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EW SHOW DAILY 44 Meeting Reporter Saturday, April 18, 2015 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer al response has led to a reduction in overall visual impairment world- wide, Dr. Pineda said. For instance, he said there has been a major reduction in onchocerciasis-related blindness in Western Africa; Ghana and Morocco reported elimination of blinding trachoma; Brazil began providing eyecare services through the country's national social security system; and India has made funds available for eyecare services to the poorest people at the district level. As a response to corneal blind- ness, Dr. Pineda said that corneal transplantation has the potential to provide higher social returns than cataract surgery, justifying the cost not only of the procedure itself but of the development of the infra- structure necessary to support the procedure. That infrastructure is particu- larly important for the successful implementation of corneal trans- plantation on a scale that presents a significant response to blindness as a social/public health issue—the procedure is reliant on having estab- lished systems and infrastructures in place for the collection, storage, and distribution of donor tissue. Eye banks thus play a key role, and there are several barriers to eye banking in developing countries. Among these problems are inefficient operations. For instance, in India, Dr. Pineda said that there are more than 700 eye banks. Each provides only 25 transplantable corneas a year. Voluntary operations, he said, are reactive, not proactive, with reduced tissue utilization. More generally, affordability is a major issue for eye banks in the developing world. Storage media is expensive; however, for the last 2 years, the lower cost of Cornisol (Aurolab, Tamil Nadu, India) has been used in more than 70 eye banks in India, Kenya, and Nepal. On top of these are cultural and political barriers, including inade- quate public awareness programs and the absence of favorable legis- lation. In addition, quality surgeon ca- pacity is a key problem. In develop- ing countries, about 50,000 trans- plants are performed by just 1,000 surgeons. The surgical outcomes tend to be poor, and most surgeries remain full thickness penetrating keratoplasties (PK). This needs to be addressed through skills transfer pro- grams in collaboration with academ- ic institutions and non-government organizations. These barriers exist on top of other issues such as patient factors, with most corneal blindness pa- tients among the poor of developing nations. These barriers, however, are not insurmountable. The Santa Lucia International Eye Bank in the Phil- ippines, for instance, produces 1,529 corneas a year. The country imple- ments and has formed expanded and successful eye banking networks with other developing countries such as India, and working in col- laboration with developed countries including the U.S. and Singapore. Now, in 2015, Dr. Pineda said, there remains an "unacceptable number of corneal blind world- wide." There have, however, been improvements in medical care and infrastructure, with programs for increasing the number of quality corneal surgeons. Dr. Pineda encouraged interest- ed ophthalmologists to get involved. His own involvement, he said, has provided him with great profession- al and personal gratification. EW Editors' note: Dr. Pineda has no finan- cial interests related to his lecture. Corneal transplantation has potential for 'higher social returns' than cataract surgery O f the 285 million visually impaired globally— 39 million of whom are blind—90% live in low in- come settings. And while corneal blindness ranks 4th as the cause of blindness globally, it is the second most frequent cause of blind- ness in many developing countries. These statistics framed the keynote lecture given by Roberto Pineda, MD, Boston, at Friday's "Keratoprosthesis and Penetrat- ing Keratoplasty" session at World Cornea Congress VII, in which he discussed "Corneal Transplantation in the Developing World: Lessons Learned." Going further in on corneal blindness statistics, Dr. Pineda said that 2010 WHO data counted 4.9 million people with bilateral corneal blindness. Of this number, a stun- ning 98% was in underdeveloped countries, with higher rates in India and Africa (15–30%). Significantly—particularly given the majority socioeconomic status of this population—patients who have bilateral corneal blindness have higher disability-adjusted life years (DALY) than cataract patients, he said. Moreover, corneal blind- ness "disproportionately affects the young." These facts are particularly frustrating given that 80% of corneal blindness is avoidable. But this last point is hopeful as well: Over the last 20 years, the glob- 'Keratoprosthesis and Penetrating Keratoplasty' I n addition to Dr. Pineda's keynote address, "Corneal Transplantation in the Developing World: Lessons Learned," these physicians spoke on the following topics: • Esen K. Akpek, MD, Baltimore, spoke on "Penetrating Keratoplasty Versus KPro for Failed Graft: Long-Term Outcomes and Complications." • Mona Harris-Dagher, MD, spoke on "Preventing Vision Loss From Glaucoma Following Boston KPro Surgery." • Juan Carlos Abad, MD, Medellín, Colombia, spoke on "Novel Strategies to Improve KPro Outcomes." • Jose de la Cruz Napoli, MD, Chicago, spoke on "Primary Boston KPro: Is It a Reasonable Option?" • Maria Fideliz de la Paz, MD, Barcelona, Spain, spoke on "Osteo- Odonto-keratoprosthesis Update." • Radhika Tandon, MD, New Delhi, spoke on "Therapeutic Keratoplasty: Why, When, and How?" • Victor L. Perez, MD, Miami, spoke on "Graft Rejection: New Tools in Our Armamentarium." EW Dr. Pineda encourages interested corneal surgeons to get involved in addressing corneal blindness in developing nations.

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