Developing Global Conversations in Eye Banking Part 2 ... · World Blindness: WHO 2010 Report •...
Transcript of Developing Global Conversations in Eye Banking Part 2 ... · World Blindness: WHO 2010 Report •...
Corneal Transplantation
and Eye Banking:
(The Good, the Bad, and the Worst…)
Keynote Address, GAEBA Scientific Meeting, San Diego, 14 April 2015
Donald Tan MBBS FRCSE FRCSG FRCOphth FAMS
Arthur Lim Professor in Ophthalmology
Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Graduate Medical School
Dept of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
Senior Advisor, Singapore National Eye Centre
President, Asia Cornea Society
President, Association of Eye Banks of Asia
Past President, Cornea Society
Chairman, Asia Cornea Foundation
Chia-Li Pang BSC MA
Senior Manager, Singapore Eye Bank
Executive Director, Asia Cornea Society
Treasurer, Asia Cornea Foundation
Developing Global Conversations in Eye Banking
Part 2
(and… Heather Machin)
..she needs a
cornea, ocular
surface, and
eyelids..!!
Corneal opacification
without ocular surface
destruction
Corneal
Transplantation
End-stage OSD - severe
destruction, dry eye
Moderate ocular surface
disease - wet eye
Ocular Surface Tpltn
or Boston Kpro
Corneal Damage: 3 major groups
40% 60%
Osteo-Odonto
Keratoprosthesis (OOKP)
Mostly in Developing
Countries with poor
access to primary eye care
The “Bad”…
Transplant Indications in Developed or
Western Countries:
(good prognoses, early presentation) Keratoconus
Fuchs’ Dystrophy
PBK
Regraft
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
2011 USA(EBAA)
2011 UK 2011 Italy(S.I.TRA.C)
2011 Russia * 2011 Australia 2011 France*
13.19% 19.90%
45%
53.21%
29.79%
18.97%
18.02%
15.18%
24%
22.51%
31.14%
18.62%
20.41%
25.33%
9%
5.73%
15.00%
15.07%
10.28%
16.52%
11% 10.37% 36.57%
13.97%
1.39%
7.40%
7.78%
Keratoconus PBK/APK Fuch's Dystrophy Regraft Keratitis* Single Institution
Transplant Indications in Asia
(Developed Countries)
Infectious Keratitis
PBK
Scarring
Regraft
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
2012 Japan*(KPUM)
2012 Japan *(JCC, Tokyo)
2012 Korea(KONOS)
2012Singapore
2012 Taiwan*(NTUH)
2012 HongKong
56.85%
37.63%
20.11%
29.04%
37.61%
21.57%
18.49%
0.54%
16.93%
6.03%
25.64%
18.04%
17.20% 21.69%
10.41%
23.08%
13.33%
19.89% 11.64%
6.85% 1.96%
9.59% 6.45%
4.76%
10.10%
2.56%
3.92%
PBK/APK Corneal Scar Regraft Infectious Keratitis Keratoconus
* Single Institution
Transplant Indications in Asia (Developing Nations)
(worse prognoses, late presentations)
Infectious Keratitis
PBK
Scarring
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
2012 China*(Shandong)
2012 China*(TongRen)
India (EBAI) Philippines*(St Lucia)
2012Thailand
2012 SriLanka
54.20%
28.50%
39.00%
20.50% 25.38% 25.00%
20.20%
10.46%
15.00%
38.30%
15.84% 14.00%
3.60%
27.60%
9.00%
10.54%
25.38%
12.43%
11.00%
9.00% 12.40%
10.45%
12.30%
17.50% 4.00%
3.30% 2.86%
19.92%
Infectious Keratitis PBK/APK Regraft Keratoconus
* Single Institution
Scar
World Blindness: WHO 2010 Report
• Cornea opacities are the 4th major cause of global blindness
• Corneal disease is the major cause of childhood blindness in Asia/Africa (30%)
• when combined with other causes of corneal scarring, such as trachoma and the corneal indications for childhood blindness, corneal blindness is the second commonest cause of global blindness after cataract
• 10 million globally blind from corneal diseases
Bulletin of the World
Health Organization,
2001,79:214-221.
The
“Worst”…
• Identification of “Priority Eye Diseases”
• “corneal blindness…the only currently
available curative treatment is the surgery,
by graft of cornea. But the access is very
difficult, even in developed countries, for
lack of donors”
• “Vision 20/20 role: Corneal opacity is not,
as such, one of the VISION 20/20 priorities”
VISION 2020: Global initiative for the
elimination of avoidable blindness
Focused on Prevention Strategies
For the 10 million corneal blind….
Distribution of Eye Banks
High Low
Eye Banks Distribution
India
100,000 corneal blind/yr
15,000 transplants/yr
300 corneal surgeons
Where the World’s Corneal Blind Live
The size of each country reflects the population of corneal blind. Colors
represent readiness for eye banking and corneal transplantation
Country Readiness
High
Medium-High
Medium-Low
Low
98% of the 10 million people with corneal
blindness live in developing countries
(Courtesy of SightLife)
A Collaboration has been discussed for several years – formally and informally
– by numerous people around the world, with several key meetings:
• 2009 - SightLife Meeting, Seattle, USA
• 2011 - EBAA Meeting, Tuscon, USA – held first meetings to expand the idea
• 2012 - plan was formulated - spearhead by Graeme Pollock - to develop
collaborative
- Led to the development of an MoU – 6 Partner Associations signed
• 2013 - WEBS, Brazil
The Evolution of the Alliance
This emerged at a time when organs, tissues and the WHO were addressing
global issues, such as:
• 2008 - The Transplant Society and Society of Nephrology collaborated and
developed the Declaration of Istanbul on Organ Trafficking and Transplant
Tourism
• 2010 - Project Notify was initiated by WHO & CNT
- Led to the 2011 Experts Meeting in Bologna, Italy that included eye tissue
• 2010 – Eye Tissue Tracking systems discussions commenced with ICCBBA.
- All 6 Partner Associations represented
- Led to 2011 ocular tissue nomenclature development
• Ongoing - WHO advised collaboration
The Evolution of the Alliance
Eye Tissue, like organs and other tissue, did not know - globally:
• Who we were
• Where we were located
• What we provided
• How many donors we had
• How many transplants we did
• What our waiting list was
• Where our issues were
• Where tissue is transported (moved) – globally
• Where we can improve practice
The Evolution of the Alliance
Supported by the WHO:
• A collaborative was agreed on and an MoU was signed by 6 Partner Associations as
the primary mechanism for bringing together formal collaboration
• We agreed on:
• a flat committee structure with a project lead to work with each region as needed
and to spearhead and develop global initiatives
• sharing and notifying each other of globally significant issues – such as our
response to Ebola to disseminate messages and rapid-responses
• The need to remain as regions and nations but also service global agendas as
required
• Developing a global map of eye banks
• Developing the first global statistical data base for eye tissue
… and many more which will be discussed today
The Evolution of the Alliance GAEBA was formally launched, and incorporated, in
February 2014
In today’s meeting you will hear:
• What is happening within each region represented by your Associations
• What our peers in the organ sector have already achieved – that we can learn
• What the WHO are encouraging us to lead on
• What the Global Alliance will be doing to address issues facing each region
• What we can share and support each other with
• What you can do to be part of this, and
• What we can achieve as a collaborative sector, and
• How we can shape the future
The Future The Evolution of the Alliance
On behalf of the Representative Committee I would like to thank the following for their
assistance today:
• EBAA and San Diego Eye Bank for helping to host our first official meeting
• Our sponsors: Bioniko, Med-logics, ICCBBA and Transplant Connect
• Those who provided scholarships to delegates
• Our speakers for their willingness to present and discuss these issues in this forum
• Your willingness and interest in supporting eye banking, donors and recipients
We also welcome our guests – both here and via teleconference – from the organ and
bioethics community and the WHO for sharing their experiences with us.
Thank You….