What is Eye donation? Why is it important?There are hundreds of thousands of visually handicapped  people in our country. It is estimated that out of this about 10 lakh people can regain vision with appropriate treatment. Surgery can restore vision to those who have become blind due to cataract or those whose cornea has been affected. The damaged whitish cornea should be replaced by a crystal like healthy cornea which has been donated by a healthy person. So eye-donation should be encouraged in a large scale, as one of the best means of social service. To enable another person obtain vision is one of the best forms of charity. Even after death the donor lives in the eyes of recipient. Eyes from a dead person can enable two blind people to acquire vision. When should the eye-surgeon or eye bank be informed to donate the eyes? The eyes of a dead person can be used only if they are taken out within 6 hrs of death. When a person who has given consent for the donation of one's eyes dies, the eye should be kept wet by sprinkling water on them. Otherwise pieces of cotton wool soaked in water should be placed on both the eyes so that the cornea does not become dry till the eye-surgeon arrives. After the removal of the eyes the eyelids will be stitched together and there will be no visible sign of the eyes having been removed. The entire process is completed within 10-15 mins.  

Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft) in its entirety (penetrating keratoplasty) or in part (lamellar keratoplasty). The graft has been removed from a recently deceased individual with no known diseases or other factors that may affect the viability of the donated tissue or the health of the recipient. The cornea is the transparent front part of the eye that covers the iris, pupil and anterior chamber. The surgical procedure is performed by ophthalmologists, medical doctors who specialize in eyes, and is often done on an outpatient basis. Donors can be of any age, as is shown in the case of Janis Babson, who donated her eyes at age 10.

Indications

Indications for corneal transplantation include the following:

Optical: To improve visual acuity by replacing the opaque or distorted host tissue by clear healthy donor tissue. The most common indication in this category is pseudophakic bullous keratopathy, followed by keratoconus, corneal degeneration, keratoglobus and dystrophy, as well as scarring due to keratitis and trauma.

Tectonic/reconstructive: To preserve corneal anatomy and integrity in patients with stromal thinning and descemetoceles, or to reconstruct the anatomy of the eye, e.g. after corneal perforation.

Therapeutic: To remove inflamed corneal tissue unresponsive to treatment by antibiotics or anti-virals.

Cosmetic: To improve the appearance of patients with corneal scars that have given a whitish or opaque hue to the cornea.

Pre-operative examination

In most instances, the patient will meet with their ophthalmologist for an examination in the weeks or months preceding the surgery. During the exam, the ophthalmologist will examine the eye and diagnose the condition. The doctor will then discuss the condition with the patient, including the different treatment options available. The doctor will also discuss the risks and benefits of the various options. If the patient elects to proceed with the surgery, the doctor will have the patient sign an informed consent form. The doctor might also perform a physical examination and order lab tests, such as blood work, X-rays, or an EKG.

The surgery date and time will also be set, and the patient will be told where the surgery will take place. Within the United States, the supply of corneas is sufficient to meet the demand for surgery and research purposes. Therefore, unlike other tissues for transplantation, delays and shortages are not an issue.[1]

Procedure

On the day of the surgery, the patient arrives to either a hospital or an outpatient surgery center, where the procedure will be performed. The patient is given a brief physical examination by the surgical team and is taken to the operating room. In the OR, the patient lies down on an operating table and is either given general anesthesia, or local anesthesia and a sedative.

With anesthesia induced, the surgical team prepares the eye to be operated on and drapes the face around the eye. An eyelid speculum is placed to keep the lids open, and some lubrication is placed on the eye to prevent drying. In children, a metal ring is stitched to the sclera which will provide support of the sclera during the procedure.

Penetrating keratoplasty

A trephine (a circular cutting device) is used by the surgeon to cut the donor cornea, which removes a circular disc of cornea. A second trephine is then used to remove a similar sized portion of the patient's cornea. The donor tissue is then sewn in place with sutures.

Antibiotic eyedrops placed, the eye is patched, and the patient is taken to a recovery area while the effects of the anesthesia wear off. The patient typically goes home following this and sees the doctor the following day for the first post operative appointment.

Lamellar keratoplasty

Encompasses several techniques which selectively replace diseased layers of the cornea while leaving healthy layers in place. Advantages include improved tectonic integrity of the eye and reduced risk of rejection. Disadvantages include the technically challenging nature of these procedures which replace portions of a structure only 500 microns thick, and reduced optical performance of the donor/recipient interface compared to full thickness keratoplasty.

Deep Anterior Lamellar Keratoplasty

In this procedure, the anterior layers of the central cornea are removed and replaced with donor tissue. Endothelial cells and Descemets membrane are left in place. This technique is used in cases of anterior corneal opacifications, scars, and ectatic diseases such as keratoconus.

Endothelial Keratoplasty

Replaces the patient's endothelium with a transplanted disc of posterior stroma/Descemets/endothelium (DSEK) or Descemets/endothelium (DMEK).

This relatively new procedure has revolutionized treatment of disorders of the innermost layer of the cornea (endothelium). Unlike a full thickness corneal transplant, the surgery can be performed with one or no sutures. Patients may recover functional vision in days to weeks, as opposed to up to a year with full thickness transplants.

During surgery the patient's corneal endothelium is removed and replaced with donor tissue. With DSEK, the donor includes a thin layer of stroma, as well as endothelium, and is commonly 100-150 microns thick. With DMEK only the endothelium is transplanted. In the immediate post operative period the donor tissue is held in position with an air bubble placed inside the eye (the anterior chamber). The tissue self adheres in a short period and the air is adsorbed into the surrounding tissues.

Complications include displacement of the donor tissue requiring repositioning ('refloating'). This is more common with DMEK than DSEK. Folds in the donor tissue may reduce the quality of vision requiring repair.

Rejection of the donor tissue may require repeating the procedure. Gradual reduction in endothelial cell density over time can lead to loss of clarity and require repeating the procedure.

Patients with endothelial transplants frequently achieve best corrected vision in the 20/30 to 20/40 range, although some reach 20/20. optical irregularity at the graft/host interface may limit vision below 20/20.

Risks

The risks are similar to other intraocular procedures, but additionally include graft rejection (lifelong), detachment or displacement of lamellar transplants and primary graft failure.

There is also a risk of infection. Since the cornea has no blood vessels (it takes its nutrients from the aqueous humor) it heals much more slowly than a cut on the skin. While the wound is healing, it is possible that it might become infected by various microorganisms. This risk is minimized by antibiotic prophylaxis (using antibiotic eyedrops, even when no infection exists).

Graft failure can occur at any time after the cornea has been transplanted, even years or decades later. The causes can vary, though it is usually due to new injury or illness. Treatment can be either medical or surgical, depending on the individual case. An early, technical cause of failure, may be an excessively tight stitch cheesewiring through the sclera.

Prognosis

The prognosis for visual restoration and maintenance of ocular health with corneal transplants is generally very good. Risks for failure or guarded prognoses are multifactorial. The type of transplant, the disease state requiring the procedure, the health of the other parts of the recipient eye and even the health of the donor tissue may all confer a more or less favorable prognosis.

The majority of corneal transplants result in significant improvement in visual function for many years or a lifetime. In cases of rejection or transplant failure, the surgery generally can be repeated.

History

The first cornea transplant was performed in 1905 by Eduard Zirm (Olomouc Eye Clinic, now Czech Republic), making it one of the first types of transplant

surgery successfully performed. Another pioneer of the operation was Ramon Castroviejo. Russian eye surgeon Vladimir Filatov's attempts at tranplanting cornea started with the first try in 1912 and were continued, gradually improving until at 6 May 1931 he successfully grafted a patient using corneal tissue from a deceased person.[2] He widely reported of another transplant in 1936, disclosing his technique in full detail.[3] In 1936, Castroviejo did a first transplantation in an advanced case of keratoconus, achieving significant improvement in patient's vision.[4][5]

Advances in operating microscopes enabled surgeons to have a more magnified view of the surgical field, while advances in materials science enabled them to use sutures finer than a human hair.

Instrumental in the success of cornea transplants were the establishment of eye banks. These are organizations located throughout the world to coordinate the distribution of donated corneas to surgeons, as well as providing eyes for research. Some eye banks also distribute other anatomical gifts.

Synthetic corneas

Main article: Keratoprosthesis

Boston keratoprosthesis

The Boston keratoprosthesis is the most widely used synthetic cornea to date with over 900 procedures performed worldwide in 2008. The Boston KPro was developed at the Massachusetts Eye and Ear Infirmary under the leadership of Claes Dohlman, MD, PhD.[6]

AlphaCor

In cases where there have been several graft failures or the risk for keratoplasty is high, synthetic corneas can substitute successfully for donor corneas. Such a device contains a peripheral skirt and a transparent central region. These two parts are connected on a molecular level by an interpenetrating polymer network, made from poly-2-hydroxyethyl methacrylate (pHEMA). AlphaCor is an FDA-approved type of synthetic cornea measuring 7.0 mm in diameter and 0.5 mm in thickness. The main advantages of synthetic corneas are that they are biocompatible, and the network between the parts and the device prevents complications that could arise at their interface. The probability of retention in one large study was estimated at 62% at 2 years follow-up

Eye donation is an act of donating one’s eyes after his/her  death. Only corneal blinds can be benefited through this process not other Blinds. It is an act of charity, purely for the benefit of the society and is totally voluntary. It is done after death. The eye donation of the deceased can be authorized by the next of kith & kin even if the deceased did not pledge to donate his / her eyes before death.

Eye donation provides people who are blind with an opportunity to regain their vision through corneal transplantation, research and teaching The eyes, which are received through such magnanimous gestures, are of great benefit to the society. The front, clear and transparent tissue of the eye called as cornea can be used to restore vision to corneal blind person. The other portions of the eye are also used for research and  training   purposes to develop cures for some of the common eye diseases.

.The need for donated eyes far exceeds the availability of donations. People are waiting, hoping and praying for just such a gift. More than 46,000 corneal transplants are performed every year, and the overall success rate of the procedure is 90 percent...meaning your generosity has an impact that is positive and lasting. Donation is a selfless act supported by all major religions. Only after every attempt to save your life has been made will the issue of donation arise. Your family will be asked if you have expressed a desire to participate in organ, tissue and eye donation. There is no cost to the family. A decision to become a donor will ultimately change someone's life. This gift will be treasured and appreciated for years to come.

Eye banks retrieve and store eyes for cornea transplants and research. US eye banks provide tissue for about 46,000 cornea transplants a year to treat conditions such as keratoconus and cornea scarring. The cornea is not the only part of the eye that can currently undergo transplantation. The sclera can also be used to repair recipient eyes in surgery. In contrast to other organs, there is an adequate supply of corneas for transplants.

When an organ/tissue donor dies, consent for donation is obtained either from a donor registry or from the donor's next of kin. A certified eye bank technician is then dispatched to the hospital, funeral home, or medical examiner's office to recover the donor's eyes. The whole eye, called a globe, is enucleated from the donor and taken back to the eye bank for processing. Or the cornea is excised in-situ and placed in storage media. A sample of the donor's blood is also collected to test for infectious diseases such as HIV, Hep B and C, CMV, RPR, and sometimes others. The blood type is also tested, even though corneas are not a vascular tissue and match typing is not necessary to transplantation. Back at the eye bank, if the cornea was not excised in-situ, the cornea and part of the white sclera are cut away from the rest of the eye and placed in a container with preservation medium, and the sclera is then cleaned and preserved in alcohol. The corneas undergo visual examination and evaluation underneath a slit-lamp and endothelial cell

counts underneath a specular microscope. The corneas are rated, usually on a scale of 0-4 for donor suitability based on the specular and slit-lamp evaluations.

There is a wide variety of storage media used in eye banking. The most popular is Optisol GS, which can preserve cornea tissue for up to 14 days if kept refrigerated. Eusol-C is another commonly used media. Organ culture media can also preserve corneas and does not require refrigeration.

To avoid violating the Health Insurance Portability and Accountability Act, Eye banks must through their legal anatomical authorizations obtain consent which allows EBAA representatives access to donor information for accreditation reviews.

Information about eye donation

In India approximately 0.6% people are blind. Out of these about 3% people are

blind due to corneal opacity. Normally the cornea is transparent, regular and

smooth structure.

Important causes of the corneal opacities:

1. Corneal Ulcer: After healing of the corneal ulcer affected cornea becomes

opaque (looses its transparency). Corneal ulcer is commonly caused by

injury and as complication of conjunctivitis. If these conditions are not

treated or not treated properly then the cornea develops ulcer as

complication. In past trachoma was one of the leading causes of the corneal

blindness.

2. Eye injury can also result in corneal opacity.

3. Malnutrition and Vitamin A deficiency: In these conditions corneal ulcer

develops and cornea melts.

4. Chemical injuries to eye: Such chemical injuries are caused by acid, lime

and alkali. Chemical injuries results in widespread damage to the eye

surface and causes corneal opacity.

5. Complication of operation on eye, including complication of cataract

surgery.

6. Congenital abnormalities: Sometimes the child is born with corneal opacity.

Features of corneal diseases (Blindness)

1. Corneal opacity: Cornea looks white or hazy. Normally cornea is

transparent and structures behind the cornea are seen through transparent

cornea.

2. Reduced eye sight: Vision may be markedly reduced. Even patient may be

blind due to corneal opacity.

3. In case of corneal ulcer besides reduced vision, the affected eye is red and

painful. Patient has difficulty in opening eye and there is foreign body

sensation. Corneal ulcer looks yellowish or yellowish pale.

Prevention of Corneal Blindness

To prevent development of blindness due to corneal diseases the following

measures may be taken:

1. Prevent eyes from injuries: Especially prevent eyes while doing agriculture

related work. Proper protective glasses / protective shield should be used

while chipping stone, using hammer and chisel, hammering nail, grinding

metal and welding. Choose toys carefully for children. Toys should not have

sharp edges.

2. Prevent children from malnutrition and vitamin A deficiency. Malnutrition

is usually caused by repeated diarrhoea / diarrhoea and vomiting.

Therefore these diseases should be treated early and effectively. Children

below six years of age should be given vitamin A in adequate quantity.

Dose of Vitamin A may be given to children as per advice of doctor/

paramedical worker.

3. In case of presence of any feature or features of corneal disease or

conjunctivitis, proper treatment should be taken at the earliest from eye

specialist / doctor. No indigenous medicine or anything (milk, ghee, kajal

etc.) should be used in eyes.

Treatment of blindness due corneal diseases

1. Most of the corneal diseases causing blindness can be prevented.

2. By timely, proper treatment of the corneal diseases blindness can be

prevented.

3. In many of the cases of the corneal blindness, eye sight can be improved

or restored by the replacement of diseased cornea with clear transparent

cornea from eye received in donation. This procedure is called corneal

grafting. In this procedure patient’s opaque (diseased) cornea is removed

and replaced by clear, healthy cornea obtained from donated eye.

What is Eye Donation?

Eye donation means pledge to donate eyes, during the life time, so that after

the death of such eye donor eyes can be removed for medical purposes (for

corneal transplantation). During the life time person has to pledge to donate

eyes, for which a simple eye donation form has to be filled up. In this form the

person writes his name, age and address. This form is signed by the donor,

her/his next of kin and close relative or friend. Eye donor should tell about

her/his decision about eye donation to next of kin; family members and

friends so that they fulfil his/her desire after her/his death by informing eye

bank. The eyes are collected only after the death. Under no circumstances the

eyes are removed during the life time. The eyes of eye donor are removed/

collected only after getting consent from the next of kin and relatives after the

donor’s death, therefore it is necessary that the donor informs them of his/her

decision. Eyes can be collected only within six hours of death.

How to donate eyes:

Anybody can donate the eyes by filling the eye donation pledge form. The eyes

are accepted only after the death.

Anybody, man or woman, person of any caste or religion, of any age can fill up

the eye donation pledge form.

Persons who wear spectacle, suffering from cataract or operated for cataract

can also donate his/her eyes. The cornea of the eye donor should be clear,

healthy and free from any disease.

The eyes of person who did not pledge to donate eyes during life time can also

be donated by the family members after his/her death. In this case it is

necessary that the deceased (departed) person had not expressed against eye

donation during his life time.

The eyes should be donated within six hours (as early as possible) after the

death. The eye donor’s death should be informed to the nearest Eye Bank /

Eye Department of the Medical College/ District Hospital/ Eye specialist by

her/his family members / relatives.

On receiving information about death of the donor, eye specialist/ doctor of

the eye bank will reach the donor’s house or hospital where donor’s dead

body is. They will check the medical record of the deceased eye donor and

check the eyes to see if they are suitable for use. After that the eyes are

removed from the dead body and small quantity of blood is also drawn in a

syringe for few tests.

The eye donor’s relatives are not charged for this procedure and no money is

paid to them for eye donation.

The family members of the eye donor should cooperate with doctor and staff

who comes to accept the eyes in donation. The family members and relatives

of donor should keep the medical record of the deceased ready and should

sign the prescribed consent form.

The removal of eyes from the dead body does not produce any deformation of

the face. The procedure of removal of eyes for eye donation purpose takes

about 15 -20 minutes and there is no bleeding.

In case the family members decide to donate the eyes of deceased, they

should inform the nearest eye bank at the earliest and cover the eyes of

deceased with clean wet towel or cloth to avoid drying of the eyes.

The family members of the eye donor and recipients of the eyes are not

introduced to each other. The personal details of eye donor and recipient are

kept confidential in the eye bank. The information that the eyes have been

used is given to the family members of the eye donor, if they so desire.

Duly filled eye donation pledge form can be deposited in any eye bank, but the

eyes should be donated to the nearest eye bank. It is not necessary that the

eyes should be donated to the eye bank in which the pledge form was

deposited.

The eyes received in donation are not sold or purchased. The eyes received in

donation are used only for the medical purpose for restoring the eye sight of

the person who is blind due to corneal opacity.

The eyes received through eye donation are examined for their suitability for

transplantation in patient’s eye. Only the cornea is transplanted in eye having

corneal opacity. In case eyes are not suitable for transplantation then they are

used for medical research purposes. The eyes used for research purposes, also

helps in enhancing medical knowledge and thus helpful.

Donate your eyes and help two blind persons affected by the corneal blindness

to see world again.

Discuss about the eye donation with your family members, relatives and

friends and motivate them also for eye donation.

The eyes are invaluable gift that you can give to humanity.

Pledge to donate the eyes during your life time and set an example for your

family and the society.

For further details contact nearest Eye Bank/ Eye Department of Medical

College/ District Hospital or Eye specialist.

Some more information about eye donation

In India nearly three lakh people are blind due to diseases of Cornea. In most

of the cases this tragedy affects the children and they are forced to spend their

remaining life in darkness. Large number of such corneal blind people can be

benefited by corneal transplantation. In our country there is large gap

between required number of corneas and availability of cornea through eye

donation. It is because of lack of eye donors.

In corneal transplantation procedure the diseased, white /opaque cornea is

replaced with clear donor cornea. Such cornea is obtained from eyes of eye

donors.

Majority of corneal transplantation operations are successful.

The eye donation form can be obtained from any eye bank. You need to fill up

your name, age, address in the prescribed form and sign the form. Two

persons, next of kin and one family member/ relative/ friend also signs the

pledge form as witness. On receiving eye donation pledge form eye donor is

registered in the eye bank and given a certificate and an eye donor card. The

eye donors are advised to always keep the eye donor card with them.

The eyes received in donation are processed in the eye bank and stored. From

these eyes the cornea is removed and transplanted in the eyes of needy

patients from waiting list maintained by the eye bank/ hospital with in 24 to 72

hours.

The eyes are accepted in donation only after the death of eye donor. Under no

circumstances the eyes are removed during the life time.

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LET THEM SMILE WITH OUR EYES – DONATE EYES

(Ministry of Health and Family welfare, Govt. of India, declare National Eye Donation

Fortnight. This fortnight will be celebrated in between August 25 to September 8. And

September 8 will be observed as National Eye Donation Day.)

India is shouldering the largest burden of global blindness. There

are 45 million people in the world who are blind, of which as many as

15 million are Indian. Three times that number suffers from a

significant impairment of vision that threatens their ability to be

physically or financially self-sufficient. The cumulative loss to

the country's GNP is estimated to be to the tune of US $11.1 billion

(Shammana et al 1998). The total population of our country is 1.08

billion, out of the same 52 million are having mild visual problems,

including 3,20,000 children. If we look at the root cause of the

blindness, we may be surprised to hear that 66% of the causes are

either preventable or curable. While the problem is formidable, the

need to take up the challenge of curtailing it is compelling.

Institutions of eye care are striving to create a positive impact and

comprehensive quality eye care has become the core objective of one

among them, the Chennai based Sankara Nethralaya, Chennai. The Department of

Medical Sociology of Sankara Nethralaya is frequently organizing public health education

programmes in various places like schools, colleges, and industrial establishments in

collaboration with NGOs.  Various issues on eye care and eye donation are explained in

such public health education programmes.

What is an eye bank?

An eye bank is an organisation, which obtain, evaluates and distributes eyes from

humanitarian-minded citizens for use in corneal transplantation, research and education. To

ensure patient safety, the donated eyes are evaluated under strict medical standards. All

donated eyes not suitable for corneal transplantation are used for valuable research and

education.

Why should eyes be donated?

Donated human eyes are necessary in preservation and restoration of sight through corneal

transplantation, research and education. More than 90% corneal transplant operation

successfully restores vision in people suffering from blindness due to corneal problems. Infants

born with cloudy corneas have an opportunity to see following corneal transplantation.

What is the cornea?

The cornea is the clear, transparent dome in front of the "black portion" of the eye. It is also the

main focussing surface, which converges light rays as they enter the eye to focus on the retina.

It is thus the most important part of the optical apparatus of the Eye. Loss of transparency

directly results in loss of vision.

What is corneal Transplantation?

A Corneal transplant is an operation, which replaces the opaque cornea with a clear cornea

Obtained from a human donor eye.

Before the corneal transplantation After the corneal transplantation

How does a cornea become opaque?

1.Infection

2.Injuries

3.Iatrogenic (Malpractice, Improper Post-op. care after any eye surgery)

4.Malnutrition

5.Congenital/Hereditary.

Magnitude of the problem in India

1/4th of the world’s blind in India1/4th of the world’s blind in India

27 million27 million - moderate sight impairment- moderate sight impairment

9 million9 million - bilateral blind- bilateral blind

260,000260,000 - blind children- blind children

No of Corneal Blinds in India 4.6 Million Out of 4.6 Million 90% are below the age of 45

years including 60% are below the age of 12 years.

Out of 4.6 Million, at least 3 Million can benefit by Corneal transplantation.