Corneal Transplantation and Eye Banking: (The Good, the Bad, and the Worst…) Keynote Address, GAEBA Scientific Meeting, San Diego, 14 April 2015 Donald Tan MBBS FRCSE FRCSG FRCOphth FAMS Arthur Lim Professor in Ophthalmology Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School Dept of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore Senior Advisor, Singapore National Eye Centre President, Asia Cornea Society President, Association of Eye Banks of Asia Past President, Cornea Society Chairman, Asia Cornea Foundation Chia-Li Pang BSC MA Senior Manager, Singapore Eye Bank Executive Director, Asia Cornea Society Treasurer, Asia Cornea Foundation Developing Global Conversations in Eye Banking Part 2 (and… Heather Machin)
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Developing Global Conversations in Eye Banking Part 2 ... · World Blindness: WHO 2010 Report • Cornea opacities are the 4th major cause of global blindness • Corneal disease
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Corneal Transplantation
and Eye Banking:
(The Good, the Bad, and the Worst…)
Keynote Address, GAEBA Scientific Meeting, San Diego, 14 April 2015
Donald Tan MBBS FRCSE FRCSG FRCOphth FAMS
Arthur Lim Professor in Ophthalmology
Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School
Dept of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
Senior Advisor, Singapore National Eye Centre
President, Asia Cornea Society
President, Association of Eye Banks of Asia
Past President, Cornea Society
Chairman, Asia Cornea Foundation
Chia-Li Pang BSC MA
Senior Manager, Singapore Eye Bank
Executive Director, Asia Cornea Society
Treasurer, Asia Cornea Foundation
Developing Global Conversations in Eye Banking
Part 2
(and… Heather Machin)
..she needs a
cornea, ocular
surface, and
eyelids..!!
Corneal opacification
without ocular surface
destruction
Corneal
Transplantation
End-stage OSD - severe
destruction, dry eye
Moderate ocular surface
disease - wet eye
Ocular Surface Tpltn
or Boston Kpro
Corneal Damage: 3 major groups
40% 60%
Osteo-Odonto
Keratoprosthesis (OOKP)
Mostly in Developing
Countries with poor
access to primary eye care
The “Bad”…
Transplant Indications in Developed or
Western Countries:
(good prognoses, early presentation) Keratoconus
Fuchs’ Dystrophy
PBK
Regraft
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
2011 USA(EBAA)
2011 UK 2011 Italy(S.I.TRA.C)
2011 Russia * 2011 Australia 2011 France*
13.19% 19.90%
45%
53.21%
29.79%
18.97%
18.02%
15.18%
24%
22.51%
31.14%
18.62%
20.41%
25.33%
9%
5.73%
15.00%
15.07%
10.28%
16.52%
11% 10.37% 36.57%
13.97%
1.39%
7.40%
7.78%
Keratoconus PBK/APK Fuch's Dystrophy Regraft Keratitis* Single Institution
Transplant Indications in Asia (Developing Nations)
(worse prognoses, late presentations)
Infectious Keratitis
PBK
Scarring
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
2012 China*(Shandong)
2012 China*(TongRen)
India (EBAI) Philippines*(St Lucia)
2012Thailand
2012 SriLanka
54.20%
28.50%
39.00%
20.50% 25.38% 25.00%
20.20%
10.46%
15.00%
38.30%
15.84% 14.00%
3.60%
27.60%
9.00%
10.54%
25.38%
12.43%
11.00%
9.00% 12.40%
10.45%
12.30%
17.50% 4.00%
3.30% 2.86%
19.92%
Infectious Keratitis PBK/APK Regraft Keratoconus
* Single Institution
Scar
World Blindness: WHO 2010 Report
• Cornea opacities are the 4th major cause of global blindness
• Corneal disease is the major cause of childhood blindness in Asia/Africa (30%)
• when combined with other causes of corneal scarring, such as trachoma and the corneal indications for childhood blindness, corneal blindness is the second commonest cause of global blindness after cataract
• 10 million globally blind from corneal diseases
Bulletin of the World
Health Organization,
2001,79:214-221.
The
“Worst”…
• Identification of “Priority Eye Diseases”
• “corneal blindness…the only currently
available curative treatment is the surgery,
by graft of cornea. But the access is very
difficult, even in developed countries, for
lack of donors”
• “Vision 20/20 role: Corneal opacity is not,
as such, one of the VISION 20/20 priorities”
VISION 2020: Global initiative for the
elimination of avoidable blindness
Focused on Prevention Strategies
For the 10 million corneal blind….
High Low
Prevalence
Corneal Blindness
Distribution of Eye Banks
High Low
Eye Banks Distribution
India
100,000 corneal blind/yr
15,000 transplants/yr
300 corneal surgeons
Where the World’s Corneal Blind Live
The size of each country reflects the population of corneal blind. Colors
represent readiness for eye banking and corneal transplantation