In a special national societies’ session on the last day of the 80th Annual Conference of the All India Ophthalmological Society (AIOS) in Mumbai, Maharashtra (a.k.a. DREAMCON AIOC 2022), key members of the Eye Banking Association of India (EBAI) convened to discuss the eye banking situation in the country. This included how it was affected by the challenges brought about by the pandemic and what it has in store for the future in combating blindness — not just in India, but also in other parts of the world.
India’s Post-pandemic Eye Banking Status
Dr. Sunita Chaurasia of LV Prasad Eye Institute in Hyderabad, opened the session with a presentation on sustainable eye banking amidst post-COVID challenges. “The trajectory of eye banking in India was evolving quite favorably to reach a status of self sufficiency, but then came 2020,” reported Dr. Chaurasia. Like all other industries in the world, the pandemic brought an effect (and challenges!) that no one was prepared for, and eye banking was no exception.
“The COVID-19 pandemic impacted the eye banking daily operations, distracted our goals and strategies towards eliminating corneal blindness, but nevertheless, there were insights and several lessons learned in the process,” she explained.
Also, Dr. Chaurasia emphasized that before the pandemic, India (after the U.S. and Brazil), is the third country in the world that performs the most eye transplants. COVID-19 brought about contraindications to the collection and utilization of corneas for eye transplant. Within India itself, differing mandates across states and on the national level hindered the operation of eye banks. The most impact is the surgical backlog all these have caused. “The pandemic brought the eye banking status of India to 20 years backwards. The goals and targets we had now have to be re-visited and re-framed. But it made us realize our strengths and vulnerabilities, and the resilience to deal with the trying times,” said Dr. Chaurasia.
On Training, Policy Planning and Advocacy
Dr. Manisha Acharya, head of corneal services and eye bank director at Dr. Shroff’s Eye Charity Hospital (SECH) talked about the importance of India’s eye banking community being at pace with the advancing technology. Established in 1914, SECH is one of the oldest and largest eye care institutions in the country, and has conducted millions and millions of vision restoring procedures. “But it is not about the numbers anymore,” noted Dr. Acharya. “We have to continue training. Training at the technician level, for example on tissue harvesting and preparation, and in standardizing the SOPs, among others. Even the trainers need training,“ she explained.
According to Dr. Acharya, it is time to be part of the eye banking revolution in India. While the COVID-19 pandemic has brought unprecedented challenges, it made the eye banking community in India realize the need to step up all its pillars to modern heights. To illustrate the gap, only 15% of the eye banks in India are contributing to 80% of the total transplants being done in the country, said Dr. Acharya. “Standardization of all Indian eye banks through training and implementation of quality protocols can improve these statistics. Through proper orientation and training, the processes can be modified,” she added.
In the goal of eliminating corneal blindness by 2030 (and in all other similar programs before that), India has always been at the forefront, highlighted Dr. Namrata Sharma, AIOS secretary-general and professor of ophthalmology for the Dr. Rajendra Prasad Centre for Ophthalmic Sciences (RPC) at the All India Institute of Medical Sciences (AIIMS) in New Delhi. But there are other internal problems needing to be addressed. Like in other developing countries, eye care services in India are poorly integrated into the health systems. “The availability, accessibility, and acceptability of eye care services have an influence on eye conditions and vision impairment. In many countries, eye care needs are greater in rural areas, but services are often provided in hospitals in urban areas. And this situation is even much worse in terms of corneal blindness,” highlighted Dr. Sharma.
In her report, Dr. Sharma itemized the areas in eye banking where India is facing the most challenges: availability of donor tissue, storage and preservation of tissue, utilization of donated tissue, infective complications, graft failure, shortage of skilled corneal surgeons, pushing the frontiers in eye banking research, and operation on research in eye banking.
“We have to explore the use of synthetic constructs and other available modalities as alternatives to corneal transplantation. And what we are lacking is a corneal transplant registry just like in other countries. As much as we would want to, this has not materialized yet,” noted Dr. Sharma.
Urgent Internal Issues to Address
But before getting to that level, there are urgent issues needing to be addressed. For example, the eye banking community in India is currently experiencing a shortage of available medium for tissue preservation. The session panel had a heavy discussion regarding this matter. Is this a raw material issue? Can eye banks prepare or manufacture their own media? Apparently, the rules, especially in transporting corneal tissue, vary across states in India. Suffice to say that a lot of things need to change for the better operation of eye banks. The list goes on … and then the more critical issue is the need to advocate for policy changes that would favor corneal transplantation and research in the country.
“The potential for cornea donation and transplantation [in India] has yet to be optimized. To resolve the problems, countries need to fast track policy changes. A well designed regional governance framework needs to be put in place to coordinate individual national efforts in matching supply with demand,” emphasized Dr. Sharma.
Editor’s Note: The DREAMCON AIOC 2022 was held as a physical show on 2-5 June at the JIO World Centre in Mumbai, India. Reporting for this story took place during the conference. Media MICE is the Official Media Partner of AIOC 2022.