Hyderabad: LV Prasad Eye Institute (LVPEI) is an institution that has given a new look to ophthalmology in the country. The organisation was established three and a half decades ago in Hyderabad to provide eye care to everyone who came to the hospital irrespective of their status. Now it is recognised as the first global organisation to reach the 50,000 milestone in transplantations. It became the first organisation in the world to receive this stature. ETV Bharat interviewed Dr Gullapalli Nageswara Rao, founder of the organisation, along with Dr Prashant Garg, executive chairman, of L V Prasad Eye Institute, and Dr Pravin Vaddavalli, director, of Shantilal Sanghvi Cornea Institute, an associated body of LVPEI. Excerpts:
Dr Gullapalli Nageswara Rao, Founder, LVPEI
It’s a tremendous achievement to have reached the 50,000 corneal transplant milestone. How has been the journey so far?
It has been a glorious journey. It is very gratifying that we could touch the lives of so many people in an area where in India, it was far from possible. When we started the journey, everyone discouraged me not to pursue this path because it would invariably fail. We continued and it worked. It happened because of support from a lot of people and organisations. I am grateful to those on the journey with me, many of whom I don’t even know. I have to express my gratitude to thousands of eye donors who made this possible. If they weren’t there to support and encourage, we wouldn’t have achieved it. The myth that nobody donates eyes in India, we have proven wrong. If you convince the person and explain the benefits of donating eyes, they agree to do that. In our experience, at least 60 per cent of families consented to donate their eyes. The numbers are better than any American hospital.
The numbers are impressive, but it must not have been easy, considering the apprehensions and lack of knowledge people have about organ donation and transplant. How did you convince people to extend the support?
There was knowledge and people were willing, it’s just that we are not practising. What we did was we learned lessons from somewhere and implemented them in India and it worked. For that, we got a lot of support and cooperation from some organisations in the USA. They helped us to set up our eye bank and systems with standards as par with any international corneal transplant institution. Since I was trained in America, when I came back I utilised my practice in India, set up a training system and trained many doctors. Once the doctors are available and corneal donors are available, the journey becomes comparatively easier.
While it all sounds very promising, there must be some challenges. Would you like to tell us about the areas that need more attention from your end?
One of the challenges that my team is working on is to improve the success rate of transplants once it’s done. Many people don’t come back for follow-up. If they don’t come back for follow-ups, the chances of failure are higher. People have to realise that follow-up is very crucial and they have to comply with medications and instructions given by the doctors. Unless that’s done, getting a transplant is of no use.
Dr. Prashant Garg, executive chairman, LVPEI
What is the success rate of corneal transplants in India?
In general, of all solid organ transplants, the cornea has the highest success rate, mainly because the cornea doesn’t depend on the blood supply for survival. It gets its nutrition from the inside of the eye and the oxygen in the atmosphere. It is because of this that when we transplant a cornea from one individual to the other, the body doesn’t recognise it as a foreign object and so it tends to accept it much more readily than other organs. For this reason, there are certain diseases where the success of corneal transplantation is higher at 96 to 97 per cent. In some diseases such as infections, the success rate may be lower. But even though the success rate is lower, the fact is that even if the corneal transplant doesn’t work the first time, it can successfully be repeated the second time. It also gives us a lot of hope that there is no incurable part of the blindness that we are dealing with. We can cure blindness with corneal transplants.
Who among those with eye issues needs a corneal transplant?
We have a multi-pronged approach. The first approach is to reduce the need for corneal transplants. Appropriate intervention and identification of disease followed by early treatment can prevent a lot of patients who require corneal transplants from getting to that stage. Once they get to that stage, we now have advancements in transplant procedures such as layer-by-layer transplants, which have a very high success rate. Once the transplant is done, then the journey is also a lifelong commitment by both the doctor as well as the patient. We have to continue to take care of the transplant throughout life. So it is a multi-pronged approach, rather than just one surgery.
Dr. Pravin Vaddavalli, director, Shantilal Shanghvi Cornea Institute, LVPEI
You are managing the corneal eye bank. What are the challenges of managing such a crucial vertical?
If I talk about the eye banking status in the country, there are many problems. We have close to about 200 eye banks in the country but 90 per cent of them are dysfunctional. They don’t have a cornea collection. Among 60,000 corneas that are collected presently in the country, 70 per cent of them are collected only in 10 eye banks. This means the eye banks in the country have become more like a status symbol. There’s no commitment that an eye bank demands. On the other hand, when I compare our four eye banks in different centres of our organisation with other existing ones, each of them has eye donation centres linked to these. We can collect over 12,000 corneas every year, which amounts to almost 20 per cent of the corneas collected in the country. Some of the problems that I see are a lack of commitment and that the eye banks should be run by adequately trained resources. Many people who started eye banks do not invest in training human resources. They don’t get technicians and counsellors trained. Therefore, the activities of the eye banks go into the hands of less-trained or untrained people, which creates problems. Another issue is medical setup. You are collecting human cornea and going to transplant these tissues into another human, so there’s a potential risk of transmitting diseases if the quality of the cornea is not appropriate. It is not just taking cornea from one person to transplant it to the other, you need to follow certain medical standards so that the desired objective of corneal transplantation is achieved, which is the restoration of sight. Many medical institutions do not follow these protocols. We also don’t have an accreditation and certification system. They are put in place by the Eye Bank Association of India but they are not uniformly implemented. These are the main factors that, if improved, will enhance the availability and quality of cornea in times to come.
We learned that the LVPEI is helping other states to set up eye banks. How is this collaboration going to work?
We started this journey long back when we partnered with Orbis International (a non-profit organisation that works toward the prevention and treatment of blindness). They started a program where they identified 10 eye banks across the country and gave us the responsibility to upscale their performance and improve the quality of eye banking. That was our first initiative as far as our objective of capacity building is concerned. In 2017, The Hans Foundation, another non-profit organisation, came forward and pointed out that many states in the country require corneal tissue but there are no functioning eye banks and if we could help them set up. So in collaboration with the foundation, we took the responsibility. The first such eye bank we inaugurated was at All India Institute of Medical Science (AIIMS) in Rishikesh, next to the regional eye institute in Guwahati and immediately after COVID-19, we helped Banaras Hindu University Institute of Medical Sciences start their eye bank. Recently, we have signed an MoU to work on two eye banks in Patna and Ranchi. We are working on creating a similar model of eye banks in other parts of the country. We train their human resources about the protocols, help them set up the infrastructure, and handhold them for at least two years to perform it at an optimal level until they become self-sufficient.
Dr Gullapalli Nageswara Rao, founder, LVPEI
You started the Grief Counsellor system a few years back to create awareness around corneal donation. Do tell us about the initiative and how it works.
It’s the training of people to be able to talk to the families at the most difficult times. It is when you realise that the particular family member is unlikely to survive during the hospitalisation, we begin counselling the family members. We begin by telling them about corneal donation and how their contribution can help two people to see. This all needs to be done carefully and with empathy. This is what we train our grief counsellors. They are placed in general hospitals full time where patients are admitted. I have seen the benefits of that when I lived in the USA for 12 years. The first seven years were terrible, for corneas weren’t available and we had to operate whenever there was an availability. Often we were doing corneal transplants in the middle of the night. Patients used to wait for months to get cornea at that time. There used to be a waiting list of people requiring cornea. Then came the hospital cornea retrieval programme and a grief counsellor came into the picture. Overnight things changed. I was able to schedule the patients for corneal transplant surgeries the way I scheduled cataract surgeries. Planned and scheduled surgeries for patients and not in the middle of the night. That was a great lesson and I wanted to bring that in India and implement it into our hospitals. Thankfully, there was cooperation, initially from Nizams and then other hospitals, and now many hospitals are supporting that.
Even though we have advanced in medical technology and the chances of failure have reduced, people still avoid eye-related issues as compared to other problems in their bodies. What could be the reason?
For a long time, it was a lack of awareness but now that’s not the case. It’s the access to care that is causing this resistance. There’s no issue with the availability of facilities as they are available everywhere. The affordability of treatment is also not a problem since there are many government hospitals as well where you don’t have to spend a lot of money. So the problem is with the accessibility of the facilities. That’s where the challenge lies.
Do we have skilled ophthalmologists and optometrists in India?
We don't do two poorly. In India, we have 80,000 to 100,000 skilled doctors compared to the United Kingdom and other developing countries. We are ahead of many countries in terms of eye care. Presently, we have the highest number (8 million) of cataract surgeries in the world. That used to be 1 million in the 90s and it has multiplied by eight times in the last three decades. The same thing can happen in every area with focus, investment, creating a system and replicating it.
In the last few years, Myopia cases are also increasing in India. What are the reasons identified by the medical professionals?
I think the factors that are identified are too much near work. It’s not only the screen time but even if you read a book can impact your eyes. Another reason is fewer outdoor activities. Everyone should spend adequate time outside and reduce screen time. In Singapore, there are schools made of glass walls so that natural light can come in. There are a lot of theories and a lot of work is going on. At our institute, we are trying to identify the factors. We also have a good system of advising the families of these children about how to prevent or arrest the progression of myopia.
Lastly, as a society how can we contribute to corneal donations?
The idea is that whenever there’s a death in the family, think of helping two people with corneas. You can help people with your other organs like kidneys, heart, and liver. There’s so much that our bodies can do even after we die and before they get burned. It’s an opportunity to give life to some people. We should first start creating awareness in urban areas that they have an opportunity to donate their organs better than any other donation that we can think of. Someone once told me that the return of our organ donation is the blessing of those who benefited. Blessings are the best form of wealth that you can accumulate.
Read more
Prevention of Blindness Week India 2024 - Making People Aware About 'Vision'
Health experts warn against rising heart attacks, eye-related complications in winter
