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

(Developed Countries)

Infectious Keratitis

PBK

Scarring

Regraft

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

2012 Japan*(KPUM)

2012 Japan *(JCC, Tokyo)

2012 Korea(KONOS)

2012Singapore

2012 Taiwan*(NTUH)

2012 HongKong

56.85%

37.63%

20.11%

29.04%

37.61%

21.57%

18.49%

0.54%

16.93%

6.03%

25.64%

18.04%

17.20% 21.69%

10.41%

23.08%

13.33%

19.89% 11.64%

6.85% 1.96%

9.59% 6.45%

4.76%

10.10%

2.56%

3.92%

PBK/APK Corneal Scar Regraft Infectious Keratitis Keratoconus

* 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

Country Readiness

High

Medium-High

Medium-Low

Low

98% of the 10 million people with corneal

blindness live in developing countries

(Courtesy of SightLife)

Capacity versus Need….(the irony)

(Courtesy of SightLife)

Partners So, can we make a difference?

A Collaboration has been discussed for several years – formally and informally

– by numerous people around the world, with several key meetings:

• 2009 - SightLife Meeting, Seattle, USA

• 2011 - EBAA Meeting, Tuscon, USA – held first meetings to expand the idea

• 2012 - plan was formulated - spearhead by Graeme Pollock - to develop

collaborative

- Led to the development of an MoU – 6 Partner Associations signed

• 2013 - WEBS, Brazil

The Evolution of the Alliance

This emerged at a time when organs, tissues and the WHO were addressing

global issues, such as:

• 2008 - The Transplant Society and Society of Nephrology collaborated and

developed the Declaration of Istanbul on Organ Trafficking and Transplant

Tourism

• 2010 - Project Notify was initiated by WHO & CNT

- Led to the 2011 Experts Meeting in Bologna, Italy that included eye tissue

• 2010 – Eye Tissue Tracking systems discussions commenced with ICCBBA.

- All 6 Partner Associations represented

- Led to 2011 ocular tissue nomenclature development

• Ongoing - WHO advised collaboration

The Evolution of the Alliance

Eye Tissue, like organs and other tissue, did not know - globally:

• Who we were

• Where we were located

• What we provided

• How many donors we had

• How many transplants we did

• What our waiting list was

• Where our issues were

• Where tissue is transported (moved) – globally

• Where we can improve practice

The Evolution of the Alliance

Supported by the WHO:

• A collaborative was agreed on and an MoU was signed by 6 Partner Associations as

the primary mechanism for bringing together formal collaboration

• We agreed on:

• a flat committee structure with a project lead to work with each region as needed

and to spearhead and develop global initiatives

• sharing and notifying each other of globally significant issues – such as our

response to Ebola to disseminate messages and rapid-responses

• The need to remain as regions and nations but also service global agendas as

required

• Developing a global map of eye banks

• Developing the first global statistical data base for eye tissue

… and many more which will be discussed today

The Evolution of the Alliance GAEBA was formally launched, and incorporated, in

February 2014

In today’s meeting you will hear:

• What is happening within each region represented by your Associations

• What our peers in the organ sector have already achieved – that we can learn

• What the WHO are encouraging us to lead on

• What the Global Alliance will be doing to address issues facing each region

• What we can share and support each other with

• What you can do to be part of this, and

• What we can achieve as a collaborative sector, and

• How we can shape the future

The Future The Evolution of the Alliance

On behalf of the Representative Committee I would like to thank the following for their

assistance today:

• EBAA and San Diego Eye Bank for helping to host our first official meeting

• Our sponsors: Bioniko, Med-logics, ICCBBA and Transplant Connect

• Those who provided scholarships to delegates

• Our speakers for their willingness to present and discuss these issues in this forum

• Your willingness and interest in supporting eye banking, donors and recipients

We also welcome our guests – both here and via teleconference – from the organ and

bioethics community and the WHO for sharing their experiences with us.

Thank You….

www.gaeba.org