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Strong network serves US patients who require corneal transplants
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The most common live tissue transplant performed in America is some form of a corneal transplant. We who perform these transplants and those patients who receive them are blessed to have an outstanding organization, the Eye Bank Association of America, or EBAA, representing our interests.
As a disclosure, I am an active corneal transplant surgeon, have served three terms on the board of directors of the EBAA over the past 30 years, currently serve as the associate director of the Minnesota Lions Eye Bank, have been involved in corneal preservation research since 1972, and am a co-inventor of Optisol GS, the most commonly utilized corneal preservation solution in America.
There are 83 U.S. member eye banks in the EBAA. These eye banks create a nationwide network that shares tissue effectively, which allows keratoplasty, whether lamellar or penetrating, to be scheduled as an elective procedure.
In my residency and fellowship, corneal transplant recipients were put on a waiting list, and as tissue became available, they were called in on an emergency basis with surgery often being performed at night and on weekends. Today, corneal transplant recipients are scheduled much the same as an elective cataract surgery, and perhaps once a year I am forced to cancel and reschedule a patient because appropriate tissue is not available.
According to EBAA statistics, domestic eye banks recovered 114,348 corneas in 2011. There were 46,196 corneal transplants in 2011, up from 33,035 in 2001. In 1991, 35,831 transplants were performed, and keratoplasty volume was steady from 1991 until 2007, when endothelial keratoplasty procedures became popular. The popularity of endothelial keratoplasty has driven a 6% to 8% growth in total volume for the past 5 years. In 2011, endothelial keratoplasty was the single most common corneal transplant performed and accounted for 47% of grafts. U.S. eye banks also export significant tissue — 16,629 corneas in 2011 — to surgeons abroad, where there is a severe shortage. It is critical that only high-quality, safe tissue be released for transplantation, and the standards of the EBAA member eye banks are established by a medical standards committee and third-party regulators, including the U.S. Food and Drug Administration.
It is expensive to harvest, process, screen, preserve and transport high-quality corneal tissue. If one compares the cost vs. the benefit, our eye banking costs are minimal, especially when compared with the cost of providing a transplantable kidney, pancreas or heart. A corneal transplant commonly takes a patient from legally blind to fully functional with the ability to work, read and drive. Most of us who are active in this field of surgery are amazed that reimbursement has fallen to a level that makes it a very unattractive offering for many surgeons and facilities. There is definitely a disconnect between the total work required, the impact on a patient’s quality of life, and the level of compensation. Those of us who are committed to the field of corneal transplantation will always provide this service to our patients, but if facility or tissue processing fees fall to a level that is below costs, there is concern that patient access could be damaged.
Fortunately, thanks to a strong network of quality eye banks, the EBAA and a well-trained cohort of corneal surgeons, the American patient who requires a corneal transplant today is very well served. Outside the U.S., in the less-developed countries of the world, the treatment of corneal blindness remains an extreme challenge secondary to an inadequate eye banking network and a shortage of qualified surgeons. The EBAA has committed for the next decade to help strengthen the number and quality of eye banks worldwide. This worthy goal is deserving of support.