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How COVID-19 is a challenge for cornea donation

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Marking World Sight Day on October 8, Dr Virender Sangwan, cornea and uveitis specialist, Director of Innovation, Dr Shroff’s Charity Eye Clinic and a patron of SeekMed, details the importance of cornea donation, how telemedicine could address the gaps in the demand-supply chain for corneas in India and the possible role of the National Digital Health Mission in connecting donors and receivers

Can you imagine yourself in a situation where your eyes see nothing and be unmoved by it? Any individual would answer this with a big no. However, India houses the largest number of visually impaired people in the world, most of which are cases of preventable blindness. Preventable blindness refers to the eye diseases which can be cured or avoided with timely care and treatment.  Studies have shown that ignoring the problems of vision is the major contributor of blindness in the nation. While many drives have been initiated by the Indian government in the last 10 years, we stand unaware regarding eye donation even today. Though the rate has reduced, yet we have a long way to go before we can achieve a win over avoidable blindness problems.

How the actual scenario looks like?

While, we are a nation of over 1.3 billion people, while the National Programme for Control of Blindness (NPCB) set a target of 50,000 donations less than 20,000 eye donations occurred in 2017-18. There are 1.2 million corneal blind in our country with 25,000-30,000 new cases being added every year. The burden of corneal blindness in our country is 0.12 per cent.

It has been estimated that 29 million blind years can be prevented if these avoidable causes are addressed reducing economic burden due to blindness. Corneal blindness is responsible for 26 per cent of cases of childhood blindness with majority (19 per cent) of cases being attributed to vitamin A deficiency.

The requirement however, is as high as 2,50,500 says a research published by National Center for Biotechnology Information while the number of transplants that took place was close to only a 1,00,000. The Transplant Surgery Rate (TSR) per million population in India being only 15.

While the gap is huge, it is addressable. Pledging to donate eyes can save your eyes from going to waste and help others simultaneously. The situation has got even worse after the on-set of COVID-19 pandemic. People fear donating and accepting eyes as eyes are considered as a critical entry point for the virus.

In a recent pan India survey by AIIMS, New Delhi, only 1125 donations took place from March – June 2020 (COVID times) as opposed to 6991 donations in the same period in 2019. The number of transplants in this time span being 515 this year as compared to 2374 last year. Decrease in both collection and transplant this year in comparison to last year by 80 per cent indicates how alarming the situation is. The challenges being that every eye donation requires COVID testing of the deceased and catering to the emotional needs of the family while convincing them to donate in these difficult times.

 How is technology helping?

Development in technology is to be thanked for minimally invasive treatment procedures available today that can possibly help India overcome the challenge to a certain extent, but not completely. These are the procedures given in the field of ophthalmology is a multi-pronged approach by its very nature. The chances of infection is minimal and one does not even need to wait for years before they can enjoy the gift of vision again. It is also easy on pockets as compared to a transplant for obvious reasons. However, certain diseases like corneal blindness, perforated corneal ulcers, keratoconus, bullous keratopathy, corneal melts post inflammatory disease and severe corneal dystrophies have no cure other than cornea transplant.

Even after numerous awareness drives eye donation stays as a stigma among people which poses a global challenge. For every pair of eyes donated, upto two visually challenged people can get gifted with vision. With the help of mobile technology, telemedicine has been efficient in reaching out to people in the farthest corners of the nation. This helps in generating awareness among people about the diseases as well as how we can help each other by donating eyes in our lifetime. With a userbase of over 400 million people in India, mobile phone technology can be developed as a support to government awareness drives.

Can National Digital Health Mission help?

A lot is being expected from the recently announced National Digital Health Mission. The data base that would be generated out of the digital health mission would surely help in collating information of people in need of cornea or eye donation in general and of the people who want to donate their eyes. The plan is still in its initial stages and has been implemented only in some sections of the country. However, it is sure to promote better awareness among potential donors and availability for those in need.

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