4. 6.8 million people (vision <6/60)
1 million = Bilateral
Curable by Keratoplasty = about 10 %
This figure will be 10.6 million in 2020
– “RAAB study - 2007” = Corneal blindness= 1% of total blindness.
– New patients/year = 40,000 – 50,000 (??)
1. Dandona et al. Br J Ophthalmol. 2003; 87:133-41
2. NPCB-2012; News Letter, NPCB; Govt of India.
Corneal Blindness: India
5.
6. Infectious Keratitis (Corneal Ulcer)
Pseudophakic Bullous keratopathy
Hereditary Dystrophies/ Corneal Ectasia
Corneal Injury: open globe/chemical/thermal
Trachoma
Vitamin A deficiency
Corneal Blindness:
Major causes in INDIA
6
7. Madurai: 113/ 100,000 person/yr
India: 1.31 million ulcers/year
Gonzales CA et al. Incidence of corneal ulceration in Madurai District, South India. Ophthalmic Epidemiology, 1996;3:156-66
Infective keratitis: in India
8. Pseudophakic Bullous Keratopathy (PBK)
Exact data not available
Incidence = 0.1-1.0%
PBK occurs both from
Masters and Learner
In 2012-13 = 6.2 million Cataract Sx
performed by us
In Simple Math: @ 0.5% =
the FIGURE of PBK/edema = ?
10. Dystrophies: Indian data
Exact data not available
Fuchs’ Dystrophy = 1/4th of all Transplants
– Primary OR
– as Post cataract Sx Corneal edema/PBK
Macular Dystrophy = is also Higher
Others, Like - Granular, Lattice, etc. are less
12. KCN: Global and Indian data
Prevalence = 50 to 130 per 100,000 population.
Overall Annual incidence = 2.0 per 100,000
In last decade – More newly diagnosis of KCN
Better diagnostic sensitivity - especially with increase topography use
Newly identified KCN cases during Screening for LASIK
Kymes SM and The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study Group. Quality of life in keratoconus.
Am J Ophthalmol. 2004;138:527-35.
Jonas B et al. Prevalence and associations of keratoconus in rural Maharashtra in central India: the central India eye and
medical study. Am J Ophthalmol. 2009;148:760-5
India = 2,300 per 100,000 population !!
13. Injury: Open globe and Chemical
Everyday we see such cases
Open globe and Alkali burns more
common in children
Gen-X ophthalmologists
are not interested –
not learning good suturing
Complacence attitude …..
Delayed intervention leads to
permanent visual loss
14. Trachoma: Coming Back !
In 84-87 NPCB-WHO Survey = 3%
In 2001-2005 = No active Trachoma
In 2010-11 : New areas
Uttarakhand = 15.2%
Haryana
Gujarat
Punjub
Rajasthan = 7.6%
UP = 5.9%
RAAB Study NPCB
< 10 years age
Musca Sorbens
Eye Seeking Flies
15. Vitamin A deficiency
Now: not a problem
Good coverage with Mass Immunisation
Cluster problem is still there along with PEM
22. Fugal ulcer with
impending perforation
Urgent Th-PKP with
Optical quality tissue
Th PKP (PhD Microbiologist # CL user)
1 M
3 Y
6/6p
23. Bangladesh # Minister’s daughter
KCN # DALK LE #
Infection on Day 5
# Conj Hooding
# PR Inaccurate
– Evisceration
advised
1 Year 3 Years
Th PKP
Presentation
24. INDIA USA
Indications Percentage Percentage
Corneal Scar 28.1
40%
7.9
11%Therapeutic PK 12.2 2.9
PBK 10.6 27.2
Non-Fuchs’ Dystrophy 7.2
14.4%
9.3
49.9%Keratoconus 6.0 15.4
Fuchs’ dystrophy 1.2 15.2
Failed Graft 17.1 10.9
Others 17.7 2.7
Keratoplasty Indications: India Vs USA (2005-06)
25. At present: 20000+ keratoplasty/year in India
Surgery-wise Types – no data available
Keratoplasty: in INDIA
KP data 2012-13 = 984
Type of Surgery No. %
PKP 306 31%
Th PK 335 34%
DSEK 247 25%
DALK 44 5.6%
Tectonic 35 4%
Boston KPRO 19 2%
Corneal Surgeon in INDIA = 300 – 350
About 25% are doing Lamellar Surgeries
Only 35% Eye Banks gives
Full Surgery-wise data
26. We need Solutions # 2
Quality Eye Banking
For Solutions # 1
Aim of this CME
27.
28.
29. Eye Banking: All INDIA (Last 10 years) 2003-12
We Need to perform = 100,000 Keratoplasty/Year in year 2020
@ 50% utilization
We need Collection = 200,000 Cornea/year
Our collection has improved from = 20451 to 49510
And Utilization from = 8,014 to 20,615
Utilization percentage improved from 39% to 46%
As per Vision2020 India:
30. Based on 10.2 million deaths annually -
In 2012, Total collections = < 0.5% of all deaths
With a goal of 100,000 transplants and utilization of 50% -
Target of consenting donors = 100,000/year
We need = 1% of all deaths
Goal of Indian Eye Banking
32. Top 10 Eye Banks: India (2011) # Utilization wise
Collection is not a Good Term
Unless we talk about
Utilizable Cornea
Utilization = 2.0 – 82.0%
Average = 46%
Ideal utilization = 65%
33. State No.
TN 8796
Gujarat 8213
Mah 6914
AP 6865
Karntk 3251
Haryana 3144
WB 2920
Del 2400
Kerala 1576
Rajas 1201
Others 4130
Total 49410
INDIA (2012-13)INDIA (11th five years Plan)
34. State No.
TN 8796
Gujarat 8213
Mah 6914
AP 6865
Karntk 3251
Haryana 3144
WB 2920
Del 2400
Kerala 1576
Rajas 1201
Others 4130
Total 49410
Problems
with
Data
Collection
NPCB (2012-13)
State No. (C) Difference
TN 7434 - 1362
Gujarat 6518 - 1695
Mah 4828 - 2086
AP 6518 - 347
Karntk 3625 + 376
Haryana 3552 + 408
WB 2726 - 200
Del 2926 + 526
Kerala 1415 - 161
Rajas 1405 + 204
Others 2666 - 1464
Total 44806
EBAI (2012-13)
36. Total No. of EBTC/EB/EDC (Registered) = 749
Eye Banks collecting eyes:
>1000 : 14
500 to 1000 : 14
100 to 500 : 49
1 to 100 : 64
EBAI Present Scenario # Data # 2012-13
Total = 141
On an Average -
EBAI gets information from 150 Centres
Discrepancy in NPCB and EBAI data every year
No utilization data from NPCB
37. No Government recognized training / certification center for eye
bank personnel
No Government approved / accepted Accreditation system in place
No Robust HCRP system in Govt sectors eye banks
This is important = As Eye Banks with HCRP program reporting
about 65 to 70% utilization against 45% national average
Some Eye banks have surplus corneas
EBAI Present Scenario # Other areas
38. GOVT Eye Bank/EDC *Own Collection EDCs Utilisation
Govt. Regional Eye Hospital Warangal-AP 60 0 EDC
Govt. General Hospital Ananthapur-AP 7 0 EDC
D.B.C.S. Nalgonda-AP 4 0 EDC
District Hospital Jangaom-AP 40 0 EDC
Regional Eye Hospital Kurnool-AP 16 0 EDC
SVRRGG Govt. Hospital Tirupati-AP 8 0 EDC
RIO Kolkata-WB 0 1226 177
Govt. Medical College-Surat Eye Bank Surat-Gujarat 52 9 15
Surat Muncipal Inst. Of Medical Education Surat-Gujarat 128 31 24
Govt. Medical College Hospital Aurangabad 38 0 17
Armed Force Medical College Hospital (AFMC) Pune-MS 50 1 12
Govt. Medical College Calicut-Kerala 0 0 0
Medical College Kozhikode Kozhikode-Ke 82 0 40
Medical College Kottayam 0 0 0
Govt. Ophthalmic Hospital Thirvandram 0 0 0Year 2012-13 reports not received
Medical College Thrissur 0 0 0Year 2012-13 reports not received
JIPMER Pondicherry 0 0 0Year 2012-13 reports not received
RIO-Chennai, Dist. 324 A1 Lions EBTRF Chennai 1053 0 310
Govt. Rajaji Hospital (GRH) Eye Bank Madurai 0 0 0Sending to Aravind EH, Madurai
LLRM Medical Meerut Meerut-UP 65 42 82
IMA Eye Bank Varanasi-UP 100 0 0 to BHU, BHU EB not reoprting
PGIMER Chandigarh 0 0 0Year 2012-13 reports not received
Govt. Medical College Hospital, Sector-32 Chandigarh 54 76 77
Army Hospital (R & R) Eye Bank New Delhi 0 0 0Year 2012-13 reports not received
Safdarjung Hospital New Delhi 0 0 0Year 2012-13 reports not received
Guru Nanak Eye Hospital - Eye Bank New Delhi 505 42 279
National Eye Bank, Dr. RPC Opht. Sci, AIIMS New Delhi 920 142 830
Dept. of Ophth. PT. B.D. Sharma PGIMS Rohtak-Haryana 165 4 120
Indira Gandhi Mecial College Simla-HP 0 0 0Year 2012-13 reports not received
Eye Bank Rajindra Hospital Patiala-Punjab 66 12 37
Total= 4998 3413 1585 2020 40% Utilization
39. Data collection – Online facility will be implemented soon
Set up Government approved training / certification center in each
zone to begin with and then in each State gradually
Launch the EBAI-NABH Eye Bank Accreditation program
Updated Medical Standard of Eye banking: Meeting already held in
Delhi on 12th Sept. (IAPB-EBAI-NPCB along with expertise of
Sightlife, USA to match international standard)
EBAI: TASK Ahead
40. Popularise Required Request law in each state gradually
Increase eye collection by clubbing top performer in each region
with potential under performer in the same region
Increase utilization rate by working closely with eye banks reporting
lower utilization (To find out and solve the issues)
National Cornea Distribution System for sharing surplus corneas
(Pilot project is on # SightLife-partner Eye Banks in India with
individual surgeon) – It is the time to incorporate with EBAI.
EBAI: TASK Ahead
41. Popularise Required Request law in each state gradually
Increase eye collection by clubbing top performer in each region
with potential under performer in the same region
Increase utilization rate by working closely with eye banks reporting
lower utilization (To find out and solve the issues)
National Cornea Distribution System for sharing surplus corneas
(Pilot project is on # SightLife-partner Eye Banks in India with
individual surgeon) – It is the time to incorporate with EBAI.
EBAI: TASK Ahead
42. Cornea Surgical Capacity Building
Increasing Cornea surgeons pool to 1000 by 2020 AD
(At present fellow training capacity/year = Just 50+)
Training of Junior consultants in Medical Colleges (400 Medical
Colleges in India – 2 from each College)
National Registry and Networking between Eye Banks and
Corneal Surgeons
EBAI: TASK Ahead # Corneal Surgeons
43. For surplus tissues – We need better media than MK medium
We have:
Optisol GS – 14 days – Cost @ Rs. 2000/vial
Eusol C – 14 days – Cost @ Rs. 3000+/vial
Life 4 C – 14 days – Cost @ Rs. 4500/vial
Cornisol – 14 Days – Aurolab Product – Cost @ 975/vial
Many Eye Banks are using Cornisol – with good reports
EBAI: TASK Ahead # Storage media
No Financial Interest on any product
44. A BIG Question
EBAI – has NO Income (Only Membership Fees + Interest)
International Agencies/Eye Banks are helping us in various
capacities
Friends of EBAI are there – they donate. Mostly unconditional.
- Some logistics issues are there.
In AGM today – we will discuss those and resolve.
EBAI: TASK Ahead # Funding Issue