Corneal blindness in Asia

New Sri Lankan eye bank providing high-quality corneas

With the recent opening of the new National Eye Bank of Sri Lanka, that country will be well able to meet its own needs for cornea donors, and will be able to export them throughout Asia and beyond.

The new eye bank is situated at the Colombo Eye Hospital. It should be possible for the centre to ultimately process up to 2,000 corneas a year. This would allow the export of top-quality corneas, as good as any from the US or Europe, conforming to international medical standards, at an affordable cost, notes Donald Tan MD, director of both the Singapore National Eye Centre and Singapore Eye Bank. He is also the president of the Asia Cornea Society (ACS).

The opening is a culmination of an ambitious programme initiated by the ACS, through the Association of Eye Banks of Asia (AEBA) of which Dr Tan is also president. The goal of AEBA is to address the chronic shortage of quality donor corneas by creating standards for the collection, preparation, storage and delivery of donor corneas throughout Asia.

'We knew we needed to start a new eye bank. We focused on the one country where we thought this would be possible – Sri Lanka. From the 1960s into the 1980s that country had a very successful international eye bank that supplied corneas to many parts of Asia. However, that programme dwindled after the passing of its founder Dr Hudson Silva,' Dr Tan told EuroTimes.

Dr Tan and colleagues at AEBA approached Sri Lankan authorities, offering to work with them to revitalise the nation's eye bank. A local philanthropy organisation in Singapore provided start-up funds. Many of the Sri Lankan staff, which includes coordinators, managers and laboratory personnel, received training at the Singapore Eye Bank, which served as a model for the new project.

'The new national eye bank was set up within the Colombo Eye Hospital, which is itself next to a large general hospital. The general hospital has proved to be a good source of donors. In earlier times, donor eyes came from around the country, including rural areas. It was very difficult to maintain the standards required to collect and preserve the donor eyes. So, using the Singapore Eye Bank as an example, we initiated a hospital eye donation programme. We had the enthusiastic support of the hospital staff, and everything went very well,' Dr Tan recalled. The eye bank had the early support of the Sri Lankan president His Excellency Mahinda Rajapaksa, who led the opening ceremonies.

'He thought it was a fantastic idea, not only to provide corneas for Sri Lanka but for export as well, since the potential donor supply could easily outstrip their needs. He was keen to revitalise Sri Lanka's role in providing corneas for Asia, and beyond- to the Middle East, even to Europe. With government support we were able to get the eye bank up and running in a matter of months,' noted Dr Tan.

Sri Lanka is predominantly Buddhist, with most of its people practising a particularly ancient form of Theravada Buddhism that dates to the 2nd century. This particular form places a very high value on helping others, and has long supported organ donation, which accrues merit to the donor. More than 800,000 Sri Lankans carry donor cards, and over the years prime ministers and presidents of that country have donated their corneas.

'They have this great concept that values life and supports helping other people.

'So we knew the intrinsic concept was correct. What is a major battle in other areas – promoting eye donation – was not that much of an issue in this case,' said Dr Tan.

Corneal donation rates vary widely throughout Asia. Cultural taboos about organ donation greatly limit the supply in some countries. The AEBA has an outreach programme to improve education on the virtues of eye donation.

'We learned form our experience in Singapore, where we have a Taoist kind of Buddhism. People believe in the afterlife, and on certain occasions we burn paper money for our ancestors. People burn paper Mercedes, and some don't want to give their eyes thinking they can't drive the Mercedes, so a bit tongue-in-cheek, we promoted a campaign saying you can burn a paper chauffeur with the paper Mercedes,' he explained.

The Singapore programme also switched from whole eye donation to removing corneas in situ, retaining the globes, and using artificial eye caps. This enabled them to tell potential donors and family members that they were not removing the eyes, just the corneas, and replacing them with artificial corneas. Another approach was to ask to remove just one eye, which would still allow the departed one to see in the afterlife.

Dr Tan and colleagues also approached all the religious leaders in Singapore for their help. Singapore is a microcosm of Asia, with all the races and all the religions represented. Buddhist, Hindu, Muslim and Christian religious leaders all provided active support, including pledging to donate their own eyes.

'That had a profound effect. It clarified to the public that your religion is not contrary to eye donation. Today because of all these initiatives the Singapore Eye Bank is able to cover 93 per cent of local needs,' he noted.

Following the early success of the Singapore and Sri Lankan cornea donor programmes, the AEBA hopes to create an Asian standard for cornea donation. The ultimate objective is to create a network of self sufficient eye banks that are able to procure local donors, match demand in the country, and be able to export excess tissue to other countries, all with highest quality clinical standards.