Corneal blindness is a major cause of blindness worldwide and is second only to cataract. India accounts for a substantial portion of the global burden. The causes of corneal blindness range from different kinds of infections such as trachoma, eye-injury and inflammatory eye diseases. These conditions disrupt and damage the structural integrity of the cornea, with the resulting scarring eventually leading to functional blindness.
A corneal transplant is considered the standard treatment for corneal blindness. Corneal transplant in India has progressed a lot since India set up its first eye bank in 1945, and today has one of the world’s largest eye banking network. However, challenges such as logistics, lack of proper public awareness, and underutilisation of donated corneas persist. With advancements in corneal transplant technology, there is an unprecedented opportunity for India to leverage these advances and enhance patient outcomes.
Innovation in corneal transplant techniques
Traditionally, corneal transplantation by the penetrating keratoplasty technique where the entire thickness of the cornea is replaced, has been the gold standard treatment for corneal blindness. However, it carries the risk of graft rejection and complications related to sutures. However, over the last two to three decades, the procedure known as endothelial keratoplasty, in which only the damaged layers of the cornea are replaced, has become the treatment of choice. This leads to faster recovery times, reduced rejection rates, and better outcomes with regard to post-transplant vision.
A significant advance is the Intra-operative Optical Coherence Tomography (iOCT) that provides the eye surgeon with continuous feedback on intraoperative surgical manoeuvres. Another important technological advance is the use of femtosecond lasers in corneal surgery. These lasers allow for precise cuts and can create intricate patterns, improving the fit between donor and recipient tissues. This precision reduces healing times and improves the structural integrity of the transplanted cornea.
Bioengineered and artificial corneas
Some patients may not be suitable for a conventional corneal transplant or there may be shortage of corneas for transplant due to a gap in the availability of donors. In these cases, bioengineered / artificial corneas or keratoprostheses can be used to restore vision by replacing part of the cornea or the whole of the diseased cornea. Today, tissue-engineered hydrogels, which assist in regenerating the tissue of the recipient are also being used. With research into bioengineered corneas using collagen-based materials or stem cells and using 3D bioprinting technology for creating corneal tissue making progress, the future will see these potentially addressing the challenge of donor tissue shortages.
Leveraging innovation
To fully benefit from these technological advances, we must enhance the eye bank infrastructure for eye donation and corneal tissue preservation. Creating a network of modern eye bank facilities with advanced storage techniques can increase the availability of high-quality donor tissues.
The government must also support local research initiatives for cost-effective solutions tailored to India’s needs. Government funding and incentives for innovation in ophthalmology can promote developments in artificial corneas and tissue engineering. Public-private partnerships (PPPs) between government entities, private companies, and non-profit organisations can facilitate the transfer of technology and expertise. This can also help in subsidising the cost of advanced treatments for underprivileged patients.
Continuing medical education and advanced training will help keep eye surgeons updated on the latest technologies and advanced corneal transplant techniques.
With a coordinated effort from all stakeholders, the integration of new technologies into the system for corneal transplants can turn the tide against corneal blindness and help restore vision to lakhs of more individuals, enhancing their quality of life and contributing to the nation’s social and economic development.