Photo : Purabi Deshpande / Research Matters
From lush green forests to snow filled mountains, the colorful rainbow, the flowing stream, the brilliant feather of the birds -- all these are simple joys of life. And how do we ‘see’ them? The credit for this perception of sight goes to the most beautiful and important sensory organ -- the eyes that introduce us to light.
But not everyone on Earth is fortunate enough to view the feast of nature’s creation. As per a 2015 report by the Lancet Global Health Journal, there were about 36 million people across the globe who were blind and another 217 million had moderate to severe vision problems. Alarmingly, the number of blind people worldwide is estimated to increase to 38.5 million by 2020, and 115 million by 2050. In India, out of the 1.26 billion people, about 1.2 million (1 in every thousand) have a condition called ‘corneal blindness’.
Blindness, as we know it, is a medical condition where a person is deprived of his/her sight because of numerous reasons including cataract, glaucoma, refractive error, surgical complication and corneal blindness where the cornea, a glass-like covering on our eyes, is affected. Corneal diseases like trachoma (a bacterial infection of the eye), deficiency of vitamin A, ophthalmia neonatorum (conjunctivitis in the newborn baby), use of harmful traditional medicines, onchocerciasis (infection of a parasitic worm), leprosy and ocular trauma, is the leading cause of blindness after cataract and glaucoma.
Losing sight affects a person’s life in many ways -- negatively impacting his/her families, affecting his/her livelihood, depriving him/her of opportunities in education and socio-economic developments. In countries where the infrastructure is not friendly for those without sight, the affected person ends being being a dependent and living an undignified life.
The power of the gift of sight
Is there a way to bring light into these people’s lives? The answer is yes, at least to a fraction of them. A good proportion of blindness can be cured, provided the fortunate ones with a good vision are kind enough to donate their eyes (cornea) to be used after their death. Although all types of blindness are not curable, the corneal blindness can be cured by replacing the cornea of a blind person with a functional cornea collected from a deceased person with healthy vision.
Stressing on prevalence and solution to corneal blindness, Dr. Jai Kelkar, a renowned eye specialist from the National Institute of Ophthalmology, Pune says, “India has the world’s largest corneal blind population, so corneal donation is one of the major requirements in India. Donating your eyes after your death and giving the gift of sight to the needy is one of the most wonderful things one can do”.
The good news is that more than 90% of corneal transplantation cases are successful and thus, can help to eliminate blindness to a great extent. As per a report by the Eye Bank Association of India (EBAI), 11 lakh corneally blind people need corneal replacement and 20,000 new cases get added to this every year. Eye donation is the only way to address corneal blindness.
While the demand for a cadaver cornea is high, we are yet to address the needs of those waiting for corneal transplantation. The National Programme for Control of Blindness (NPCB) survey of June 2017 states that 10,574 corneas were collected nationwide against the target of 50,000 in 2017. Among those who decide to donate, not all corneas collected are useful for transplantation. “About 60,000 corneas are collected by the 450+ eye banks across the country. Quality, and acceptability wise, only 50% of these can be used for transplantation”, says Prof. D Balasubramanian, Distinguished Scientist & Director of Research Emeritus at L V Prasad Eye Institute (LVPEI).
Corneal blindness is commonly found among children and young adults, and a replacement can change their entire life. A pair of eyes can bring light to two corneal blind people. Multiple eye banks across the country are engaged in the process of collecting the eyes from a donor, which takes only 10-15 minutes and leaves no scar on the face of the donor. And it costs nothing for such a noble cause. After collection, the eyes are examined by experts and generally used for transplantation within 96 hours. “Any cornea can be transplanted to any eye. There is no immunological rejection of the type that recipient blood, liver, kidney, etc. suffer if blood group is not matched with that of the donor”, points out Prof. Balasubramanian.
Awareness of eye donation in India
The first eye bank in India was initiated at the Regional Institute of Ophthalmology at Chennai way back in 1945. Unfortunately, even after seven decades, we are far behind in eye donation. To address the concerns of those with endless wait for a healthy cornea, there is a growing public awareness campaigns to motivate everyone to donate eyes, irrespective of their cast, sex and religion. The National Eye Donation Fortnight, a campaign aimed at creating this mass public awareness about the importance of eye donation, is observed every year from 25th August to 8th September.
But why are we lagging behind? Various factors like inadequate facilities in hospitals, lack of motivation among public and different social and religious thoughts are responsible for the reluctance of people to donate their eyes. Dr. Kelkar thinks that continuous awareness programs, adequate scientific knowledge about eye donation and encouragement are required to establish the dream of ‘no blindness because of corneal diseases’. “Ophthalmologists, general physicians, non-governmental organizations (NGOs), medical students and especially the religious leaders and community leaders play an important role in motivating community people for eye donation”, she adds.
On a lighter note, perhaps the term ‘eye donation’ is to be blamed too! “We need only the cornea and thus we must say ‘cornea donation’, and not eye donation”, quips Prof. Balasubramanian, who reasons it further - “Just making this point alone has led to a far greater number of donations across India”, he adds. “Campaigns by the government and involvement of celebrities like Amitabh Bachchan, Aishwarya Rai and Rajinikanth in eye donation campaigns are creating positive response among common people. Sharing of experiences of those who had successful corneal transplants, movies, short TV serials and campaigns in local languages might lead to more positive responses”, hopes Prof. Balasubramanian.
Inspired? Here is how to do it
Practically anybody above the age of one can donate eyes. Donors could also include those with a poor eyesight, diabetes and hypertension, except in cases of deaths due to unknown causes or due to infectious diseases like rabies, hepatitis, syphilis , septicemia and AIDS, where donation is not possible due to safety reasons.
So, if you haven’t already pledged your eyes, you can fill the pledge form available online (http://ebai.org/donator-registration/) and send it to the nearest eye bank. In addition, relatives of a deceased person can also decide to donate the eyes of the deceased. Eye banks around the country can help you with donations and related purposes when contacted on the toll free number 1919.
But when should you call an eye bank in case of a death? “Corneas can be enucleated from a deceased person within time duration of six hours from the actual time of occurrence of death. For successful corneal transplantation retrieval of cornea at correct time after death is necessary. For the transplantation to these retrieved corneas, some blood tests of the donor are also required for which blood sample from the deceased body is collected. Also, a Death Certificate (Form-4) issued by the doctor attending the deceased needs to be submitted”, informs Dr. Kelkar, about the procedure.
On this National Eye Donation Fortnight, here is your opportunity to brighten two lives after you are long gone. For further information and reading, do visit http://ebai.org and http://npcb.nic.in.