new surgical procedure that allows selective replacement of cornea cells, improving the patients’ recovery time and in many cases, the body’s acceptance of the transplant. While the number of corneas exported from the United States is low relative to the roughly 10 million people with corneal blindness around the world, American eyes serve as seeds, helping other countries develop their own eye banks. The importance of U.S. eye banks is to send corneas to other countries to prime the pump, said Jake Requard, president of VisionShare, a consortium of eye banks in the United States. It’s to train corneal eye surgeons in other countries and help the ophthalmological community talk to government leaders, religious leaders and so on and look at ways of actually developing their own eye banks there. In Syria, imports generate public acceptance for cornea donation, said Dr. Said. When you see your neighbor’s life changed from getting a corneal transplant, you might start to think that donating your corneas is a good idea. For people who believe they need their eyes in the afterlife, clarification of religious doctrine is sometimes not enough. It’s a question of mentality, Dr. Said added. In India, Dr. Rao believes the obstacles to eye donation are social and legislative rather than religious. His institute is seeking a law mandating that hospitals ask the families of people who die whether they would like to donate the eyes. The shortage of eye tissue in many places means that transplants are available only to the wealthy. Building domestic eye banks, experts say, could reduce the price of corneas and allow more people to get transplants. But the experts also say that such growth, however beneficial, is unlikely to improve a more basic problem: lack of access to eye care for the poor.