Corneal Blindness – WHO Data:

Using the World Health Organization’s (WHO; Geneva, Switzerland) definition of blindness, it is estimated that there are currently 45 million people worldwide who are bilaterally blind, of which 6 to 8 million are blind due to corneal disease. In some areas of Africa, nearly 90% of the total blindness is due to corneal pathology.  The prevalence of corneal disease varies from country to country and even from one population to another depending on many factors, such as the availability and general standards of eye care.  This data comprises of all types of corneal blindness and the exact figure of corneal blindness due to endothelial defect is not clearly known.
Corneal blindness in developing countries with emphasis to India:

In India, there are approximately 6.8 million people who have corneal blindness with vision less than 6/60 in at least one eye, and of these, about 1 million have bilateral corneal blindness. If the present trend continues, it is expected that the number of individuals with corneal blindness in India will increase to 8.4 million in 2010 and 10.6 million by 2020.

Although cataract is responsible for nearly 20 million of the 45 million blind people in the world, the next major cause is trachoma, which is responsible for blindness in 4.9 million people, mainly due to corneal scarring and vascularization. Ocular trauma and corneal ulceration are also significant causes of corneal blindness and may be responsible for 1.5 to 2.0 million new cases of uniocular blindness every year. Infectious conditions such as trachoma and corneal ulcer are common in the developing world, whereas noninfectious entities like corneal dystrophies and pseudophakic bullous keratopathy are more common causes of corneal blindness in developed countries.   

Gonzales et al found that the annual incidence of corneal ulceration in Madurai District in South India was 113 per 100,000 people,  which is 10 times the annual incidence of 11 per 100,000 reported from Olmsted County, Minnesota, in the US.  By applying the 1993 corneal ulcer incidence rate in Madurai District to all of India, approximately 840,000 people develop corneal ulcers per year. This figure is 30 times the number of corneal ulcers seen in the US.  The rampant and unjustified use of topical steroids in cases of red eye leading to corneal super infection  is an important factor for the high prevalence of corneal blindness in developing countries. The Andhra Pradesh Eye Disease Study (APEDS)  in Andhra Pradesh (India) estimated that 1,200 people per million population are blind (<3/60) from corneal pathology. The prevalence of unilateral blindness due to corneal opacity in low income settings is estimated to be in the range of 5,000 to 20,000 people per million populations.

Ocular trauma has been reported to be the most important cause of the unilateral loss of vision in developing countries, and up to 5% of all bilateral blindness has been attributed to direct ocular trauma. Corneal and corneoscleral perforation and subsequent scarring due to ocular trauma may result in a variable amount of blindness.

Adding to the existing prevalence of corneal blindness in developing countries is the high rate of failed corneal grafts as well as the low availability of good quality donor corneas. In India, nearly 3.5 million good quality donor corneas are required to restore vision in all the eyes that can be treated with keratoplasty. However, only approximately 20,000 corneas or eyes are collected annually, while every year, approximately 40,000 new cases of corneal blindness are added to the existing backlog, creating a huge disparity between demand and supply. Thus, attempts to reduce the load of corneal blindness by corneal transplantation surgery are not optimally successful in developing countries.

We propose to establish WORLD’S FIRST CORNEAL ENDOTHELIAL STEMCELL BANK(CESBANK) and supply to the corneal surgeons of the entire world the Corneal Endothelial Stem cells so that they can treat their patients with our stem cells.

CESBANK- An Introduction:

The CESBANK will distribute collection kits to all eye banks whoever are willing to cooperate and ask them to separate the endothelial layers, put them in the kits and send to us. Such Corneal endothelial layers will be subjected to all kinds of screening tests (When eye banks harvest eye itself they would have done most of the screening tests to avoid spread of infection through the donated material). Then they will be divided, isolated and expanded then Cryopreserved. Whenever there is a need from any hospital from any part of the world, we shall send them to the concerned physician for application to the patient.

With the present technology, we shall only provide the expanded cells directly to the hospitals without cryopreservation, but gradually we shall conduct studies with the expanded cells and their viability with various methods of cryopreservation and then implement long term storage facility of a larger quantity.