Eye banking: an introduction

This article introduces the work of eye banks, institutions responsible for collecting (harvesting) and processing donor corneas, and for distributing them to trained corneal graft surgeons

Blindness and poverty in India: the way forward

A few recent studies have shown that poverty is an exacerbating and often determining factor in the incidence of disabling conditions, including visual impairment. Recent estimates from the World Health Organization indicate that 90 per cent of all those affected by visual impairment live in the poorest countries of the world. India is home to one-fifth of the world's visually impaired people and therefore, any strategies to combat avoidable blindness must take into account the socio-economic conditions within which people live. This paper looks at the relationship between poverty and blindness in India and suggests strategies to address blindness prevention in a comprehensive manner

The promise of stem cell therapy for eye disorders

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Population-based cross-sectional study of barriers to utilisation of refraction services in South India: Rapid Assessment of Refractive Errors (RARE) Study

AIM: To assess the barriers to the uptake of refraction services in the age group of 15-49 years in rural Andhra Pradesh, India. METHODS: A population-based cross-sectional study was conducted using cluster random sampling to enumerate 3300 individuals from 55 clusters. A validated questionnaire was used to elicit information on barriers to utilisation of services among individuals with uncorrected refractive error (presenting visual acuity 35 years with binocular distance visual acuity of ≥6/12). RESULTS: 3095 (94%) were available for examination. Those with uncorrected refractive errors cited affordability as the main barrier to the uptake of eye-care services. Among people with uncorrected presbyopia, lack of 'felt need' was the leading barrier. CONCLUSION: The barriers that were 'relatively easy to change' were reported by those with uncorrected refractive errors in contrast to 'difficult to change' barriers reported by those with uncorrected presbyopia. Together, the data on prevalence and an understanding of the barriers for the uptake of services are critical to the planning of refractive error services

Corneal nerve alterations in diabetes mellitus

The morphologic status of corneal innervation was studied in rats with streptozocin-induced diabetes. Animals were killed at 1, 4, 16, and 36 weeks. Corneal innervation was studied by light and electron microscopy using nonspecific cholinesterase reaction, gold chloride impregnation, and plastic-embedded sections. Increased irregularity in the periodicity of nerve fiber beading was observed in diabetic corneas with gold impregnation. Ultrastructural evidence of irregularities in the basal lamina of Schwann cells was demonstrated in 16- and 36-week-old diabetic animals, along with occasional axonal degeneration. These alterations constitute a constellation of early pathologic manifestations in the innervation of diabetic cornea. To our knowledge, this study represents the first demonstration of neural changes in diabetic corneas as well as nerve fiber changes in an avascular tissue in diabetes

Clinical and Epidemiologic Research Population-Based Assessment of Prevalence and Risk Factors for Pterygium in the South Indian State of Andhra Pradesh: The Andhra Pradesh Eye Disease Study

PURPOSE. To describe the prevalence and risk factors for pterygium in a population-based sample of individuals aged 30 years and older in South Indian state of Andhra Pradesh. METHODS. A cross-sectional study was conducted in one urban and three rural locations in which 10,293 subjects were examined. All the subjects underwent comprehensive eye examination and a detailed interview by trained professionals. Pterygium was defined as fleshy fibro vascular growth, crossing the limbus, and typically seen on the nasal conjunctiva in either eye. RESULTS. Data were analyzed for 5586 subjects who were aged 30 years and older at the time of participation. The mean age of the participants was 47.5 years (SD 13 years; range 30-102 years). In total, 46.4% were male, 56.7% had no education, 52.2% of them were involved in outdoor occupations, and 25% belonged to urban area. The prevalence of pterygium was 11.7% (95% confidence interval [CI]: 10.9-12.6). The multiple logistic regression analysis revealed significantly higher odds of pterygium among older age groups, rural residents (odds ratio [OR]: 1.8; 95% CI: 1.4-2.4; P > 0.01), and those involved in outdoor occupations (OR: 1.8; 95% CI: 1.5-2.2, P < 0.001). Education had a protective effect (OR: 0.6; 95% CI: 0.5-0.7; P < 0.001). CONCLUSIONS. Pterygium is common in the South Indian state of Andhra Pradesh. Exposure to sunlight is a significant modifiable risk factor. Protecting the eyes from sunlight may decrease the risk of pterygium. However, the important public health challenge is to encourage the use of this protection as a routine in developing countries such as India

Awareness of eye donation in an urban population in India

Purpose: Awareness of eye donation and willingness to pledge eyes for donation was assessed in the urban population of Hyderabad, India, where corneal blindness is a significant problem. Methods: A total of 2522 subjects of all ages, representative of the Hyderabad population, participated in the Andhra Pradesh Eye Disease Study. Subjects >15 years old were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation. Results: Age-gender-adjusted prevalence of awareness of eye donation was 73.8% (95% CI: 66.5-81.0%) but only 1.9% (95% CI: 0.16-3.66%) had pledged eyes. With multivariate analysis, significantly less awareness of eye donation was found in illiterate subjects (OR 0.1; 95% CI: 0.1-0.14), subjects ≥70 years old (OR 0.3; 95% CI: 0.2-0.6), subjects of lower socio-economic status (OR 0.4; 95% CI: 0.3-0.6), females (OR 0.6; 95% CI: 0.5-0.8) and Muslims (OR 0.7; 95% CI: 0.6-0.9). Media was the major source of information about eye donation. Of those aware of eye donation, 44.9% were willing to pledge eyes. Willingness to pledge eyes for donation was significantly lower in Muslims (OR 0.18; 95% CI: 0.13-0.24) than in Hindus and in subjects =60 years old (OR 0.3; 95% CI: 0.2-0.5). Conclusions: These data show that although only a few had pledged eyes there is enough potential in this population for obtaining many more corneas for transplantation. The information about distribution and demographic associations of awareness and willingness for eye donation could help in developing strategies to increase procurement of corneas for dealing with corneal blindness

Quantitative and morphological characteristics of the human corneal endothelium in relation to age, gender, and ethnicity in cataract populations of South Asia

Purpose: To describe the differences of corneal endothelial cell densities, cell size variability and cell hexagonality in cataract populations of south Asia between sexes and ethnic groups. Methods: 1,235 eyes of 1,235 male and female patients 40-75 years of age with senile cataract were examined with non contact specular microscopy with semi-automated analysis technique. The cell data of the study population was analyzed in relation to age, sex, and ethnic groups. Mean arithmetic differences and the coefficient of variation of repeated observations were calculated to estimate precision of the technique utilized. The main outcome measures were corneal endothelial cell density, cell size variability and cell hexagonality. Results: The mean corneal endothelial cell density was 2,720 cells/mm2, mean cell size variability was 37.8% and percent cell hexagonality 40%. We found statistical significant difference between the three ethnic populations in all the corneal endothelial cell measurements (p < 0.0001). Females had a 2.9% greater cell density than males (p = 0.0001). There was no significant difference in mean cell density according to age. Variability of cell size, however, increased with age (p < 0.001). These findings were consistent across the three ethnic groups. Conclusions: In a total sample of 1,235 eyes distributed evenly in three cataract patient populations of south Asia, we found statistically significant differences of corneal endothelial cell densities of cell size variability and cell hexagonality between sexes and ethnic groups