BLOG: The best way to treat corneal blindness
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According to the WHO, about 39 million people worldwide are blind, of whom 12%, or about 5 million, have corneal blindness. About 50% to 60% of those are eligible for transplants, but in most parts of the world these are not highly available. Even when they are, there is a heavy burden of initial postoperative care of 6 to 12 months. If this is all successful, graft survival worldwide averages about 10 years, meaning the typical recipient will need more than one graft during his or her lifetime. Naturally, the cost of corneal transplants is another barrier, as is the availability of tissue.
So, given all these barriers to success, what’s the best way to manage corneal blindness? SightLife, a nonprofit network of eye banks and programs committed to eliminating corneal blindness, says the best way to treat this condition is never to develop it. An innovative SightLife program taking place in Nepal and initiated by female ophthalmic leaders is taking the novel approach that educating caregivers in local communities and empowering them with inexpensive antibiotic ointment will address this problem upstream in the disease process. Corneal injuries are a leading cause of infection that develops into blinding corneal opacity. The SightLife Women Advocates program believes that earlier treatment can prevent scar tissue formation. Most of us would agree that antibiotic treatment within 24 hours would be ideal. This prompt treatment would require local community access to care. But in rural Nepal and India, where the SightLife program is being piloted, patients used to have to travel to a regional health center, often walking for multiple days each way. Because of this travel burden, most waited until they clearly had an infection, and the average time to presentation was 8 days. This rendered them three times more likely to need a transplant and at least four times more likely to end up with corneal blindness, according to a study performed at a local charity eye hospital.
It’s difficult to train local caregivers who have little or no formal medical training in the ability to definitively treat all corneal injuries, but teaching them to dispense ophthalmic ointment for patients with injured corneas can be 98% successful and is 95% more cost-effective than a corneal transplant, according to a 2018 publication from SightLife. In its first year, the program treated 3,500 patients in local communities and provided antibiotics to about 1,600. While it’s uncertain how many would have led to corneal blindness, clearly this approach makes perfect sense.
For us in the U.S., where health care is abundant and ubiquitous, it’s hard to imagine the challenge of an eye injury in a remote village in India or Nepal. But much of the world lives in remote villages. Indeed, if SightLife’s innovative program could be scaled to more countries, it could meaningfully elevate the quality of care and quality of life among the world’s poorest people. We should all be proud of the SightLife Women Advocates who have initiated this program in Nepal.
Disclosure: Hovanesian reports he is a proud donor to SightLife. Visit www.sightlife.org.