Upgradation and modernization of eye banking services: Integrating tradition with innovative policies and current best practices

Abstract

Purpose: The purpose of this study is to review the history and evolution of the National Eye Bank (NEB) and analyze the impact over the years and report the outcome of the invested resources.

Methods: Review of archival material, records, project reports, policy and procedures' manuals, and publications was done. Descriptive and analytical processing of data obtained was undertaken. Parameters evaluated included total collection, transplantation, utilization rates of donor cornea, changing trends over time in terms of numbers and duration of recipients waiting, impactful research translated into changes in standard operating protocols, new facilities, and subsequent effects on numbers or quality assurance measures and overview of major achievements. Periodic situational analysis with contextual relevance and interpretation of outcomes was done pertaining to national goals and international standards.

Results: The NEB and cornea services have played a key leadership role in furthering the development of eye banking and corneal transplantation services. The contribution extends beyond routine patient care to education, training, generation of resources, advocacy, and policymaking. In quantifiable terms, the overall performance has steadily increased over the years. Major contributions include training of doctors, eye bank staff and corneal surgeons, introduction of innovative techniques for corneal transplantation, setting of national standards for eye banking and provision of preservation media, customized corneal, and ocular surface cell replacement therapy in collaboration with other departments and institutes.

Conclusion: The eye banking and corneal transplantation facilities have evolved with time providing quality services, modernized as appropriate with updated knowledge and incorporating technological advances supported by the systematic evidence-based approach.

Figure 1

The annual collection and utilization of corneas in India and in the National Eye Bank, 2001–2015. The numbers for cornea collection and utilization for 'All India' have been scaled down by a factor of 30 to enable better side-by-side comparison of utilization proportions each year against the National Eye Bank. The total length of each bar from the zero on x axis represents the collection or utilization and the bars are overlaid (not stacked). The 'All India' figures also include NEB collection and utilization

Figure 2

The annual utilization proportion of corneas in India and in the National Eye Bank, 2001–2015. Three year moving averages have been computed to smoothen year to year variations in corneal utilization proportion. While the 'All India' utilization is steady between 40% and 50%, the utilization at National Eye Bank has shown consistent increase since 2007 and is currently around 70%

Figure 3

(a) Positioning corneal button in an artificial anterior chamber. (b) Cutting the cornea with an automated microkeratome with 400 μ blade on surgeon request. (c) Marking the edge of cut stromal bed. (d) Repositioned anterior cap before replacing in media for distribution