Awareness and attitudes toward corneal donation: challenges and opportunities

Impact of an educational video in improving awareness of eye donation among non-medical health care workers in a tertiary health centre

PURPOSE

To evaluate the impact of an educational video in improving awareness of eye donation among non-medical healthcare workers at a tertiary health centre.

METHODS

A socio-behavioural study on knowledge and attitude towards eye donation was conducted among 373 non-medical healthcare workers through a printed semi-structured questionnaire before and after viewing a bilingual educational video. The responses were evaluated and scored.

RESULTS

Pre-intervention, only 5.4% of the participants had adequate knowledge, which improved significantly to 71.6% after watching the video (P < .001). Respondents with elementary school education showed the greatest change in knowledge. Pre-intervention, 72.4% were willing to donate their eyes, which significantly increased to 89.5% after watching the video. Pre-intervention, 66.22% showed a "highly favourable" attitude, which improved to 97.86% after watching the video.

CONCLUSION

The 25 min video about eye donation and eye banking significantly changed the participants' knowledge, willingness, and attitude. Hence, media-based (video) awareness platforms may be valuable for improving the general public's knowledge and attitude towards eye donation. This may help in enhancing the eye donation rate in the long term.

Trends in Corneal Donation From 2013 to 2022 in Aotearoa-New Zealand: Impact of Donor Age, Gender, Ethnicity, and COVID-19

PURPOSE

To evaluate corneal donation demographics in New Zealand (NZ) and explore changes over time.

METHODS

Data were collected from all donated corneas processed by the New Zealand National Eye Bank over a 10-year period from January 2013 until December 2022. Demographic data including age, self-identified ethnicity, and gender were collected, along with location and cause of death. National death data for the corresponding period were collected online from Statistics New Zealand.

RESULTS

A total of 1842 donors were processed; 1414 (76.8%) were sourced from Aotearoa-New Zealand and the remainder from Australia/United States. There was a small but statistically significant median age difference between NZ donors (68 years, interquartile range 55-76) and overseas donors [66 years (interquartile range) 51-70]. Most (n = 1151 81.4%) of NZ donors died in hospital settings, with the most common cause of death being cerebrovascular (n = 444 31.4%). Individuals were less likely to donate their cornea if they were female, [incidence rate ratio (IRR) 0.746, P < 0.001] older age (IRR 0.968, P < 0.001), or if they were of Māori (IRR 0.178, P < 0.001) or Pasifika ethnicity (IRR 0.125, P < 0.001). There was also a statistically significant decrease in donation rates over time (IRR 0.945, P < 0.001).

CONCLUSIONS

There remains a profound gap between the demand for corneal transplantation and corneal tissue donation, which is worsening with time. Donor age, gender, and ethnicity seem to influence corneal donation rates. These demographic differences may be ameliorated by increased education, cultural safety, further research into those willing to donate, and the establishment of an organ/tissue donation registry.

Jordanian nursing students' knowledge and attitudes of corneal donation

A high success rate of corneal transplants is evident. However, there is still a lack of corneal grafts available to meet demand, largely because donors are reluctant to donate. Given their critical role in future healthcare teaching and advocacy. There has not been much research on Jordanian nursing students' perspectives on corneal donation, so it's critical to identify and eliminate any obstacles. This study aims to evaluate the knowledge and attitudes of Jordanian nursing students concerning corneal donation. A cross-sectional, descriptive design was used to recruit (n = 440) nursing students from four Jordanian universities. A self-reported questionnaire was used to obtain data on knowledge and attitudes regarding corneal donation. The average age of senior nursing students was (M = 23.07, SD = 3.63) years. Varying levels of understanding were revealed amongst university students toward corneal donation items. Generally, good attitude of nursing students toward corneal donation (M = 34.1, SD = 8.1). Weak positive relationship was found between total knowledge scores and age (r = 0.141, p = 0.003) while there is no significant relationship between age and total attitude score (r = 0.031, p = 0.552). Age was found to be a significant predictor (B = 0.01, Beta = 0.12, t = 2.07, p = 0.04). Also, the educational level of fathers is a significant positive predictor (Beta = 0.128, p = 0.008) for the total attitude scores among nursing students. Limited awareness of corneal donation, highlighting the need for focused educational interventions to improve their comprehension.

Small-diameter acellular porcine corneal stroma for peripheral corneal ulceration treatment

AIM

To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma (SAPS) for the treatment of peripheral corneal ulceration (PCU).

METHODS

This retrospective clinical study included 18 patients (18 eyes) with PCU between April 2018 and December 2020. All patients had PCU and underwent lamellar keratoplasty with SAPS. Observation indicators included preoperative and postoperative best-corrected visual acuity (BCVA) and transparency of SAPS. The infection control rate in the surgical eye-lesion area was also calculated.

RESULTS

Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU. None of the patients experienced rejection after 6mo (18/18) and 12mo (16/16) of follow-up. The BCVA (0.47±0.30) at the 6mo follow-up after operation was significantly improved compared with the baseline (0.99±0.80), and the difference was statistically significant (Z=-3.415, P<0.05). The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo (Z=0, P=1). With time, the SAPS graft gradually became transparent. At the 6mo (18/18) and 12mo (16/16) follow-up, none of the patients had recurrent corneal infection.

CONCLUSION

SAPS is clinically effective in the treatment of PCU, improving the patient's BCVA and reducing the incidence of rejection after keratoplasty.

Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study

BACKGROUND

The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information.

OBJECTIVE

The primary objectives of this study were to assess health care professionals' attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application.

METHODS

Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals' perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application's usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed.

RESULTS

The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application.

CONCLUSIONS

The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis.

Views of admitted palliative care patients and their clinicians on corneal donation discussions: a qualitative content analysis of semi-structured interviews

BACKGROUND

There is a severe shortage of corneas for donation, globally, for transplantation and research purposes. One group of individuals who could potentially be donors are those who die within the inpatient palliative care unit. The aim of the study was to understand clinician and patient perceptions of corneal donations and discussion of donation in palliative care units.

METHODS

A qualitative design was utilised with data collected through semi-structured interviews and analysed using qualitative content analysis. A total of 46 interviews were undertaken involving inpatient palliative care unit patients (19) and clinicians (27) in three major inpatient palliative care units in South Australia.

RESULTS

Very few patient participants reported being asked about corneal donations during their time in palliative care. Most inpatient palliative care unit clinicians did not raise the topic as they felt other areas of care took precedence. Inpatient palliative care unit patients thought if inpatient palliative care unit clinicians did not raise the topic, then it was not important. There were some differences between patient and clinician views, such as preference about who raises the possibility of donation and when the discussion might occur.

CONCLUSIONS

Findings suggest that patients are receptive to discussing corneal donations, but clinicians are not initiating these. This is a missed opportunity for donors and potential recipients. We recommend that clinicians routinely discuss eye donation as part of palliative care.

Correlation Between the Cost and Safety of Corneal Graft Types

Background Corneal diseases are the fourth most common cause of blindness worldwide. In the majority of these diseases, vision reduction is reversible and can be restored to a large extent by replacing the cornea through specific surgery and, in particular, transplantation. In Greece, due to a lack of organized eye banks as well as donors, the grafts intended for corneal transplantation usually come from eye banks abroad. This study focuses on the dynamics of cost versus value in the decision-making process for the procurement of corneal grafts, ultimately investigating the safety that the procured grafts provide to patients. Methodology A total of 267 patients with severe vision problems who underwent 301 corneal and amniotic membrane transplants from years 2020 to 2023 at the Transplant Unit of the Athens General Hospital "Georgios Gennimatas" were included in this study. All patients who were deemed appropriate to undergo corneal transplant operations, the diagnosis that led to the specific surgery, and other relevant data were recorded and evaluated. Results There was no significant difference in the ratio between males and females (51.3% male and 48.7% female). The mean age of the patients was 66.5 years (SD = 13.7 years). Graft problems were faced by 13.9% of the patients, with the amniotic membrane by 1.5% (in the total number of surgical operations) and both eyes by 4.5% of patients. The majority of the patients had undergone only one surgery (88.8%). Reoperation was needed in 14% of the cases, and 7.6% of the cases were surgeries that occurred due to graft rejection or non-functioning grafts from surgeries performed at another hospital or clinic. In the majority of surgeries (60.8%), a Descemet's stripping automated endothelial keratoplasty graft was used. The mean cost was 3,167 euro (SD = 960.3 euro). Furthermore, in 35.8% of the surgeries, the graft was preserved with amphotericin. Conclusions The present study draws useful conclusions about the effectiveness of surgical interventions through the correlation of cost and safety of the grafts that are approved and finally used in corneal transplants, as well as the submission of proposals to improve the procedures and lead to patient benefits.

Applications of SMILE-extracted lenticules in ophthalmology

AIM

To review recent innovations, challenges, and applications of small incision lenticule extraction (SMILE) extracted lenticule for treating ocular disorders.

METHODS

A literature review was performed in the PubMed database, which was last updated on 30 December 2021. There was no limit regarding language. The authors evaluated the reference lists of the collected papers to find any relevant research.

RESULTS

Due to the simplicity and accuracy of modern femtosecond lasers and the extensive development of SMILE surgery, many healthy human corneal stromal lenticules were extracted during surgery, motivating some professionals to investigate the SMILE lenticule reusability in different ocular disorders. In addition, new approaches had been developed to preserve, modify, and bioengineer the corneal stroma, leading to the optimal use of discarded byproducts such as lenticules from SMILE surgery. The lenticules can be effectively re-implanted into the autologous or allogenic corneas of human subjects to treat refractive errors, corneal ectasia, and corneal perforation and serve as a patch graft for glaucoma drainage devices with better cosmetic outcomes.

CONCLUSION

SMILE-extracted lenticules could be a viable alternative to human donor corneal tissue.

Fusogenic liposome-coated nanoparticles for rapid internalization into donor corneal endothelial tissue to enable prophylaxis before transplantation

Cold stress (hypothermia) during storage and cytokine stress due to acute allograft rejection adversely affect the donor corneal endothelium in the short term. Pharmacological pre-treatment (before transplantation) of the donor corneal endothelium or cells (propagated in vitro for cell injection therapy) with microtubule stabilizers, cold stress protectants, and other molecules is an attractive strategy to tackle damage caused by hypothermia and cytokine stress. These molecules can be delivered intracellularly to the donor corneal endothelium or cells at controlled rates for desired periods and with one-time administration using nanoparticles. However, the death-to-preservation time of donor corneas of more than 4 to 6 h significantly decreases endothelial cell density and increases the risk of microbial contamination. Therefore, we have developed fusogenic liposome-coated nanoparticles for rapid internalization of nanoparticles into cultured corneal endothelial cells and ex vivo corneal endothelial tissue. Here, we have shown that the fusogenic liposome-coated nanoparticles have the intrinsic ability to efficiently and rapidly internalize into cultured corneal endothelial cells and ex vivo corneal tissue within 3 h by possibly fusing with the cell membrane and bypassing the endocytic pathway. Lactate dehydrogenase assay showed that the internalized fusogenic liposome-coated nanoparticles did not cause cytotoxicity in endothelial cells associated with the ex vivo cornea for at least up to 2 days. Thus, fusogenic liposome-coated nanoparticles have great potential as a platform for engineering cells and endothelial tissue of donor corneas to facilitate prophylactic drug delivery during storage and after transplantation.

A study on knowledge, attitude, and practice about eye donation among medical students and healthcare professionals at a tertiary hospital in Eastern India

Purpose

To assess and analyze the rate of knowledge, attitude, and practice patterns about eye donation among medical and healthcare professionals in a tertiary care hospital in eastern India.

Methods

This was a cross-sectional, descriptive study conducted on medical students, resident doctors, and nursing and paramedical staff at a tertiary institute in the year 2020. A pretested, structured questionnaire consisting of 28 questions in the three subsections based on knowledge and awareness, attitudes and beliefs, and practice patterns mainly willingness to donate eyes by pledging, was noted. All the responses were individually scored, and the total scores were calculated. Univariate analysis was done to find out the factors that had a positive or negative influence on the knowledge and willingness about eye donation.

Results

Around 270 participants responded to this survey. The majority of the respondents (206, 76.3%) were below 30 years and 64.4% were males. Awareness about eye donation was 95.6% but a willingness to pledge was observed in 51.5% of participants. The total practice score was lower among nonmedicos compared with medicos (3.33 ± 1.22 vs 3.74 ± 0.64), (P < 0.001). On univariate analysis, the Crude Odds Ratio with a 95% confidence interval was 25.787 (5.18-128.33) in the occupational category (P < 0.001).

Conclusion

The study reported an adequate knowledge level among doctors and healthcare workers. The practice pattern among the nursing staff and paramedical workers needs to be improved as they can play a pivotal role in strengthening the hospital corneal retrieval program. They can also be the key messengers during public awareness campaigns for eye donations in our country.

Attitudes and factors influencing organ donation decision-making in Damascus, Syria: a cross-sectional study

Organ donation is vital to saving lives, but its success depends on people's willingness to donate organs. This descriptive cross-sectional survey aimed to investigate attitudes towards organ donation in Damascus, Syria. Understanding attitudes is crucial for the success of organ donation programs, especially in countries with similar settings. This study was a descriptive cross-sectional survey aimed at understanding patients' attitudes towards organ donation in Damascus, Syria. Data was collected through a carefully constructed validated survey through face-to-face interviews. 600 participants were randomly interviewed, 62.8% agreed to donate their organs after death, with helping others being the primary reason. Religious beliefs were the primary reason for organ refusal in males, while for females, it was lack of knowledge and religious beliefs. However, there were no significant differences between genders or educational level and age groups in the acceptance of organ donation. The percentage of those who agree to donate their organs after death encourages taking an effective step to build an integrated donation system, not just a center. Bearing in mind that there is no correlation with age, gender or even educational level, which means that the system may include different groups of society.

Electro-compacted collagen for corneal epithelial tissue engineering

Bioengineered corneal substitutes offer a solution to the shortage of donor corneal tissue worldwide. As one of the major structural components of the cornea, collagen has shown great potential for tissue-engineered cornea substitutes. Herein, free-standing collagen membranes fabricated using electro-compaction were assessed in corneal bioengineering application by comparing them with nonelectro-compacted collagen (NECC). The well-organized and biomimetic fibril structure resulted in a significant improvement in mechanical properties. A 10-fold increase in tensile and compressive modulus was recorded when compared with NECC membranes. In addition to comparable transparency in the visible light range, the glucose permeability of the electro-compacted collagen (ECC) membrane is higher than that of the native human cornea. Human corneal epithelial cells adhere and proliferate well on the ECC membrane, with a large cell contact area observed. The as-described ECC has appropriate structural, topographic, mechanical, optical, glucose permeable, and cell support properties to provide a platform for a bioengineered cornea; including the outer corneal epithelium and potentially deeper corneal tissues.

Clearing the path to vision restoration: an analysis of attitudes and associated factors towards cornea donation in Syria

OBJECTIVE

This study aims to assess attitudes and associated factors towards cornea donation among visitors of a main public hospital in Damascus. Findings of this study can contribute to the development of effective donation campaigns and applying cornea donation in Syria.

METHODS

This cross-sectional study included individuals who were above 18 years old and were visitors of Al-Mouwasat University Hospital in Damascus, Syria. Data were gathered using a questionnaire administered through face-to-face interviews with the participants. A validated questionnaire was used and consisted of three sections: demographic information, awareness assessment and evaluation of participants' attitudes towards corneal donation. Associations between participants' demographics and variables were tested using χ² test, and a p value of <0.05 was considered significant.

RESULTS

637 participants were randomly interviewed. 70.8% of the sample were female and 45.7% have heard about cornea donation. 68.3% of the participants accepted donation of their cornea after death, but this decreased to 56.2% when it comes to donation from relatives after their death. The main reasons for refusing and accepting cornea donation were religious beliefs (10.8%) and intention to help others (65.8%), respectively. Women were more likely to accept donation after death than men (71.4% vs 60.8%, p=0.009). Finally, acceptance of cornea donation would increase if participants lived in a more developed country (71.7% vs 68.3%).

CONCLUSION

Despite the high willingness, corneal donation in Syria is still not enough. Corneal donation requires an ensured donation system that supports and organises the processes, a simplified education about the importance of donation, and clarifying the right instructions of religion.

Prevalence and Predictors of Knowledge and Attitudes Toward Eye Donation Among the General Population: A Systematic Review

PURPOSE

The purpose of this systematic review was to investigate knowledge and attitudes toward eye donation and sources of eye donation information among the general population.

METHODS

A search was conducted using MEDLINE through Ovid and Scopus; CINAHL through EBSCOhost and ProQuest; and Embase through Ovid database entries from January 2010 to March 2021. Quantitative studies were selected if they included participants aged 16 years or older from the general population (nonhealthcare) and had a sample size of >200. Studies were included if they measured knowledge and attitudes toward eye donation and sources of eye donation information. Methodological quality was assessed using JBI criteria, and the data were analyzed using SUMARI software.

RESULTS

A total of 25 studies were included in this review. Pooled data from 6 studies demonstrated that 30.8% of participants [95% confidence interval (CI) = 11.0-55.4] had some knowledge of eye donation. Seventeen studies reported that 40.6% (95% CI = 39.8-41.3) were willing to donate their eyes, and 5 of these studies found that 7.3% (95% CI = 6.5-8.3) had already pledged their eyes. Eleven studies reported on the source of eye donation information, indicating 50.9% of participants (95% CI = 49.8-52.1) received information from mass media.

CONCLUSIONS

The results of this review indicate that understanding eye donation knowledge and attitudes is crucial for developing interventions or tools to increase eye donation rates. Further studies in different populations are required.

An Overview of Corneal Transplantation in the Past Decade

The cornea is a transparent avascular structure located in the front of the eye that refracts light entering the eyes and also serves as a barrier between the outside world and the internal contents of the eye. Like every other body part, the cornea may suffer insult from trauma, infection, and inflammation. In the case of trauma, a prior infection that left a scar, or conditions such as keratoconus that warrant the removal of all or part of the cornea (keratoplasty), it is important to use healthy donor corneal tissues and cells that can replace the damaged cornea. The types of cornea transplant techniques employed currently include: penetrating keratoplasty, endothelial keratoplasty (EK), and artificial cornea transplant. Postoperative failure acutely or after years can result after a cornea transplant and may require a repeat transplant. This minireview briefly examines the various types of corneal transplant methodologies, indications, contraindications, presurgical protocols, sources of cornea transplant material, wound healing after surgery complications, co-morbidities, and the effect of COVID-19 in corneal transplant surgery.

Analysis of motivating factors for eye donation among families of eye donors in South India - A questionnaire-based study

Purpose

To report the factors influencing eye donation among families of successful eye donors in India.

Methods

The consenting family members of 434 deceased individuals who donated eyes between April 2019 and March 2020 were retrospectively interviewed via a telephonic questionnaire survey. Details regarding the donors and their families, motivating factors for eye donation, and time taken for tissue recovery were collected and analyzed.

Results

The mean age of donors was 66.8 years, and only 13.9% of them had pledged to donate their eyes before death. For 62.3% of donations, children of donors were the primary consenters for eye donation. In 18.8% of donors, there was a previous history of eye donation in the family. Many donations were motivated by a non-governmental organization volunteer (40.5%) or by a grief counselor at the hospital (27.4%). Hospital-based corneal retrieval programs and donations where the first eye bank contact was made through hospital personnel had the greatest percentage of rapid enucleations (performed within 3 h after death) (48.7% and 49.1%, respectively; P = 0.001 and P = 0.02, respectively).

Conclusion

Children of donors, typically in the working-age group, most often make the decision for donation, and hence, future awareness programs should focus on this specific population. All types of hospitals should advocate for eye donation as they are a common point of contact for a grieving family, and health-care professionals at all levels should be considered for training as motivators for eye donation.

Live Donation of Corneal Tissue in the Setting of Orbital Exenteration for Malignancy

Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.

Evolution of corneal transplantation techniques and their indications in a French corneal transplant unit in 2000–2020

Purpose

This retrospective cohort study assessed the evolution of corneal transplantation and its indications in the last 21 years (2000–2020) in a specialized ophthalmology department in a tertiary referral center in France.

Methods

The surgical techniques and indications, patient age and sex, and postoperative best-corrected visual acuity (BCVA) 6 months after keratoplasty were extracted.

Results

In total, 1042 eyes underwent keratoplasty in 2000–2020. Annual numbers of corneal transplantations increased by 2.2-fold. Penetrating keratoplasty (PKP) was the sole technique for the first 11 years. Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) were introduced in 2011 and 2014, respectively. Cases of both quickly increased, accounting for 28% and 41% of cases in 2015–2020, respectively. Eventually, DSAEK and DMEK were respectively used for most pseudophakic bullous keratopathy (PBK) and all Fuchs endothelial cell dystrophy (FECD) cases. PKP cases declined to 27%. Deep anterior lamellar keratoplasty (DALK) was rare (3% of all cases). These changes associated with rises in PBK and particularly FECD cases, and a strong decline in keratoconus, causing FECD, PBK, and keratoconus to move from being the 4^th, 1^st, and 3^rd most common indications to the 1^st, 2^nd, and 6^th, respectively. On average, BCVA improved by 0.1–0.3 logMAR. Patient age dropped steadily over time. Female predominance was observed.

Conclusions

The invention of DSAEK and then DMEK precipitated an enormous change in clinical practice and a large expansion of keratoplasty to new indications. This study confirms and extends previous findings in other countries.

The impact of having a relative in a need for cornea: the Knowledge, Attitude, and Willingness for Corneal Donation (KAWCD) questionnaire

Despite the advancement in the field of corneal transplantation, corneal donation is still the only source for cornea. In our study, we aimed to find predictors for a person's willingness toward cornea donation, and the impact of having a relative in a need for cornea transplantation on the willingness to donate cornea. The study included two cohorts to be compared, first degree relatives of patients waiting for corneal transplantation, and general ophthalmology patients who do not have relatives waiting for corneal donation. We designed questionnaire on Knowledge, Attitude, and Willingness for Cornea Donation (KAWCD), a tool specifically designed to measure the knowledge about corneal donation, and the attitude towards it. A total of 269 participants were included in this study, with a mean age of 49.59 (± 17.24) years. We included 182 (67.7%) participants who did not have a relative with or in need for corneal transplantation, and 87 (32.3%) participants who are first degree relatives to patients on the waiting list for corneal transplantation. Upon assessing factors predicting willingness for corneal donation, we found that attitude (p < 0.001; OR 1.126 (95% CI 1.08 to 1.17)) and age (p = 0.022; OR 0.973 (95% CI 0.95 to 0.99)) are the only predictors for willingness to donate. We found that the willingness to donate cornea is related to the attitude, rather than the knowledge about corneal donation. We believe awareness campaigns should focus on encouragement to donate corneas, rather than providing information about it.

Biomechanical Evaluation of Decellularized and Crosslinked Corneal Implants Manufactured From Porcine Corneas as a Treatment Option for Advanced Keratoconus

Currently corneal transplantation is the main treatment for late-stage keratoconus; however, transplantation procedures are accompanied by significant risk of post-surgical complications; this in addition to supply limitations imposed by a worldwide shortage of human donor corneas, has driven the development of alternative therapies. One such therapy is the use of corneal implants derived from porcine corneas (Xenia^®, Gebauer Medizintechnik GmbH, Neuhausen, DE). In contrast to human donor tissue, these implants can be produced on demand and due to the processes used pose no risks for host-immune rejection. Their use has already been demonstrated clinically in patients for preventing the progression of topographic changes in keratoconus whilst improving visual acuity. The implants are derived from natural tissue and not standardised synthetic material, whilst this likely reduces the risk of issues with bio-incompatibility, there is inevitably variability in their intrinsic mechanical properties which requires investigation. Here, speckle interferometry is employed to examine the biomechanical properties, in response to physiologically representative forces, of native porcine corneal tissue prior to processing and after a proprietary 4-stage process involving decellularization, washing, compression and crosslinking. The control lenticules had an average Young’s modulus (E) of 11.11 MPa (range 8.39–13.41 MPa), following processing average E of the lenticules increased by 127% over that of the unprocessed tissue to 25.23 MPa (range 18.32–32.9 MPa). The variability in E of the lenticules increased significantly after processing suggesting variability in the propensity of the native tissue to processing. In summary, it is possible to produce thin (<90 µm) lenticules from porcine corneas with enhanced stiffness that are effective for treating late-stage keratoconus. Due to the observed variability in the responses of lenticules to processing, interferometry could be a useful technique for ensuring quality control in commercial production via biomechanical screening.

Eye Donation: Awareness, Knowledge, Willingness, and Barriers among Paramedical and Allied Health Science Students at a Tertiary Care Teaching Hospital in South India

Background

Visual impairments have physical, emotional, social, and economical consequences and are a crucial element influencing one's quality of life. A total of 1.285 million people are estimated to be visually impaired worldwide of which 39 million are categorised as blind. These figures are startling, given that 80 percent of known vision impairments are either treatable or preventable. Corneal transplants appear to be our best hope for resolving this problem; however, a global shortage of available donors continues to dampen efforts addressing this issue.

Methods

This two-year cross-sectional study employed a convenience sampling technique and a standardised questionnaire to survey 150 paramedical and allied health science students at a tertiary care teaching hospital and assessed the awareness, knowledge, willingness and barriers regarding eye donation.

Results

The study revealed a 93.3% awareness rate of the donation procedure, of which 46% attributed their awareness to media sources. However, other aspects assessed had much lower awareness rates; when the eyes are donated (53.3%), optimal time period for retrieval of tissue/organ (54%), ideal part transplanted (54%), age limit not restricting donation (67%), donation by donors using spectacles (48%), confidentiality of the donor and recipient (54%), hospital having the facility of an eye bank (63%). 49 percent of the respondents were willing to pledge themselves as eye donors, and a majority of the unwilling respondents reported that familial opposition was the reason for their hesitation.

Conclusion

Knowledge levels appear to be below expectations, and more effort is required to ensure that knowledge is imparted to our healthcare practitioners, who will then transfer this knowledge to the population, resulting in an increase in donation rates.

Safety and efficacy of corneal tissue harvested from organophosphorous deceased patients

Purpose:

To analyze the quality of tissues and outcome of corneal transplants from tissues harvested from the donors of organophosphorus poisoning victims.

Methods:

A retrospective study was carried out on corneas harvested from organophosphorus poisoning victims between January 2016 and December 2018. Details of quality of tissues and outcome following keratoplasty were collected from the eye bank and outpatient records, respectively.

Results:

Four hundred and seventy-eight donor corneas were collected from the victims of organophosphorus poisoning during the study period. The mean age of the donor was 38.8 ± 16.5 years. The mean donor-to-preservation time was 6.2 ± 3.2 hours. The mean endothelial cell density on specular microscopy was 2986.5 ± 369.0 cells/mm². Four hundred and twenty-two (88.2%) donor corneas were utilized. Of the 121 corneas utilized at our institute for transplantation, 73 and 48 corneas were for optical and therapeutic/tectonic indications, respectively. Of the 73 optical grafts, 25 patients were lost-to-follow-up and 58.3% (28/48) who came for one-year follow-up were found to be clear.

Conclusion:

Donor corneas retrieved from organophosphorus poisoning are safe for transplantation. The postoperative outcome of the tissue utilized from these donors is satisfactory.

Knowledge and Attitudes toward Cornea Donation among Different Social Groups in Poland

BACKGROUND

Limited access to corneal tissue for transplantation remains a challenge in many parts of the world. To date, little attention has been paid to the problem of the cornea donor shortage in Poland, where the number of waiting patients exceeds the number of transplants performed three-fold. The aim of this study was to assess the knowledge and willingness towards participating in corneal donation among different social groups in Poland.

METHODS

This prospective, cross-sectional study was conducted among health professionals, medical students, clerics, teachers, journalists, employees and patients of the District Railway Hospital in Katowice. Online and paper questionnaires were used to collect socio-demographic data and information regarding awareness of, knowledge about and attitudes toward corneal donation. For health professionals and medical students, the questionnaires contained additional questions concerning knowledge and solutions for expanding the donor pool. Descriptive analysis and associations were evaluated using the chi² test.

RESULTS

In the survey, 1026 participants took part, including 370 (36.06%, group 1) health professionals and 656 (63.94%, group 2) participants from a non-medical field. A total of 330 (89.18%) from group 1 and 528 (80.49%) respondents from group 2 expressed willingness to donate their corneas. The main reason for refusal of donation in both groups was a lack of knowledge concerning eye donation (7.8%). A social campaign (64.6%) was the most frequently chosen solution for increasing the number of potential donors by health professionals and medical students. In the group of doctors, not knowing how to report a potential donor was chosen as the greatest source of difficulty in donor reporting (40%).

CONCLUSIONS

In the present study, the willingness to donate one's eyes was substantial in both groups. Social campaigns and improving knowledge concerning the donor reporting process among health professionals might be beneficial in expanding the donor pool.

Awareness on Eye Donation in the North-eastern State of Tripura, India - The Tripura Eye Survey

Purpose: To determine the awareness on eye donation and willingness to pledge eyes for donation among the population aged ≥40 years in the northeastern state of Tripura, India. Methods: A population-based cross-sectional study was carried out among 2,500 participants. The investigators conducted a detailed interview on awareness of eye donation and willingness to pledge eyes for donation. 'Awareness' was defined as having heard about eye donation. Those who reported awareness of eye donation were asked a question on willingness to pledge their eyes. Results: A total of 2,440/2,500 (97.6%) participants responded to the questionnaire. Among these, 1,216 (49.8%) participants were men, and 859 (35.2%) had no education. The mean age of the participants was 54.7 years (standard deviation:12.1 years). Overall, 61.4% (95% CI:59.5-63.4; n = 1,499) reported awareness of eye donation; of those only 3.8% (95% CI:2.9-4.9; n = 57) were willing to pledge their eyes for donation. On multivariable analyses, the odds of awareness were higher among those who had school education (OR:2.12; 95% CI: 1.73-2.56) or higher education (OR:11.79; 95% CI:7.35-18.93). Deformity associated with eye donation (n = 327;76.9%) followed by religious reasons (n = 63; 14.8%) and a belief that those who donate eye are 'born blind in the next birth' (n = 23; 5.4%) were the main reasons for lack of willingness to pledge their eyes for donation. Conclusions: Although the awareness regarding eye donation was satisfactory, there was lack of willingness to pledge eyes for donation. There is a need for focussed information, education, and communication campaigns to encourage eye donation in Tripura.

Adaptation of the MAUQ and usability evaluation of a mobile phone-based system to promote eye donation

INTRODUCTION

Mobile Applications (apps) are commonly used in the health care settings to improve the quality of care, however prior to the release of the app it is vital to evaluate its usability. Therefore, the aim of this study is to adapt the mobile Health App Usability Questionnaire (MAUQ) and measure the usability of the Eye donor Aust App using the modified instrument (m-MAUQ).

METHODS

The study was undertaken using a convenience sample of 94 patients and their carers attending three eye clinics and one outpatient department in a large hospital in Sydney Australia. The study was conducted in two phases. Phase 1 involved the adaptation of the MAUQ, and validity testing of the modified version. Phase 2 included the usability evaluation of the Eye donor Aust App using the modified MAUQ (m-MAUQ).

RESULTS

The m-MAUQ comprised of 15 items and the content validity of the instrument was considered satisfactory. Exploratory factor analysis supported a three-factor structure namely: ease of use and satisfaction (nine items), usefulness in obtaining information (three items), and system information arrangement (three items). The internal consistency for the subscales and the total scale was high with Cronbach's alpha values greater than 0.90. The usability score for the Eye donor Aust App was high (mean 5.99; SD 0.74). The construct validity was supported as there were no differences in usability scores among males and females. Older people found the app less useful for obtaining information about eye donation.

CONCLUSIONS

The results support the use of the m-MAUQ as a valid instrument to measure the usability of the Eye Donor Aust App. This instrument requires further testing in other groups of people. Usability testing of the Eye Donor Aust app demonstrated that the participants were satisfied with the content and functionality of the app stating that it was well organised, visually appealing and user friendly. This result could translate into more people using the app and thereby increasing their knowledge and attitude towards eye donation as well as registering to become a donor.

Eye Banks: Future Perspectives

Technological progress and societal change are transforming medicine, and cornea banks are no exception. New infectiological factors, statutory requirements, management concepts, globalisation and digitalisation are also influencing how such facilities will operate in the future. The goal of providing high quality material to patients with corneal disease remains unaltered. The present article seeks to shed light on the type of material this will involve and under what circumstances it is to be obtained.

Awareness and attitudes toward corneal donation among Canadians: informational and motivational videos can increase willingness toward corneal donation

OBJECTIVE

To assess the knowledge of corneal transplantation, willingness toward corneal donation, and the efficacy of a short informational and motivational video in increasing the willingness toward corneal donation among Canadian adults.

METHODS

Cross-sectional interventional study. A survey targeted Canadian adults, assessing their knowledge and attitude toward corneal donation and the efficacy of a 1-minute-long informative and motivational video on increasing willingness toward corneal donation.

RESULTS

The survey was accessed by 1361 individuals and 1013 completed the questionnaire (74% completion rate). The sample consisted of 36% males and 64% females, with an average age of 37.0 ± 15.3 years. The majority (58%) thought to lack basic knowledge about corneal donation. Similarly, objective knowledge of corneal donation was relatively low, with an average score of 7.8 ± 4.5 (out of 20). In our sample, 44% had not opted-in for organ donation, among whom willingness to donate one's own cornea increased from 59% pre-video to 79% post-video (relative increase of 34%; p < 0.001). Lack of awareness about the benefits of corneal donation was the most commonly cited reason for unwillingness to donate.

CONCLUSIONS

The results demonstrated a general lack of awareness of corneal donation among the Canadian population and highlighted the efficacy of a short informative and motivational video in increasing willingness to donate corneal tissue. With lack of awareness about the benefits of corneal donation being among the primary reasons for the unwillingness to donate, simple but efficacious interventions via informative and motivational videos can increase tissue donors and help reduce corneal tissue shortage.

Making the decision to donate eyes: Perspectives from the families of the deceased in Madurai, India

Purpose:

To identify factors affecting family members' decision whether to donate eye organs.

Methods:

A community-based case-control study based on in-home interviews with families of deceased individuals who had or had not donated eye organs, in Madurai district, Tamil Nadu, India. Data collected were knowledge and awareness of eye donations, whether the deceased individual had expressed or pledged willingness to donate, and family members' attitudes and willingness to donate their own eye organs.

Results:

Seventy-six families of donors and 256 families of non-donors completed the survey. Multivariable analysis showed that the following variables were significantly associated with a donation: age, whether the deceased had registered for eye donation, pre-expressed willingness of deceased to donate, whether family members personally know beneficiaries of eye donations, and higher score on a scale evaluating knowledge and awareness about eye donation. The majority of donors' families (71%) had been encouraged by someone to donate. Among non-donor families, a substantially larger fraction (52.8%) indicated they would have donated had someone reminded or encouraged them to do so, in comparison with those who indicated lack of awareness or knowledge (14.5%).

Conclusion:

Community programs are likely to be effective if they encourage individuals to pledge their eyes or express their willingness to donate their eyes to family members in advance of death; they increase public awareness of the value of eye donation. A friend, family member, neighbor or counselor approaching bereaved families and having a dialogue about eye donation would substantially increase the probability of a decision to donate.

Safety of grafting acellular human corneal lenticule seeded with Wharton's Jelly-Derived Mesenchymal Stem Cells in an experimental animal model

The present study was conducted to evaluate safety of grafting acellular human corneal lenticule seeded with Wharton's Jelly-derived Mesenchymal Stem Cells (WJSC) in an experimental animal model. Human corneal lenticules were decellularized with a rate of about 97% with an acceptable lack of cytotoxicity and relatively intact ultrastructure of the lenticules. 12 rabbits underwent unilateral stromal pocketing with implantation of decellularized lenticules. Implantation was performed for 6 rabbits along with graft recellularization with WJSCs. Rabbits were euthanized after 1 month (n = 6) and 3 months (n = 6) to evaluate progression of graft bio-integration. No clinical rejection sign was detected during the study. Histopathological analysis showed that, grafts were integrated well with the least distortion of surrounding collagen bundles. After 3 months, labeled WJCS was detected representing viability of stem cells in the host. Increased expression of keratocyte-specific markers showed the potential of recruiting WJSCs as keratocyte progenitor cells to reinforce corneal ultrastructure.

Translational and Regulatory Challenges of Corneal Endothelial Cell Therapy: A Global Perspective

Cell therapies are emerging as a unique class of clinical therapeutics in medicine. In 2015, Holoclar (ex vivo expanded autologous human corneal epithelial cells containing stem cells) gained the regulatory approval for treating limbal stem cell deficiency after chemical eye burn. This has set a precedent in ophthalmology and in medicine, reinforcing the therapeutic promise of cell therapy. However, to generalize and commercialize cell therapies on a global scale, stringent translational and regulatory requirements need to be fulfilled at both local and international levels. Over the past decade, the Singapore group has taken significant steps in developing human corneal endothelial cell (HCEnC) therapy for treating corneal endothelial diseases, which are currently the leading indication for corneal transplantation in many countries. Successful development of HCEnC therapy may serve as a novel solution to the current global shortage of donor corneas. Based on the experience in Singapore, this review aims to provide a global perspective on the translational and regulatory challenges for bench-to-bedside translation of cell therapy. Specifically, we discussed about the characterization of the critical quality attributes (CQA), the challenges that can affect the CQA, and the variations in the regulatory framework embedded within different regions, including Singapore, Europe, and the United States. Impact statement Functional corneal endothelium is critical to normal vision. Corneal endothelial disease-secondary to trauma, surgery, or pathology-represents an important cause of visual impairment and blindness in both developed and developing countries. Currently, corneal transplantation serves as the current gold standard for treating visually significant corneal endothelial diseases, although limited by the shortage of donor corneas. Over the past decade, human corneal endothelial cell therapy has emerged as a promising treatment option for treating corneal endothelial diseases. To allow widespread application of this therapy, significant regulatory challenges will need to be systematically overcome.

Regenerative capacity of the corneal transition zone for endothelial cell therapy

The corneal endothelium located on the posterior corneal surface is responsible for regulating stromal hydration. This is contributed by a monolayer of corneal endothelial cells (CECs), which are metabolically active in a continuous fluid-coupled efflux of ions from the corneal stroma into the aqueous humor, preventing stromal over-hydration and preserving the orderly arrangement of stromal collagen fibrils, which is essential for corneal transparency. Mature CECs do not have regenerative capacity and cell loss due to aging and diseases results in irreversible stromal edema and a loss of corneal clarity. The current gold standard of treatment for this worldwide blindness caused by corneal endothelial failure is the corneal transplantation using cadaveric donor corneas. The top indication is Fuchs corneal endothelial dystrophy/degeneration, which represents 39% of all corneal transplants performed. However, the global shortage of transplantable donor corneas has restricted the treatment outcomes, hence instigating a need to research for alternative therapies. One such avenue is the CEC regeneration from endothelial progenitors, which have been identified in the peripheral endothelium and the adjacent transition zone. This review examines the evidence supporting the existence of endothelial progenitors in the posterior limbus and summarizes the existing knowledge on the microanatomy of the transitional zone. We give an overview of the isolation and ex vivo propagation of human endothelial progenitors in the transition zone, and their growth and differentiation capacity to the corneal endothelium. Transplanting these bioengineered constructs into in vivo models of corneal endothelial degeneration will prove the efficacy and viability, and the long-term maintenance of functional endothelium. This will develop a novel regenerative therapy for the management of corneal endothelial diseases.

Corneae from body donors in anatomy department: valuable use for clinical transplantation and experimental research

Background

Explanted corneae are highly needed for the surgical management of patients with severe corneal diseases. The aim of this study was to determine whether the body donors from the Institute of Anatomy are a suitable source of donor corneae.

Methods

At the Institute of Anatomy at Saarland University Medical Center in Homburg, corneae are prelevated from body donors who had consented to the removal of tissues for transplantation purposes during their lifetime. Following the report of death, the LIONS Eye Bank is informed and the contraindications of corneal explantation are clarified. Obtaining a blood sample within 24 h postmortem is mandatory.

Results

The Institute of Anatomy had 150 body donors in the time period from January 2018 to June 2019. Out of these, 68 (45.3%) were reported to the Eye Bank. The age of the donors (median 82 years (range: 57–96)) is not critical since the quality of the corneae depends on the number of endothelial cells (mean: 2109 ± 67 cells/mm² (range: 511–2944 cells/mm²)). Contraindications were present in 19 (12.6%) cases. The corneae were extracted from 49 (32.7%) body donors. Out of these 98 corneae, 46 (46.9%) were successfully transplanted. Of all non-transplanted corneae, 6 (6.1%) were microbiologically contaminated, 10 (10.2%) had a positive serology, 22 (22.5%) had an endothelial cell count < 2000 cells/mm² and 6 (6.1%) are at time of this analysis still in culture medium. The non-transplanted tissues were used for research.

Conclusions

Explanted corneae from the Institute of Anatomy are a valuable option in obtaining grafts for corneal transplantation, which is why we are working toward on expanding cooperation with this department.

Interactive online survey raises awareness about cornea donation

Objective

To assess the impact of a 5 min interactive online survey on raising awareness about cornea donation and willingness to become a donor.

Methods

An interactive online questionnaire was used to collect information regarding awareness, perceptions and attitudes towards cornea donation and to educate the participants about the process and value of cornea donation. Willingness to become a cornea donor was assessed at the beginning and the end of the survey.

Results

The survey was completed by 1769 Greek residents. Willingness to become a cornea donor increased from 40.5% (n=717) at the beginning of the survey to 55.2% (n=977) by the end of it (p<0.00001). Younger participants, those whose work or studies were unrelated to the medical field, and those with the least knowledge about cornea donation and transplantation were more likely to change their views towards donation by the end of the survey (42.3%, 44.8% and 82.1% increase in willingness to donate, respectively). Major deterrents to donation were lack of information, concerns about the use of the donated corneas and corruption within the medical field.

Conclusion

Our 5 min online survey had a significant impact on changing the mentality towards cornea donation in Greece. We live in an online era and incorporation of online tools and applications in awareness campaigns towards cornea and organ donation has become a necessity.

Preparation and Administration of Adeno-associated Virus Vectors for Corneal Gene Delivery

Gene delivery approaches using adeno-associated virus (AAV) vectors are currently the preferred method for human gene therapy applications and have demonstrated success in clinical trials for a diverse set of diseases including retinal blindness. To date, no clinical trials using AAV gene therapy in the anterior eye have been initiated; however, corneal gene delivery appears to be an attractive approach for treating both corneal and ocular surface diseases. Multiple preclinical studies by our lab and others have demonstrated efficient AAV vector-mediated gene delivery to the cornea for immunomodulation, anti-vascularization, and enzyme supplementation. Interestingly, the route of AAV vector administration and nuances such as administered volume influence vector tropism and transduction efficiency. In this chapter, a detailed protocol for AAV vector production and specific approaches for AAV-mediated gene transfer to the cornea via subconjunctival and intrastromal injections are described.

Irradiated Human Fibroblasts as a Substitute Feeder Layer to Irradiated Mouse 3T3 for the Culture of Human Corneal Epithelial Cells: Impact on the Stability of the Transcription Factors Sp1 and NFI

Because of the worldwide shortage of graftable corneas, alternatives to restore visual impairments, such as the production of a functional human cornea by tissue engineering, have emerged. Self-renewal of the corneal epithelium through the maintenance of a sub-population of corneal stem cells is required to maintain the functionality of such a reconstructed cornea. We previously reported an association between stem cell differentiation and the level to which they express the transcription factors Sp1 and NFI. In this study, we investigated the impact of replacing irradiated 3T3 (i3T3) murine fibroblast feeder cells by irradiated human corneal fibroblasts (iHFL) on the expression of Sp1 and NFI and evaluated their contribution to the proliferative properties of human corneal epithelial cells (hCECs) in both monolayer cultures and human tissue engineered corneas (hTECs). hCECs co-cultured with iHFL could be maintained for up to two more passages than when they were grown with i3T3. Western Blot and electrophoretic mobility shift assays (EMSAs) revealed no significant difference in the feeder-layer dependent increase in Sp1 at both the protein and DNA binding level, respectively, between HCECs grown with either i3T3 or iHFL. On the other hand, a significant increase in the expression and DNA binding of NFI was observed at each subsequent passage when hCECs were co-cultured along with i3T3. These changes were found to result from an increased expression of the NFIA and NFIB isoforms in hCECs grown with i3T3. Exposure of hCECs to cycloheximide revealed an increased stability of NFIB that likely resulted from post-translational glycosylation of this protein when these cells were co-cultured with i3T3. In addition, iHFL were as efficient as i3T3 at preserving corneal, slow-cycling, epithelial stem cells in the basal epithelium of the reconstructed hTECs. Furthermore, we observed an increased expression of genes whose encoded products promote hCECs differentiation along several passages in hCECs co-cultured with either type of feeder layer. Therefore, the iHFL feeder layer appears to be the most effective at maintaining the proliferative properties of hCECs in culture most likely by preserving high levels of Sp1 and low levels of NFIB, which is known for its gene repressor and cell differentiation properties.

Impact of quality assurance on utilization of corneal tissues in a community Eye Bank

Purpose

To determine the linkage between Quality Assurance Program (QAP) and increase in utilization of donor corneas at a community Eye Bank.

Methods

A donor cornea is defined as utilized when it is used for cornea transplant. Two metrics, utilization rate (UR) and non-utilization rate (NUR), were defined. The Eye Bank implemented QAP from 2011. As a part of QAP, detailed gap analysis of tissue utilization was performed. Four major categories causing non-utilization of recovered corneas were identified. These categories were poor “Tissue Quality”, “Seropositive” donor blood sample, “Medical History” of donor, and donor “Blood Sample Issues.” The years 2008–2011 were labelled the pre-intervention period, and the years 2012–2017 were labelled the post-intervention period. Annual UR and annual NUR for the four categories of non-utilization from the pre and the post-intervention periods were statistically compared.

Results

In the pre-intervention period, the Eye Bank recovered 1425 donor corneas in total and transplanted 762. In the post-intervention period, the Eye Bank recovered 6661 corneas in total and transplanted 4393. The UR improved from 53.47% (762/1425) in the pre-intervention period to 65.95% (4393/6661) in the post-intervention period (P < 0.001). NUR in “Tissue Quality” category decreased from 34.32% to 29.7% from the pre to the post-intervention period (P < 0.001). NUR in “Blood Sample Issues” category reduced from 3.23% to 0.32% from the pre to the post-intervention period (P < 0.001). NUR in “Medical History” category decreased from 5.68% to 0.33% from the pre to the post-intervention period (P < 0.001).

Conclusions

The study indicates that QAP improves UR of recovered corneas. In countries with a shortage of donor corneas, increasing utilization of recovered corneas can lead to an increase in corneal transplants. Implementation of QAP at the Eye Bank can be a means of achieving this outcome.

The future of keratoplasty: cell-based therapy, regenerative medicine, bioengineering keratoplasty, gene therapy

PURPOSE OF REVIEW

To provide an update on the state of development of novel therapeutic modalities for the treatment of corneal diseases.

RECENT FINDINGS

Novel corneal therapeutics may be broadly classified as cell therapy, regenerative medicine, bioengineered corneal grafts and gene therapy. Cell therapy encompasses cultivation of cells, such as corneal endothelial cells (CECs) and keratocytes to replenish the depleted native cell population. Regenerative medicine is mainly applicable to the corneal endothelium, and is dependent on the ability of native, healthy CECs to restore the corneal endothelium following trauma or descemetorhexis; this approach may be effective for the treatment of Peter's anomaly and Fuchs endothelial corneal dystrophy (FECD). Bioengineered corneal grafts are synthetic constructs designed to replace cadaveric corneal grafts; tissue-engineered endothelial-keratoplasty grafts and bioengineered stromal grafts have been experimented in animal models with favourable results. Gene therapy with antisense oligonucleotide and CRISPR endonucleases, including deactivated Cas9, may potentially be used to treat FECD and TGFBI-related corneal dystrophies.

SUMMARY

These novel therapeutic modalities may potentially supersede keratoplasty as the standard of care in the future.

Attitude, beliefs and awareness towards corneal donation in Saudi Arabia

Purpose

Corneal donation has not received adequate attention in Saudi Arabia, and donors are lacking. This study explores the underlying knowledge of, attitude regarding, and practice of corneal donation in Saudi Arabia, which will possibly help in designing healthcare policies and creating a national eye bank.

Methods

This observational cross-sectional study used a self-administered questionnaire and was administered to the residents of Saudi Arabia from August to December 2017. We surveyed 1292 random subjects who agreed to fill out the self-administered questionnaire. The sample included Saudi and non-Saudi residents across adult age groups from medical and non-medical professions.

Results

Of the 1292 respondents, only 4.3% believed that they had sufficient knowledge about corneal donation; 66.3% of the sample had not decided whether to donate their corneas after death; 40.2% stated that they would be more willing to donate if they had sufficient knowledge about corneal donation; and 46.1% of the population did not know where to apply to donate their corneas. Those who believed that they had sufficient information about corneal donation were significantly more likely to donate (p < 0.001) than those who believed they did not have enough information.

Conclusion

Increased awareness about corneal donation is required, as a higher level of awareness was associated with a higher willingness to donate corneas. Establishing healthcare policies and creating community campaigns is necessary to increase corneal donation awareness and willingness.

Public attitudes toward corneal donation in northern Jordan

Purpose

The aims of this study were to assess the knowledge and attitude toward corneal donation among Jordanian population and to report the reasons which may influence subject’s decision and attitude toward corneal donation.

Methods

A self-designed questionnaire was developed. The participants were asked about reasons for both willingness and unwillingness to donate their corneas. These reasons were stated in the questionnaire and the participants had to express their agreement by one of five options: strongly disagree, disagree, neutral, agree, or strongly agree.

Results

A total of 500 participants (218 males and 282 females) completed the questionnaire. The average age (±SD) of the study participants was 32.8 (±11.7) years. About 67.2% of the subjects were willing to donate their corneas, whereas 32.8% were not willing to do so. The main motive for willingness was doing a good deed by helping others to see. On the other hand, fear of the body being treated badly and that other organ might be taken than the ones specified for donation were the main reasons for unwillingness to donate corneas. The age of participants, gender, and the monthly income did not significantly influence the willingness to donate (P>0.05). However, the level of education had a significant influence on people’s decision to donate their corneas.

Conclusion

Many Jordanians have positive attitude toward corneal donations. Ethical factors need to be addressed to promote for corneal donation. In addition, increasing the awareness of donation and its benefits may help increase the supply of corneal tissues.

DE. Generating Human Organs via Interspecies Chimera Formation: Advances and Barriers

The shortage of human organs for transplantation is a devastating medical problem. One way to expand organ supply is to derive functional organs from patient-specific stem cells. Due to their capacity to grow indefinitely in the laboratory and differentiate into any cell type of the human body, patient-specific pluripotent stem (PS) cells harbor the potential to provide an inexhaustible supply of donor cells for transplantation. However, current efforts to generate functional organs from PS cells have so far been unsuccessful. An alternative and promising strategy is to generate human organs inside large animal species through a technique called interspecies blastocyst complementation. In this method, animals comprised of cells from human and animal species are generated by injecting donor human PS cells into animal host embryos. Critical genes for organ development are knocked out by genome editing, allowing donor human PS cells to populate the vacated niche. In principle, this experimental approach will produce a desired organ of human origin inside a host animal. In this mini-review, we focus on recent advances that may bring the promise of blastocyst complementation to clinical practice. While CRISPR/Cas9 has accelerated the creation of transgenic large animals such as pigs and sheep, we propose that further advances in the generation of chimera-competent human PS cells are needed to achieve interspecies blastocyst complementation. It will also be necessary to define the constituents of the species barrier, which inhibits efficient colonization of host animal embryos with human cells. Interspecies blastocyst complementation is a promising approach to help overcome the organ shortage facing the practice of clinical medicine today.