Wednesday, January 30, 2002

The gift of sight

By JANE BOLLER
Special to The Citizen

Someone has given me the best present in the whole world, but I don't even know who the giver was. What I do know is that he or she was a very thoughtful, generous and compassionate human being because I received the gift of sight through cornea donation.

This is a good time to have a corneal transplant. Twenty-five years ago, corneal transplants were largely unsuccessful and 25 years from now, there may be a shortage of corneas for transplant, due to the tremendous popularity of LASIK eye surgery. More than 1.25 million people in the United States had LASIK surgery in 2001 and estimates are even higher for the future. That could result in millions of corneas being lost for transplantation, though they could still be used for research and teaching.

"We won't know the impact of LASIK surgery on cornea transplants for 15 to 20 years," according to Dr. Edward Holland, director of Cornea Services at the Cincinnati Eye Institute and medical director at the Northern Kentucky Eye Laser Center.

The Eye Bank Association of America in Washington, D.C. (EBAA), a nonprofit organization with 108 member eye banks, ensures tissue safety by means of strict requirements for its members. Currently, LASIK surgery is in the EBAA medical standards as a contraindication (a condition that makes a particular procedure inadvisable) for corneal transplants. What can be done about this possible crisis?

First and foremost, we all need to consider being organ and tissue donors right now. Note your wish on your driver's license, fill out donor cards at your local eye bank, put it in your will, but most importantly, tell your next of kin.

"It is extremely important that the family knows about the donor's wishes," says Rusty Kelly, EBAA chief operating officer and managing director. When the family clearly understands the donor's consent to tissue and organ donation, they can help ensure those wishes are carried out.

Dr. Holland says there is a major cornea shortage internationally today, excluding the United States and Western Europe. Unfortunately there are countries where no cornea transplants are performed at all and others where only the wealthiest of patients receive them.

"Cornea disease is the leading cause of blindness in one of eight people throughout the world," adds Dr. Holland, a noted cornea expert.

The cornea is the clear tissue in front of the pupil and the iris, acting like a windowpane. It is the main focusing element of the eye and if it becomes cloudy from disease (as mine did), infection or injury, vision will be dramatically reduced.

Well over 90 percent of corneal transplant operations are successful today, but it hasn't always been so. The first transplant was performed in 1905 and the operations were largely unsuccessful until the late 1970s. Advances in modern medicine, such as improved surgical techniques, operating with microscopes, improved sutures and advances in eye banking, have sparked a turn around in the success rate of corneal transplants.

The first eye bank to procure and distribute eye tissue for transplantation, education and research was established in the 1950s in New York City and by the 1970s, a network of such banks had spread across the country. The EBAA was established in 1961.

More than 50,000 corneas were distributed by 88 eye banks in the United States and Canada in 2000, according to EBAA statistics. Most were used for the 45,000 corneal transplants in this country, but some were distributed internationally.

The increased efficiency in eye banking is especially evident in storage capabilities. A cornea now can be stored for two weeks, although corneas are usually distributed in far less time, according to Carol Engel, executive director of the Minnesota Lions Eye Bank in Minneapolis.

"The practice across the country is to distribute the tissue within three to five days from the time of recovery," explains Kelly.

Recovery occurs within six hours of death, after which the cornea is taken to an eye bank within a certain time period. Criteria for potential tissue donors vary from eye bank to eye bank after meeting EBAA standards, depending upon the needs of the community.

EBAA 2000 figures show that 89 percent of all donors were Caucasian, 85 percent of the donors were 41 years or older, and men outnumbered women as donors almost two to one. The most common causes of donor deaths were heart disease (39 percent) and cancer (17 percent).

The cornea has no blood vessels so tissue typing is not necessary for a corneal transplant, as with organ transplants. Gender, race and eye color do not enter into corneal transplant criteria either. That makes me even more curious about my new cornea and what sort of a life it had before it became my window on the world.

Since the gift of sight is made anonymously, recipients should express gratitude to all tissue donors in the past. As for the future, please act now. Become a donor, tell your family and spread the word.

(For more information, contact Jane Boller at (952) 933-5199 or mjboll@att.net.)