Eye Donor Awareness: Frequently Asked Questions

Who is an ideal candidate to receive an eye donation? Is it possible to help someone who is completely blind?
In talking about reception of the tissue, the eye tissue is used several different ways, most commonly for corneal transplantation. Patients who need a corneal transplant are those who have a disease, scar, or active infection involving the cornea. The cornea is the clear part of the eye much like a watch crystal. People who are completely blind and cannot see light cannot benefit from any type of corneal transplantation. Other parts of the eye including the sclera or white part of the eye are used in some types of oculoplastic surgery and in glaucoma surgery. So you can be an eye donor and help more than 1 or 2 people.
I assume a donor must be dead?
For the most part, corneal donation comes from people who are dead. In very rare circumstances, a donor may be living. For example a patient who has an ocular tumor in the back of the eye may be able to donate the eye at the time the eye is removed. If an eye is blind and it is removed, but is healthy in the front, that cornea might also be used. There are no instances of donation between people who are living in other circumstances. Another special circumstance where a person may donate a cornea to themselves is where one eye can still see and one can't. That is very rare.
Is it possible to use artificial tissue to help those who need this procedure?
There are types of surgery called keratoprostheses, which use artificial corneas. These are very difficult to use and are still being investigated and probably no more than 400 or 500 are done each year worldwide. It's used where it's impossible to get the donor cornea to take. For example, some patients with severe scarring of the eye socket where the lids don't operate normally might benefit from a keratoprosthesis. There are newer types of prostheses being developed to substitute for the cornea, but nothing is as useful as a human-donated cornea. The University of Iowa will be using the FDA approved keratoprosthesis alphacor in 2004.
Is this a new procedure? How common is this procedure?
Corneal transplantation is not a new procedure. The first ones were done in the late 1800s. The first eye bank was established more than 50 years ago. This procedure has been done routinely since the 1960s. The first eye bank was in Russia in the 1930s. At present, there are over 44,000 corneal transplants done every year, making it the second-most common transplant after blood donors.
What would you do if a living person wanted to donate an eye?
You have to discuss with the potential donor the motivation for the donation. Under ordinary circumstances, eyes are not the same as kidneys and are generally considered to need both for your best function. In circumstances where you've lost vision in an eye or you no longer see daylight, there might be exceptions, but otherwise donation would not be acceptable.
Would someone with macular degeneration benefit from a donor procedure such as this?
Patients with macular degeneration have a disease of the retina. The retina is like the photographic film inside a camera. It is a thin tissue that lies in the inside of the eye. Consequently, unless the cornea is also affected in some way, corneal transplantation would not help a patient with macular degeneration. There are some people who have corneal dystrophies such as Fuchs who also have macular degeneration, and they can benefit from transplantation when the cornea becomes cloudy.
Are people with glaucoma candidates for this procedure?
People with glaucoma have an eye condition where the optic nerve is being damaged, usually by pressure inside the eye that is too high. The cornea is not affected by glaucoma, but some patients will have both glaucoma and a corneal condition. Those patients may require surgery for the glaucoma and surgery for the cornea. Glaucoma is one of the factors that harms corneal transplant, so the glaucoma must be controlled before or at the time of the corneal transplant.
Would diabetic retinopathy benefit from a transplant? Or would this or diabetes in general prevent someone from being a donor?
For the first part, I would refer you to the answer about macular degeneration. Diabetic retinopathy affects the retina, not the cornea directly, so transplant would not help unless there is also a problem with the cornea. For the second part of your question, only the advanced stages of diabetes that require insulin prevent a patient from being a donor. Patients who have diet-controlled diabetes may still be eye donors. Patients who have severe forms of diabetes may donate their eyes for research rather than for corneal transplantation. Research is a very valuable mission and may lead to prevention or cure of blindness for many more than 1 patient.
Is this an operation that is done more frequently on elderly patients or younger patients?
Many patients who receive transplants are older, but the populations who are very old or very young are the populations that receive most transplants. Similarly, most of the donors are also older. The typical eye bank will accept donations from the age of 2 to 70 and donors younger than 2 and older than 70 are helpful for research tissue but not for corneal transplantation. In general, patients receive corneal tissue from donors approx the same age or younger than themselves.
Is there a certain time frame that the eye must be recovered from the donor?
Yes, there are time frames which are best. It's always the sooner the better. Eye banks are allowed to set their own time frame but typically if the donor has been kept cool, the tissue may be recovered for up to 8-12 hours and then placed in special solution before 24 hours. This would allow the tissue to be used for up to 7 days.
Can you tell me where to go for help on organic brain damage?
Organic brain damage, where there's no known cause for the damage, is a contraindication to corneal donation. There are many causes for organic brain damage. Among them are chronic abuses of alcohol or hardening of the arteries. Organic brain damage may lead to clinical dementia and patients with organic brain damage are usually helped through their family doctor or internist with the assistance of a neurologist.
Who is the ideal candidate for this procedure (corneal donation)?
The ideal candidate is a person who has corneal disease that is in the center of the cornea, and no other problems. The typical ideal candidate is one who has a condition called keratoconus. Patients with this condition have thinning of the central cornea to the point they can't wear glasses or contact lenses. Corneal transplant replaces that thin zone, allowing them to see. This group has the best prognosis for good vision with a clear graft. In general, good candidates have corneal conditions which need the transplant and have good ocular and physical health so they can take care of the transplant, and it will survive.
What was the procedure Stevie Wonder was having tried on him at Hopkins?
The procedure that Stevie Wonder was considering is to implant electrodes in the retina area that would then pick up light and transmit it to the brain. There are some similar procedures done creating artificial retinas with electrodes implanted in the brain that help patients to tell night and day and shadowy images. These are somewhat useful in very select patients but they take a great deal of learning. They will not be widely available for many more years.
What is your opinion of Lasik Surgery of the eyes, and how does one decide on a good surgeon to perform the operation?
My opinion of Lasik surgery of the eye is that is it very useful for the right people. We do Lasik surgery at the University of Iowa as do most academic medical centers. The second part of the question is difficult to answer. The best way to find a surgeon is talking to patients who've had the surgery or learning about the surgeon's experience both with Lasik and in ophthalmology in general. The patient needs to be careful that the surgeon they pick counsels them and examines them before surgery and after surgery. In some circumstances patients are "co-managed". Co-management involves other ophthalmologists or optometrists who see you first and then refer you for surgery. If you are in such a situation, you should know the financial arrangements to be sure that the co-manager is compensated appropriately and that you are not being led to surgery only for someone else's profit.
What is the success rate of this procedure (corneal donation) and what is considered a success?
The corneal transplant is successful if it remains clear. Success rate is usually determined at 1, 2, and 5 years. The best success rate in 1 year will be 98 percent clear corneas and is usually in patients with keratoconus or other corneal dystrophies. Over time, success rates drop, so that at 5 years, this group would be 90 percent clear. For all grafts, success rates are typically 80-90 percent in 1 year and 70-75 percent in 5 years, but that includes patients who are less than ideal candidates or who have problems that involve the peripheral cornea. These patients have a higher rate of corneal rejection.
How does one become a donor?
The first thing about becoming a donor is to tell your family. In every state it is a matter of eye bank policy that the family will be asked whether the patient wished to be a donor, even if you have signed an advance directive. When you go to the driver's license bureau in many states, you can sign a card stating that you wish to donate. The card will allow you to specify whether you wish to donate your eyes or your organs or other tissues. If you wish to donate then of course you should sign the card, but the most important thing is to tell your family and close friends about your desire to help even after you're gone. In some states, if you die and the circumstances involve the medical examiner, such as in a car accident, then the medical examiner can authorize donation, but nowadays, every attempt is made to find your family or close friends to find out what your wishes were. So the best thing is to always tell your family. If you have questions about donation, you can contact the eye bank in your area or the organ procurement organization, sometimes called OPO or OPA, for your region. They can provide further information. In Iowa, you can sign up through the Donor Registry on the internet (www.iowadonorregistry.org).
Are there any things that would disallow a person to become a donor, as far as their health while living?
The principal things that disallow you to be a donor are things that would be regarded as unsafe for people who collect the tissue. This would include obvious conditions such as HIV positive status or AIDS, severe infectious problems such as sepsis or hepatitis that is active, which would be unsafe for technicians. The concern would be transmission of these diseases to both the technician through a needle stick or to a recipient of the transplant. There are other more rare conditions such as rabies, which the eye banks and the eye bank technicians will be aware of, but the general public would probably not know about. Every donor has their medical history screened prior to being accepted and having the tissue recovered.
Can someone who has had Lasik surgery be an eye donor for transplant purposes?
The tissue can be used for research and possibly for new forms of deep endothelial corneal transplant. Anyone who's had Lasik, PRK, RK or other corneal surgeries except for cataract surgery cannot be a donor for typical transplant purposes. There are two concerns: The first is the new shape for the cornea will be incorrect for the new recipient. The second is these prior surgeries may keep the donor cornea from surviving the next surgery or transplantation. The healthy posterior portions of donor cornea can be used for this new procedure, DLEK (Deep Lamellar Endothelial Keratoplasty) that helps people with swollen corneas from cataract surgery or Fuchs Dystrophy.
Has consumer designation on driver's licenses been successful?
Consumer designation has been successful because it raises awareness of the public to the need for both tissue and organ transplantation. In this country we have a shortage of organs such as kidneys, hearts and livers for transplantation b/c the requirements are much more stringent than for tissue such as cornea, sclera, bone or skin. By raising the awareness, we make it possible for more people to become donors by asking their families. One law passed in the last year has required all hospitals to notify their regional organ procurement organizations on every death in the hospital. If they don't, the government will cut off their federal funding. This has increased the number of potential and actual donors by a large amount. But nevertheless, unless the potential donor wished to donate or the family feels they wished to be a donor, their tissue and organs cannot be recovered.
Hypothetically, what if everyone had lasik surgery and there was no one left to donate corneas? What would those who need a transplant do?
First of all, not everyone will have Lasik surgery because only about 25 percent of the population needs it. At the present time, less than 1 percent of the population who needs Lasik surgery has had it. There will always be people who have not had eye surgery who can be donors. It merely means we have to get the word out to everyone. People who need corneal transplants will be able to get corneal transplants.
I have had recent problems with what my physician called floaters. What causes this?
Floaters are symptoms of things in front of the eye when you know there's nothing there. They are typically found inside the vitreous cavity. Most of the time they are remnants of arteries that helped form your eye. When you get older the vitreous jelly begins to liquefy and you can see these floaters more easily. Most of the time, they are harmless, but patients who have new floaters, especially associated with flashes of light, should see their ophthalmologist for a complete dilated eye exam to rule out more serious problems such as retinal tears, detachments, or bleeding.
What are the risks of undergoing transplant?
Risks of transplantation are numerous. The most common is that the transplant fails to work. At the time of surgery there are the risks inherent in surgery including infection, bleeding and leaking of the wound so that the eye becomes too soft, but the more usual risks are that the patient will have a rejection episode. Rejection occurs when the body recognizes new tissue that doesn't belong there and tries to eliminate it. This happens about 1 in 7 times. Most of the time it can be prevented or treated with special medications including steroids. Other risks include glaucoma as mentioned earlier, and problems with focusing afterwards such as astigmatism or being too near or far-sighted, so that in general, the procedure is very successful with very rare severe complications, but may need to be repeated in order to finally succeed.

Dr. John Sutphin