Prof (Dr) Karuna Hazarika
(Principal-cum-Chief Superintendent, Tezpur Medical College. Can be contacted at drkaruna97@gmail.com)
Every year, National Eye Donation Fortnight is observed in India from 25th August to 8th September. It is a campaign to create public awareness about the importance of eye donation and to motivate people to help people who are deprived of eyesight due to a curable cause. We can't imagine the pain of the people who are at a loss due to the blindness resulting from corneal opacity. The cornea is transparent tissue in front of the eye which transmits reflected rays from the object to the retina for visualization. While the damage to this transparent tissue called cornea makes it opaque due to some factors/infections and results in loss of vision to the person. This is truly a curable cause of blindness with the help of corneal replacement surgery.
Blindness is one of the major public health problems in India like in other developing countries. According to World Health Organization, corneal diseases are among the major causes of vision loss and blindness after cataracts and glaucoma. Estimated, approximately 5% of the world's population is blind due to corneal diseases alone. In India, approximately 68 lakh people suffer from corneal blindness in at least one eye; of these, 10 lakh people are blind in both their eyes. The National Blindness and Visual Impairment Survey, 2019 reported that corneal blindness was the leading cause (37.5%) of blindness among patients aged less than 50 years, and was the second leading cause above 50 years. In 1976, India launched the National Program for Control of Blindness with the goal to reduce blindness. India was the first country to introduce a such type of program in the world.
It is estimated and reported by WHO that globally, at least 2.2 billion people have a near or distant vision impairment. Out of this at least 1 billion–or almost half of the cases, vision impairment could have been prevented or not yet addressed properly. These 1 billion visually impaired people include those with moderate or severe distance vision impairment or blindness due to untreated cataracts (94 million), refractive error (88.4 million), glaucoma (7.7 million), corneal opacities (4.2 million), diabetic retinopathy (3.9 million), and trachoma (2 million), and near vision impairment caused by uncorrected presbyopia (826 million). So, in 73rd World Health Assembly in 2020, on the recommendation of the WHO world report on vision (2019) adopted to make integrated people-centred eye care (IPEC) model to ensure its widespread implementation of the global agenda by the member states and their partners to reduce the burden of eye conditions and vision impairments.
In the Indian context blindness from corneal disease is a major public health problem and there are estimated to be 1.2 million corneal blind persons in India. The survey in 2019, conducted by NPCB&VI pointed out that blindness (8.2%) is due to corneal opacity. As per NPCB&VI estimates, about 30,000 new cases of corneal blindness occur in India annually. The diseases include mostly due to infection during childhood and adulthood (keratitis), trauma, and other causes like Keratoconus (cornea becomes cone-shaped), Pseudophakic Bullous Keratopathy, Fuch's dystrophy, corneal degeneration and trachoma. The type of the disease may involve one eye or both eyes leaving the opaque cornea into impairment of vision depending on visual equity. Corneal transplantation is the only option for those with corneal diseases. The Covid-19 pandemic has led to a reduction in eye donation to a great extent. But the data from NPCB shows about 45,294 donated eyes were collected in 2021-22 two times more than what was collected in 2020-21. The total eye collected against the target of 55,000 in 2020-21 is 17,402 and a total of 11,895 keratoplasties were performed. In 2021-22 target was 60,000 and so far 45,294 donated eyes were collected and 24,783 keratoplasties were performed. In 2019-20, there were 65,417 donated eyes collected and 31,019 keratoplasty procedures were performed.
In this 37th eye donation fortnight the campaign for donation is made through a short film and the message is conveyed as 'Eye donation is a noble act, make it a family tradition. The short film was released on Thursday (25/8/2022) to the general public across government facilities during the eye donation fortnight. By donating the eyes, one can enlighten the lives of at least two blind people, thus making it one of the noblest acts in life. Every year, approximately 6.8 million people with corneal blindness in India are missing out on the opportunity to regain their vision. The gap between the need and availability of donated eyes is huge that is mainly due to a lack of awareness and circulated myths associated with eye donation. This lack of awareness prevents people from donating their eyes. The fact is that any person can pledge their eye which can be donated after their death irrespective of gender, age, religion or blood group. Apart from those suffering from infections or a few high-risk communicable diseases, most people can be potential cornea donors. Even a person with a spectacle and cataract can donate an eye. The cornea or the whole eyeball is collected within 6-8 hours of death and the total time taken for the procedure is 15-20 minutes and there is no disfigurement of the face and donor. The eye bank team will rush to the spot and can collect even if the deceased had not pledged their eye during their lifetime. As care the fan is to be switched off, AC or cooler should be switched on, the head of the deceased has to be raised with a pillow and the eyes need to be covered with a wet cotton swab on closed eyes. The Eye-Bank fortunately can store cornea tissue for up to 14 days, and before it must be used for transplant. When performed by a skilled and experienced ophthalmologist, a corneal transplant can last 10 years or more without complications. The reported success rate of corneal transplants is very high, nearly 95%. An amazing statistical fact is that human corneal tissue is one of the few tissues that can be transplanted with very little risk of rejection.
In India, the very first eye bank and the first corneal transplantation were contemplated successfully by the Late Dr RES Muthiah in 1948. A movement started for a donation of eyes from this point by the Eye Bank Association of India (EBAI) to motivate the people for eye donation. Motivational propaganda throughout the country is going on for eye donation. It is observed that the barriers to eye donation are not cultural or religious but more due to misinformation and proper utilization of the donated tissue. Still, there is a need to correct these misconceptions, through suitable nationwide strategies when devising information, education and communication tools to boost the eye banking movement in India. The community should come forward shedding all inhibitions and help someone who is deprived of vision due to a correctable cause.