The 2023 Doyne Lecture-a cornea care system: evolution

Abstract

Blindness and visual impairment affect the quality of life of the individual and their family members. Corneal opacities are a key cause of vision loss around the world, especially in low-income and middle-income countries (LMIC). Corneal blindness and vision loss impacts every age group, and the risk factors and the causes are also varied. Socio-economic factors also play a significant role in its prevalence. Preventing, treating, and managing corneal conditions in LMIC contexts can therefore be quite complex and challenging. A model of eye care delivery developed and refined over the past four decades, the L V Prasad Eye Institute's cornea care system presents an example and a sense of hope. The model takes corneal care from world-class facilities in urban locations to rural locations, overcoming a variety of challenges. The initial breakthrough came with solving and ensuring a steady supply of corneal tissue. Then to training high-quality resources, building capacity, and investing in research that translates from the bench to the bedside. A variety of innovations, both in diagnosis and the operating theatre, have paved for improved outcomes that are tailored for the contexts in which this system operates. The institute envisions a future where its work further narrows the gap in eye care disparities and leads to life-changing impact in ophthalmic care of the cornea.

Fig. 1

LVPEI’s 300 centres across the southern Indian states of Andhra Pradesh, Karnataka, Odisha, and Telangana.

Fig. 2

The 10 active arms of LVPEI.

Fig. 3

The major indications for a corneal transplant.

Fig. 4

Types of corneal transplants performed at LVPEI and percentage breakup of volume.

Fig. 5

Total corneal transplants performed at LVPEI over 36 years.

Fig. 6

General performance data of LVPEI’s cornea services over 7 years.

Fig. 6

General performance data of LVPEI’s cornea services over 7 years.