Corneal Blindness - Eye Banking in India and Task Ahead

Dr. Samar K Basak
President,
Eye Bank Association of India.
basak_sk@hotmail.com
Corneal Blindness:
Eye Banking in India
And TASK Ahead

I do not have any Financial interest to disclose

 6.8 million people (vision <6/60)
1 million = Bilateral
Curable by Keratoplasty = about 10 %
 This figure will be 10.6 million in 2020
– “RAAB study - 2007” = Corneal blindness= 1% of total blindness.
– New patients/year = 40,000 – 50,000 (??)
1. Dandona et al. Br J Ophthalmol. 2003; 87:133-41
2. NPCB-2012; News Letter, NPCB; Govt of India.
Corneal Blindness: India

 Infectious Keratitis (Corneal Ulcer)
 Pseudophakic Bullous keratopathy
 Hereditary Dystrophies/ Corneal Ectasia
 Corneal Injury: open globe/chemical/thermal
 Trachoma
 Vitamin A deficiency
Corneal Blindness:
Major causes in INDIA
6

Madurai: 113/ 100,000 person/yr
India: 1.31 million ulcers/year
Gonzales CA et al. Incidence of corneal ulceration in Madurai District, South India. Ophthalmic Epidemiology, 1996;3:156-66
Infective keratitis: in India

Pseudophakic Bullous Keratopathy (PBK)
 Exact data not available
 Incidence = 0.1-1.0%
PBK occurs both from
Masters and Learner
 In 2012-13 = 6.2 million Cataract Sx
performed by us
 In Simple Math: @ 0.5% =
the FIGURE of PBK/edema = ?

Hereditary Dystrophies
Fuchs’CHED

Dystrophies: Indian data
 Exact data not available
Fuchs’ Dystrophy = 1/4th of all Transplants
– Primary OR
– as Post cataract Sx Corneal edema/PBK
Macular Dystrophy = is also Higher
Others, Like - Granular, Lattice, etc. are less

Keratoglobus
Post LASIK Ectasia
PMD
Corneal Ectasia: More detection

KCN: Global and Indian data
 Prevalence = 50 to 130 per 100,000 population.
 Overall Annual incidence = 2.0 per 100,000
 In last decade – More newly diagnosis of KCN
 Better diagnostic sensitivity - especially with increase topography use
 Newly identified KCN cases during Screening for LASIK
Kymes SM and The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group. Quality of life in keratoconus.
Am J Ophthalmol. 2004;138:527-35.
Jonas B et al. Prevalence and associations of keratoconus in rural Maharashtra in central India: the central India eye and
medical study. Am J Ophthalmol. 2009;148:760-5
India = 2,300 per 100,000 population !!

Injury: Open globe and Chemical
 Everyday we see such cases
 Open globe and Alkali burns more
common in children
 Gen-X ophthalmologists
are not interested –
not learning good suturing
 Complacence attitude …..
 Delayed intervention leads to
permanent visual loss

Trachoma: Coming Back !
 In 84-87 NPCB-WHO Survey = 3%
 In 2001-2005 = No active Trachoma
 In 2010-11 : New areas
Uttarakhand = 15.2%
Haryana
Gujarat
Punjub
Rajasthan = 7.6%
UP = 5.9%
RAAB Study NPCB
< 10 years age
Musca Sorbens
Eye Seeking Flies

Vitamin A deficiency
 Now: not a problem
 Good coverage with Mass Immunisation
 Cluster problem is still there along with PEM

Solutions # 1
Cornea Transplantation

Therapeutic PKP at Right time
1 Year
One Eyed # Impending Perforation

 Fugal ulcer with
impending perforation
 Urgent Th-PKP with
Optical quality tissue
Th PKP (PhD Microbiologist # CL user)
1 M
3 Y
6/6p

 Bangladesh # Minister’s daughter
KCN # DALK LE #
Infection on Day 5
# Conj Hooding
# PR Inaccurate
– Evisceration
advised
1 Year 3 Years
Th PKP
Presentation

INDIA USA
Indications Percentage Percentage
Corneal Scar 28.1
40%
7.9
11%Therapeutic PK 12.2 2.9
PBK 10.6 27.2
Non-Fuchs’ Dystrophy 7.2
14.4%
9.3
49.9%Keratoconus 6.0 15.4
Fuchs’ dystrophy 1.2 15.2
Failed Graft 17.1 10.9
Others 17.7 2.7
Keratoplasty Indications: India Vs USA (2005-06)

 At present: 20000+ keratoplasty/year in India
 Surgery-wise Types – no data available
Keratoplasty: in INDIA
KP data 2012-13 = 984
Type of Surgery No. %
PKP 306 31%
Th PK 335 34%
DSEK 247 25%
DALK 44 5.6%
Tectonic 35 4%
Boston KPRO 19 2%
 Corneal Surgeon in INDIA = 300 – 350
 About 25% are doing Lamellar Surgeries
 Only 35% Eye Banks gives
Full Surgery-wise data

We need Solutions # 2
Quality Eye Banking
For Solutions # 1
Aim of this CME

Eye Banking: All INDIA (Last 10 years) 2003-12
We Need to perform = 100,000 Keratoplasty/Year in year 2020
@ 50% utilization
We need Collection = 200,000 Cornea/year
 Our collection has improved from = 20451 to 49510
 And Utilization from = 8,014 to 20,615
 Utilization percentage improved from 39% to 46%
As per Vision2020 India:

Based on 10.2 million deaths annually -
 In 2012, Total collections = < 0.5% of all deaths
 With a goal of 100,000 transplants and utilization of 50% -
Target of consenting donors = 100,000/year
We need = 1% of all deaths
Goal of Indian Eye Banking

Eye Banking scenario : INDIA
Only 14 Eye Banks collect > 1000 eyes/year

Top 10 Eye Banks: India (2011) # Utilization wise
Collection is not a Good Term
Unless we talk about
Utilizable Cornea
Utilization = 2.0 – 82.0%
Average = 46%
Ideal utilization = 65%

State No.
TN 8796
Gujarat 8213
Mah 6914
AP 6865
Karntk 3251
Haryana 3144
WB 2920
Del 2400
Kerala 1576
Rajas 1201
Others 4130
Total 49410
INDIA (2012-13)INDIA (11th five years Plan)

State No.
TN 8796
Gujarat 8213
Mah 6914
AP 6865
Karntk 3251
Haryana 3144
WB 2920
Del 2400
Kerala 1576
Rajas 1201
Others 4130
Total 49410
Problems
with
Data
Collection
NPCB (2012-13)
State No. (C) Difference
TN 7434 - 1362
Gujarat 6518 - 1695
Mah 4828 - 2086
AP 6518 - 347
Karntk 3625 + 376
Haryana 3552 + 408
WB 2726 - 200
Del 2926 + 526
Kerala 1415 - 161
Rajas 1405 + 204
Others 2666 - 1464
Total 44806
EBAI (2012-13)

EBAI Utilization Data (2012-13)
Statistics - 2012 - 13 Collection Utilisation
Name of the State Op.pk. Th. pk. Lk. DALK DSEK ALK Tectonic Graft Boston K. Pro Patch graft
Andhra Pradesh 6518 2452 1185 35 33 20 0 1 0 1
Karnataka 3625 514 432 89 9 2 1 16 1 7
Kerala 1415 618 100 1 13 12 0 5 0 0
Pondicherry 817 65 173 0 0 1 0 0 0 2
Tamilnadu 7434 1275 1303 247 149 69 0 14 8 0
Maharashtra 4828 788 584 16 6 37 0 0 2 0
Gujarat 5631 1291 1274 216 79 80 0 0 0 0
Goa 0 0 0 0 0 0 0 0 0
Punjab 845 226 271 1 0 2 0 0 0 0
Rajasthan 1405 557 121 0 0 0 0 0 0 0
Haryana 3552 511 484 123 0 0 0 0 0 0
Chandigarh 230 79 73 4 1 0 0 0 0 0
Delhi 2926 567 44 72 74 2 76 12 29
Himachal Pradesh 0 0 0 0 0 0 0 0 0 0
West Bangal 2726 438 491 46 24 229 0 23 17 0
Orissa 530 238 107 39 0 0 0 0 0 0
Assam 184 37 56 20 0 0 0 0 0 0
Mizoram 50 0 0 0 0 0 0 0 0 0
Bihar 0 0 0 0 0 0 0 0 0 0
Jharkhand 10 7 0 0 0 0 0 0 0 0
Madhya Pradesh 1474 514 497 2 17 0 0 41 0 0
Chhattisgarh 36 1 14 0 0 0 0 0 0 0
Uttar Pradesh 481 160 85 6 0 0 0 0 0 0
Uttaranchal 89 44 18 0 0 0 0 0 0 0
Total= 44806 9815 7835 889 403 526 3 176 40 39

 Total No. of EBTC/EB/EDC (Registered) = 749
Eye Banks collecting eyes:
 >1000 : 14
 500 to 1000 : 14
 100 to 500 : 49
 1 to 100 : 64
EBAI Present Scenario # Data # 2012-13
Total = 141
On an Average -
EBAI gets information from 150 Centres
Discrepancy in NPCB and EBAI data every year
No utilization data from NPCB

 No Government recognized training / certification center for eye
bank personnel
 No Government approved / accepted Accreditation system in place
 No Robust HCRP system in Govt sectors eye banks
This is important = As Eye Banks with HCRP program reporting
about 65 to 70% utilization against 45% national average
 Some Eye banks have surplus corneas
EBAI Present Scenario # Other areas

GOVT Eye Bank/EDC *Own Collection EDCs Utilisation
Govt. Regional Eye Hospital Warangal-AP 60 0 EDC
Govt. General Hospital Ananthapur-AP 7 0 EDC
D.B.C.S. Nalgonda-AP 4 0 EDC
District Hospital Jangaom-AP 40 0 EDC
Regional Eye Hospital Kurnool-AP 16 0 EDC
SVRRGG Govt. Hospital Tirupati-AP 8 0 EDC
RIO Kolkata-WB 0 1226 177
Govt. Medical College-Surat Eye Bank Surat-Gujarat 52 9 15
Surat Muncipal Inst. Of Medical Education Surat-Gujarat 128 31 24
Govt. Medical College Hospital Aurangabad 38 0 17
Armed Force Medical College Hospital (AFMC) Pune-MS 50 1 12
Govt. Medical College Calicut-Kerala 0 0 0
Medical College Kozhikode Kozhikode-Ke 82 0 40
Medical College Kottayam 0 0 0
Govt. Ophthalmic Hospital Thirvandram 0 0 0Year 2012-13 reports not received
Medical College Thrissur 0 0 0Year 2012-13 reports not received
JIPMER Pondicherry 0 0 0Year 2012-13 reports not received
RIO-Chennai, Dist. 324 A1 Lions EBTRF Chennai 1053 0 310
Govt. Rajaji Hospital (GRH) Eye Bank Madurai 0 0 0Sending to Aravind EH, Madurai
LLRM Medical Meerut Meerut-UP 65 42 82
IMA Eye Bank Varanasi-UP 100 0 0 to BHU, BHU EB not reoprting
PGIMER Chandigarh 0 0 0Year 2012-13 reports not received
Govt. Medical College Hospital, Sector-32 Chandigarh 54 76 77
Army Hospital (R & R) Eye Bank New Delhi 0 0 0Year 2012-13 reports not received
Safdarjung Hospital New Delhi 0 0 0Year 2012-13 reports not received
Guru Nanak Eye Hospital - Eye Bank New Delhi 505 42 279
National Eye Bank, Dr. RPC Opht. Sci, AIIMS New Delhi 920 142 830
Dept. of Ophth. PT. B.D. Sharma PGIMS Rohtak-Haryana 165 4 120
Indira Gandhi Mecial College Simla-HP 0 0 0Year 2012-13 reports not received
Eye Bank Rajindra Hospital Patiala-Punjab 66 12 37
Total= 4998 3413 1585 2020 40% Utilization

 Data collection – Online facility will be implemented soon
 Set up Government approved training / certification center in each
zone to begin with and then in each State gradually
 Launch the EBAI-NABH Eye Bank Accreditation program
 Updated Medical Standard of Eye banking: Meeting already held in
Delhi on 12th Sept. (IAPB-EBAI-NPCB along with expertise of
Sightlife, USA to match international standard)
EBAI: TASK Ahead

 Popularise Required Request law in each state gradually
 Increase eye collection by clubbing top performer in each region
with potential under performer in the same region
 Increase utilization rate by working closely with eye banks reporting
lower utilization (To find out and solve the issues)
 National Cornea Distribution System for sharing surplus corneas
(Pilot project is on # SightLife-partner Eye Banks in India with
individual surgeon) – It is the time to incorporate with EBAI.
EBAI: TASK Ahead

 Cornea Surgical Capacity Building
 Increasing Cornea surgeons pool to 1000 by 2020 AD
(At present fellow training capacity/year = Just 50+)
 Training of Junior consultants in Medical Colleges (400 Medical
Colleges in India – 2 from each College)
 National Registry and Networking between Eye Banks and
Corneal Surgeons
EBAI: TASK Ahead # Corneal Surgeons

 For surplus tissues – We need better media than MK medium
 We have:
 Optisol GS – 14 days – Cost @ Rs. 2000/vial
 Eusol C – 14 days – Cost @ Rs. 3000+/vial
 Life 4 C – 14 days – Cost @ Rs. 4500/vial
 Cornisol – 14 Days – Aurolab Product – Cost @ 975/vial
 Many Eye Banks are using Cornisol – with good reports
EBAI: TASK Ahead # Storage media
No Financial Interest on any product

 A BIG Question
 EBAI – has NO Income (Only Membership Fees + Interest)
 International Agencies/Eye Banks are helping us in various
capacities
 Friends of EBAI are there – they donate. Mostly unconditional.
- Some logistics issues are there.
 In AGM today – we will discuss those and resolve.
EBAI: TASK Ahead # Funding Issue

Thank You
One thing for Sure – We are Growing

Corneal Blindness - Eye Banking in India and Task Ahead

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