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Corneal transplants
HEALTH NOTES Byron Y. Newman, O.D.
Corneal transplants
W
e are all certainly aware of patients with damaged and opaque corneas needing referral to ophthalmology for help, and the benefits commensurate with the successful results of corneal transplants, but it took an e-mail from a friend to present that success from a patient’s perspective. She wrote, ‘‘Eyes are a very valuable part of a human being (even when deceased), which should not be wasted either by burning or burying the body,’’ and went on to say that ‘‘donation of the corneas gives sight to two blind persons, enabling them to come out of their dark and dreary life into a life full of colors, a life where they can see and enjoy this beautiful world!’’ When asked where she read this, she replied that she hadn’t read it anywhere; she just wrote it herself after hearing about the need for donations of corneas to an eye bank. This was motivation to look more deeply into the subject from donations to recipients. A site from the University of Iowa Department of Ophthalmology (www. uihealthcare.com/topics/medicaldepart ments/opththalmology) states that corneal transplantation dates back to the late 1800s, although the first eye bank wasn’t established until the 1930s in Russia, according to the site. It has been a routine procedure since the 1960s and, at present, states the Web site, ‘‘there are over 44,000 corneal transplants done every year, making it the second most common transplant after blood donors.’’ The Eye-Bank for Sight Restoration Web site (www.eyedonation.org) claims to be the world’s first eye bank, established in 1944, and expresses concern about public awareness of the need for
eye donations. This site went on to discuss the history of how a dream of an ophthalmologist and a dynamic woman with a genius for motivating people led the way for the whole field of corneal transplantation. The Eye-Bank for Sight Restoration reports that ‘‘as early as 1905, doctors had discovered that corneal blindness could be cured by removing the damaged cornea. and replacing it with another clear human cornea.’’ But, because donor tissue was not readily available, transplants were rarely performed. In the 1940s, ‘‘a young ophthalmologist, R. Townley Paton, M.D., was convinced that cornea transplantation was a cure that could provide thousands of patients with visual redemption.. Dr. Paton had trained with the famous William Holland Wilmer at Johns Hopkins in Baltimore.’’ After establishing a practice in New York, affiliated with Manhattan Eye, Ear & Throat Hospital, he started his own practice in New York City. ‘‘At the time,’’ states the item, ‘‘the death penalty was in practice, so Dr. Paton would make periodic visits to nearby Sing-Sing prison. With permission from proper authorities, he would obtain consent for donation from prisoners on death row and bring the donor tissue back to the hospital after a prisoner had been executed. It may have been during one of these late night forays that Dr. Paton came to the brilliant conclusion that what was needed was a system for collecting eye donations, processing them and distributing them to doctors for transplant surgeries. People could pledge their eyes in advance of their death, leaving a legacy of sight, just as they already made out their wills. He envisioned an eye bank.’’ This led Dr. Paton and a group of others to form an organization to lay
1529-1839/$ - see front matter Ó 2010 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2010.09.002
Byron Y. Newman, O.D. the groundwork for the Eye-Bank for Sight Resoration. The report goes on, ‘‘To help implement the plan, Dr. Paton wisely solicited the help of Mrs. Aida Breckinridge, a known powerhouse for motivating people..Well-connected to society, business leaders and political figures at the time, Mrs. Breckinridge could wield the influence needed to popularize a unique idea. Plus, the thought of an agency to restore sight appealed to her because she herself suffered from glaucoma and was nearly blind.’’ Since ‘‘there were no legal precedents for obtaining anatomical gifts.laws had to be amended allowing any person to direct the manner in which his body should be disposed of after death.’’ ‘‘Hospitals, first in New York, and then across the country were brought on board to help provide donor tissue. Ophthalmologists from different parts of the country came in for training in cornea transplant surgery.’’ The American Red Cross and Eastern Airlines
566 helped in arranging transportation of needed corneas. ‘‘By the end of the first year, 60 cornea transplants had been made possible, according to the Eye-Bank’s first Annual Report. The initial network of 22 hospitals in the New York area had grown to include 56 others across the country.’’ ‘‘In 1961,’’ continues the article, ‘‘the Eye Bank Association of America was founded with 25 member eye banks. Today, the membership exceeds a hundred and includes locations in Canada and Puerto Rico. Now, more than 33,000 cornea transplants are performed each year in the United States.’’ (Other sources say the number is 44,000.) ‘‘In the beginning,’’ reports the Web site, ‘‘cornea transplant patients had to remain in the hospital for up to two weeks, their heads held still with
Health Notes sandbags to safeguard against rejection.’’ With advances in equipment, ‘‘Today, cornea transplants are often done on an out-patient basis.’’
Becoming a donor The first thing someone should do when deciding to become an eye donor is to tell family members about the decision in case that information is needed later and the donor cannot provide it for whatever reason. According to the University of Iowa Web site, ‘‘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 specifiy whether you wish to donate your eyes or your organs or other tissues. but the most important thing is to tell your family and close friends about your desire to help 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.’’ Hospitals report deaths to organ procurement organizations, but rarely does the family have to contact the eye bank themselves. Not every phone book lists eye banks, but they can be found by searching on the Internet if the directory does not list them.
Corneal transplants
W
e are all certainly aware of patients with damaged and opaque corneas needing referral to ophthalmology for help, and the benefits commensurate with the successful results of corneal transplants, but it took an e-mail from a friend to present that success from a patient’s perspective. She wrote, ‘‘Eyes are a very valuable part of a human being (even when deceased), which should not be wasted either by burning or burying the body,’’ and went on to say that ‘‘donation of the corneas gives sight to two blind persons, enabling them to come out of their dark and dreary life into a life full of colors, a life where they can see and enjoy this beautiful world!’’ When asked where she read this, she replied that she hadn’t read it anywhere; she just wrote it herself after hearing about the need for donations of corneas to an eye bank. This was motivation to look more deeply into the subject from donations to recipients. A site from the University of Iowa Department of Ophthalmology (www. uihealthcare.com/topics/medicaldepart ments/opththalmology) states that corneal transplantation dates back to the late 1800s, although the first eye bank wasn’t established until the 1930s in Russia, according to the site. It has been a routine procedure since the 1960s and, at present, states the Web site, ‘‘there are over 44,000 corneal transplants done every year, making it the second most common transplant after blood donors.’’ The Eye-Bank for Sight Restoration Web site (www.eyedonation.org) claims to be the world’s first eye bank, established in 1944, and expresses concern about public awareness of the need for
eye donations. This site went on to discuss the history of how a dream of an ophthalmologist and a dynamic woman with a genius for motivating people led the way for the whole field of corneal transplantation. The Eye-Bank for Sight Restoration reports that ‘‘as early as 1905, doctors had discovered that corneal blindness could be cured by removing the damaged cornea. and replacing it with another clear human cornea.’’ But, because donor tissue was not readily available, transplants were rarely performed. In the 1940s, ‘‘a young ophthalmologist, R. Townley Paton, M.D., was convinced that cornea transplantation was a cure that could provide thousands of patients with visual redemption.. Dr. Paton had trained with the famous William Holland Wilmer at Johns Hopkins in Baltimore.’’ After establishing a practice in New York, affiliated with Manhattan Eye, Ear & Throat Hospital, he started his own practice in New York City. ‘‘At the time,’’ states the item, ‘‘the death penalty was in practice, so Dr. Paton would make periodic visits to nearby Sing-Sing prison. With permission from proper authorities, he would obtain consent for donation from prisoners on death row and bring the donor tissue back to the hospital after a prisoner had been executed. It may have been during one of these late night forays that Dr. Paton came to the brilliant conclusion that what was needed was a system for collecting eye donations, processing them and distributing them to doctors for transplant surgeries. People could pledge their eyes in advance of their death, leaving a legacy of sight, just as they already made out their wills. He envisioned an eye bank.’’ This led Dr. Paton and a group of others to form an organization to lay
1529-1839/$ - see front matter Ó 2010 American Optometric Association. All rights reserved. doi:10.1016/j.optm.2010.09.002
Byron Y. Newman, O.D. the groundwork for the Eye-Bank for Sight Resoration. The report goes on, ‘‘To help implement the plan, Dr. Paton wisely solicited the help of Mrs. Aida Breckinridge, a known powerhouse for motivating people..Well-connected to society, business leaders and political figures at the time, Mrs. Breckinridge could wield the influence needed to popularize a unique idea. Plus, the thought of an agency to restore sight appealed to her because she herself suffered from glaucoma and was nearly blind.’’ Since ‘‘there were no legal precedents for obtaining anatomical gifts.laws had to be amended allowing any person to direct the manner in which his body should be disposed of after death.’’ ‘‘Hospitals, first in New York, and then across the country were brought on board to help provide donor tissue. Ophthalmologists from different parts of the country came in for training in cornea transplant surgery.’’ The American Red Cross and Eastern Airlines
566 helped in arranging transportation of needed corneas. ‘‘By the end of the first year, 60 cornea transplants had been made possible, according to the Eye-Bank’s first Annual Report. The initial network of 22 hospitals in the New York area had grown to include 56 others across the country.’’ ‘‘In 1961,’’ continues the article, ‘‘the Eye Bank Association of America was founded with 25 member eye banks. Today, the membership exceeds a hundred and includes locations in Canada and Puerto Rico. Now, more than 33,000 cornea transplants are performed each year in the United States.’’ (Other sources say the number is 44,000.) ‘‘In the beginning,’’ reports the Web site, ‘‘cornea transplant patients had to remain in the hospital for up to two weeks, their heads held still with
Health Notes sandbags to safeguard against rejection.’’ With advances in equipment, ‘‘Today, cornea transplants are often done on an out-patient basis.’’
Becoming a donor The first thing someone should do when deciding to become an eye donor is to tell family members about the decision in case that information is needed later and the donor cannot provide it for whatever reason. According to the University of Iowa Web site, ‘‘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 specifiy whether you wish to donate your eyes or your organs or other tissues. but the most important thing is to tell your family and close friends about your desire to help 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.’’ Hospitals report deaths to organ procurement organizations, but rarely does the family have to contact the eye bank themselves. Not every phone book lists eye banks, but they can be found by searching on the Internet if the directory does not list them.