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Original Investigation |

Global Survey of Corneal Transplantation and Eye Banking

Philippe Gain, MD, PhD1,2; Rémy Jullienne, MD1; Zhiguo He, PhD2; Mansour Aldossary, MD1; Sophie Acquart, PhD3; Fabrice Cognasse, PhD3; Gilles Thuret, MD, PhD1,2,4
[+] Author Affiliations
1Ophthalmology Department, University Hospital, Saint-Etienne, France
2Federative Institute of Research in Sciences and Health Engineering, Corneal Graft Biology, Engineering, and Imaging Laboratory, Faculty of Medicine, Jean Monnet University, Saint-Etienne, France
3Eye Bank of Saint-Etienne, Auvergne Loire Blood Centre, Saint-Etienne, France
4Institut Universitaire de France, Paris, France
JAMA Ophthalmol. 2016;134(2):167-173. doi:10.1001/jamaophthalmol.2015.4776.
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Importance  Corneal transplantation restores visual function when visual impairment caused by a corneal disease becomes too severe. It is considered the world’s most frequent type of transplantation, but, to our knowledge, there are no exhaustive data allowing measurement of supply and demand, although such data are essential in defining local, national, and global strategies to fight corneal blindness.

Objective  To describe the worldwide situation of corneal transplantation supply and demand.

Design, Setting, and Participants  Data were collected between August 2012 and August 2013 from a systematic review of published literature in parallel with national and international reports on corneal transplantation and eye banking. In a second step, eye bank staff and/or corneal surgeons were interviewed on their local activities. Interviews were performed during international ophthalmology or eye-banking congresses or by telephone or email. Countries’ national supply/demand status was classified using a 7-grade system. Data were collected from 148 countries.

Main Outcomes and Measures  Corneal transplantation and corneal procurements per capita in each country.

Results  In 2012, we identified 184 576 corneal transplants performed in 116 countries. These were procured from 283 530 corneas and stored in 742 eye banks. The top indications were Fuchs dystrophy (39% of all corneal transplants performed), a primary corneal edema mostly affecting elderly individuals; keratoconus (27%), a corneal disease that slowly deforms the cornea in young people; and sequellae of infectious keratitis (20%). The United States, with 199.10−6 corneal transplants per capita, had the highest transplantation rate, followed by Lebanon (122.10−6) and Canada (117.10−6), while the median of the 116 transplanting countries was 19.10−6. Corneas were procured in only 82 countries. Only the United States and Sri Lanka exported large numbers of donor corneas. About 53% of the world’s population had no access to corneal transplantation.

Conclusions and Relevance  Our survey globally quantified the considerable shortage of corneal graft tissue, with only 1 cornea available for 70 needed. Efforts to encourage cornea donation must continue in all countries, but it is also essential to develop alternative and/or complementary solutions, such as corneal bioengineering.

Figures in this Article

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Figure 1.
Rate of Corneal Transplantation (CT) and Corneal Procurement (CP) per Capita in the World

A, Distribution of CT per capita. Only countries with more than 5.10−6 CTs per capita are shown. The vertical line shows the median (10.10−6) of all countries (N = 148). Lists of the 31 countries below 5.10−6 and of the 32 performing no CTs are available in the eResults of the Supplement. B, Distribution of CP per capita. The same countries as in A are represented. The continuous vertical line, almost merged with the y-axis, shows the median (0.92.10−6) of all countries (N = 148). The dotted vertical line shows the median (25.2.10−6) of the 82 cornea-procuring countries. In A and B, yellow bars show countries for which we deemed the data of questionable robustness.

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Figure 2.
World Map Showing the Supply and Demand of Corneal Transplantation of 148 Countries

The term “embryonic” indicates that an activity does exist, revealing that there is a will to perform corneal graft and at least a small facility to store corneas, but that the number of grafts performed is extremely limited to a few cases. Hatched bars indicate countries for which we deemed the data of questionable robustness. The boundaries shown on this map do not imply any opinion by the authors regarding the legal status of any country or territory or its authorities or regarding the delimitation of frontiers or boundaries.

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