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COVID-19 pandemic aggravates shortage of eyes for corneal transplants

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Dr Jagruti Jadeja: A one-eyed tailor lost his functional vision in his only eye post a cataract surgery. It was because his cornea was too weak to withstand it. He became jobless and the responsibility to run the family fell on the shoulders of his teenage daughters. The incident left all of them hopeless, but a corneal transplant surgery worked wonders. He has not just got his vision back, but also the hope to live a decent life.

Like the tailor, there are thousands of similarly placed people who need corneal transplant surgery. So what is the problem in getting a corneal transplant done? For a corneal transplant surgery, one needs to have the right tissues (cornea) that meet all the safety parameters. And, interestingly, the majority of these tissues are made available for transplant because some kind-hearted family decides to donate the eyes of their near and dear ones post their death.

The eye banking system and the corneal surgeons with their teams play a crucial role in promoting eye donations across the globe. These surgeons and their teams can describe an infinite number of gratifying experience—the overwhelming emotions they experience every time they give meaning to ‘Tamso Ma Jyotirgamaya’ in the true sense.

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However, the COVID-19 pandemic has considerably affected eye donations and the relaxation of the lockdown guidelines has made the situation worse by predisposing to adding new cases. The spreading of the virus leading to ever-changing containment zones, survival of the virus in the human system without symptoms, and the complex procedure of taking post mortem sample for COVID-19 testing have become the impediments that considerably hurt the activities related to eye donation.

Voluntary eye donations from non-hospital deaths pose a great danger of passing on the hidden deadly virus to the transplant recipients and the eye bank teams going for eye collections. Hence, such donations have been put on hold as per the revised Guidelines. However unwelcome it might seem for the cause of combating corneal blindness, ‘do no harm’ had to take priority because several lives could be at stake with each eye collection call.

Eyes could only be received with utmost precautions and use of PPEs from the non-COVID hospitals through the Hospital Cornea Retrieval Programme. But, these could only be minuscule in numbers compared to the ones received during the pre-COVID times, and far from enough even for eye saving transplant surgeries.

Corneal blindness, resulting from various causes such as infections, injuries and malnutrition in addition to other causes, has become the second-most common cause of blindness. It especially affects the younger and active population and thereby leads to the loss of many years of productive life. India, with the collective efforts of the government and non-government systems, had notably achieved an annual collection of 60,000 to 65,000 eyes, and yet, it still had a long way to go even during the pre-COVID times.

In the recently concluded National Survey of Blindness (2015-19), the prevalence of corneal blindness has risen to 7.5% of the total cases of blindness. And more cases get added to this every year, raising the annual requirement of donor eyes to about 2 lakh corneas per year.

Logically enough, several eye donation awareness campaigns are conducted nationally every year. More focused activities are carried out during the National Eye Donation Fortnight that is observed from August 25 to September 8, with September 8 being the Eye Donation Day.

This year, COVID has made it mandatory to go for virtual ways of spreading the motivational message. As only thoroughly screened tissues made available from non-COVID hospitals through Hospital Cornea Retrieval Programme is safe enough for handling, processing and transplanting, it becomes important to have updated and aware health care personnel. These include medical officers, nurses, paramedics, administrators, grief counsellors, who are constantly vigilant for making eye donations happen.

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In view of the backlog of existing corneal blinds and the annual addition of new cases, there is no way it can be achieved without the entire society, each and everyone contributing towards the noble cause of eliminating corneal blindness. The best quality donor eyes are available from deaths occurring in relatively young people post road traffic accidents and cardiac events. Though the grief of losing a dear one can never be eliminated completely, there is no healing that can be better than our being for others, despite one’s loss.

As a mass movement, if the near and dear ones can reach out to the hospital personnel and offer to donate the eyes of the deceased proactively, there can be no setback in the drive towards eliminating corneal blindness effectively, despite COVID times. And while we hope there will be a sunrise when we see this happen, it might not, if we keep adding more new cases exponentially.

If there is one very good thing this pandemic has led everyone into, it is the more conscious approach regarding cleanliness, contaminations, hygiene maintenance, and building up immunity to stay fit. So, while you keep striving to stay safe from ‘corona’, please do pledge to prevent yourself from getting corneal blindness by avoiding preventable causes such as infections and injuries that could leave permanent damages. Hand in hand, eat healthily and wisely to prevent nutritional inflictions.

(The writer is an associate professor at M & J Institute of Ophthalmology, Ahmedabad. She is also the head of the Cornea and External Diseases Unit and in-charge of DE Ankleswaria Eye Bank)

 

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