Dr. John Sutphin
Department of Ophthalmology
Creation Date: April 2000
Last Revision Date: February 2004
Peer Review Status: Internally Peer Reviewed
Who is an ideal candidate to receive an eye donation? Is it possible to
help someone who is completely blind?
In talking about reception of the tissue, the eye tissue is used
several different ways, most commonly for corneal transplantation. Patients who
need a corneal transplant are those who have a disease, scar, or active infection
involving the cornea. The cornea is the clear part of the eye much like a watch
crystal. People who are completely blind and cannot see light cannot benefit from
any type of corneal transplantation. Other parts of the eye including the sclera
or white part of the eye are used in some types of oculoplastic surgery and in
glaucoma surgery. So you can be an eye donor and help more than 1 or 2
I assume a donor must be dead?
For the most part, corneal donation comes from people who are dead.
In very rare circumstances, a donor may be living. For example a patient who has
an ocular tumor in the back of the eye may be able to donate the eye at the time
the eye is removed. If an eye is blind and it is removed, but is healthy in the
front, that cornea might also be used. There are no instances of donation between
people who are living in other circumstances. Another special circumstance where
a person may donate a cornea to themselves is where one eye can still see and one
can't. That is very rare.
Is it possible to use artificial tissue to help those who need this
There are types of surgery called keratoprostheses, which use
artificial corneas. These are very difficult to use and are still being
investigated and probably no more than 400 or 500 are done each year worldwide. It's used where
it's impossible to get the donor cornea to take. For example, some patients with
severe scarring of the eye socket where the lids don't operate normally might
benefit from a keratoprosthesis. There are newer types of prostheses being
developed to substitute for the cornea, but nothing is as useful as a
human-donated cornea. The University of Iowa will be using the FDA approved keratoprosthesis alphacor in 2004.
Is this a new procedure? How common is this procedure?
Corneal transplantation is not a new procedure. The first ones were
done in the late 1800s. The first eye bank was established more than 50 years
ago. This procedure has been done routinely since the 1960s. The first eye bank
was in Russia in the 1930s. At present, there are over 44,000 corneal transplants
done every year, making it the second-most common transplant after blood donors.
What would you do if a living person wanted to donate an eye?
You have to discuss with the potential donor the motivation for the
donation. Under ordinary circumstances, eyes are not the same as kidneys and are
generally considered to need both for your best function. In circumstances where
you've lost vision in an eye or you no longer see daylight, there might be
exceptions, but otherwise donation would not be acceptable.
Would someone with macular degeneration benefit from a donor procedure
such as this?
Patients with macular degeneration have a disease of the retina. The
retina is like the photographic film inside a camera. It is a thin tissue that
lies in the inside of the eye. Consequently, unless the cornea is also affected
in some way, corneal transplantation would not help a patient with macular
degeneration. There are some people who have corneal dystrophies such as Fuchs
who also have macular degeneration, and they can benefit from transplantation
when the cornea becomes cloudy.
Are people with glaucoma candidates for this procedure?
People with glaucoma have an eye condition where the optic nerve is
being damaged, usually by pressure inside the eye that is too high. The cornea is
not affected by glaucoma, but some patients will have both glaucoma and a corneal
condition. Those patients may require surgery for the glaucoma and surgery for
the cornea. Glaucoma is one of the factors that harms corneal transplant, so the
glaucoma must be controlled before or at the time of the corneal transplant.
Would diabetic retinopathy benefit from a transplant? Or would this or
diabetes in general prevent someone from being a donor?
For the first part, I would refer you to the answer about macular
degeneration. Diabetic retinopathy affects the retina, not the cornea directly,
so transplant would not help unless there is also a problem with the cornea. For
the second part of your question, only the advanced stages of diabetes that
require insulin prevent a patient from being a donor. Patients who have
diet-controlled diabetes may still be eye donors. Patients who have severe forms
of diabetes may donate their eyes for research rather than for corneal
transplantation. Research is a very valuable mission and may lead to prevention
or cure of blindness for many more than 1 patient.
Is this an operation that is done more frequently on elderly patients or
Many patients who receive transplants are older, but the populations
who are very old or very young are the populations that receive most transplants.
Similarly, most of the donors are also older. The typical eye bank will accept
donations from the age of 2 to 70 and donors younger than 2 and older than 70 are
helpful for research tissue but not for corneal transplantation. In general,
patients receive corneal tissue from donors approx the same age or younger than
Is there a certain time frame that the eye must be recovered from the
Yes, there are time frames which are best. It's always the sooner
the better. Eye banks are allowed to set their own time frame but typically if
the donor has been kept cool, the tissue may be recovered for up to 8-12 hours
and then placed in special solution before 24 hours. This would allow the tissue
to be used for up to 7 days.
Can you tell me where to go for help on organic brain damage?
Organic brain damage, where there's no known cause for the damage,
is a contraindication to corneal donation. There are many causes for organic
brain damage. Among them are chronic abuses of alcohol or hardening of the
arteries. Organic brain damage may lead to clinical dementia and patients with
organic brain damage are usually helped through their family doctor or internist
with the assistance of a neurologist.
Who is the ideal candidate for this procedure (corneal donation)?
The ideal candidate is a person who has corneal disease that is in
the center of the cornea, and no other problems. The typical ideal candidate is
one who has a condition called keratoconus. Patients with this condition have
thinning of the central cornea to the point they can't wear glasses or contact
lenses. Corneal transplant replaces that thin zone, allowing them to see. This
group has the best prognosis for good vision with a clear graft. In general, good
candidates have corneal conditions which need the transplant and have good ocular
and physical health so they can take care of the transplant, and it will survive.
What was the procedure Stevie Wonder was having tried on him at Hopkins?
The procedure that Stevie Wonder was considering is to implant
electrodes in the retina area that would then pick up light and transmit it to
the brain. There are some similar procedures done creating artificial retinas
with electrodes implanted in the brain that help patients to tell night and day
and shadowy images. These are somewhat useful in very select patients but they
take a great deal of learning. They will not be widely available for many more
What is your opinion of Lasik Surgery of the eyes, and how does one
decide on a good surgeon to perform the operation?
My opinion of Lasik surgery of the eye is that is it very useful for
the right people. We do Lasik surgery at the University of Iowa as do most
academic medical centers. The second part of the question is difficult to answer.
The best way to find a surgeon is talking to patients who've had the surgery or
learning about the surgeon's experience both with Lasik and in ophthalmology in
general. The patient needs to be careful that the surgeon they pick counsels them
and examines them before surgery and after surgery. In some circumstances
patients are "co-managed". Co-management involves other ophthalmologists or
optometrists who see you first and then refer you for surgery. If you are in such
a situation, you should know the financial arrangements to be sure that the
co-manager is compensated appropriately and that you are not being led to surgery
only for someone else's profit.
What is the success rate of this procedure (corneal donation) and what is
considered a success?
The corneal transplant is successful if it remains clear. Success
rate is usually determined at 1, 2, and 5 years. The best success rate in 1 year
will be 98 percent clear corneas and is usually in patients with keratoconus or
other corneal dystrophies. Over time, success rates drop, so that at 5 years,
this group would be 90 percent clear. For all grafts, success rates are typically
80-90 percent in 1 year and 70-75 percent in 5 years, but that includes patients
who are less than ideal candidates or who have problems that involve the
peripheral cornea. These patients have a higher rate of corneal rejection.
How does one become a donor?
The first thing about becoming a donor is to tell your family. 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 specify
whether you wish to donate your eyes or your organs or other tissues. If you wish
to donate then of course you should sign the card, but the most important thing
is to tell your family and close friends about your desire to help even 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. So the best thing is to always tell
your family. If you have questions about donation, you can contact the eye bank
in your area or the organ procurement organization, sometimes called OPO or OPA,
for your region. They can provide further information. In Iowa, you can sign up through the Donor Registry on the internet (www.iowadonorregistry.org).
Are there any things that would disallow a person to become a donor, as
far as their health while living?
The principal things that disallow you to be a donor are things that
would be regarded as unsafe for people who collect the tissue. This would include
obvious conditions such as HIV positive status or AIDS, severe infectious
problems such as sepsis or hepatitis that is active, which would be unsafe for
technicians. The concern would be transmission of these diseases to both the
technician through a needle stick or to a recipient of the transplant. There are
other more rare conditions such as rabies, which the eye banks and the eye bank
technicians will be aware of, but the general public would probably not know
about. Every donor has their medical history screened prior to being accepted and
having the tissue recovered.
Can someone who has had Lasik surgery be an eye donor for transplant
The tissue can be used for research and possibly for new forms of deep endothelial corneal transplant. Anyone
who's had Lasik, PRK, RK or other corneal surgeries except for cataract surgery
cannot be a donor for typical transplant purposes. There are two concerns: The first is the
new shape for the cornea will be incorrect for the new recipient. The second is
these prior surgeries may keep the donor cornea from surviving the next surgery
or transplantation. The healthy posterior portions of donor cornea can be used for this new procedure, DLEK (Deep Lamellar Endothelial Keratoplasty) that helps people with swollen corneas from cataract surgery or Fuchs Dystrophy.
Has consumer designation on driver's licenses been successful?
Consumer designation has been successful because it raises awareness
of the public to the need for both tissue and organ transplantation. In this
country we have a shortage of organs such as kidneys, hearts and livers for
transplantation b/c the requirements are much more stringent than for tissue such
as cornea, sclera, bone or skin. By raising the awareness, we make it possible
for more people to become donors by asking their families. One law passed in the
last year has required all hospitals to notify their regional organ procurement
organizations on every death in the hospital. If they don't, the government will
cut off their federal funding. This has increased the number of potential and
actual donors by a large amount. But nevertheless, unless the potential donor
wished to donate or the family feels they wished to be a donor, their tissue and
organs cannot be recovered.
Hypothetically, what if everyone had lasik surgery and there was no one
left to donate corneas? What would those who need a transplant do?
First of all, not everyone will have Lasik surgery because only
about 25 percent of the population needs it. At the present time, less than 1
percent of the population who needs Lasik surgery has had it. There will always
be people who have not had eye surgery who can be donors. It merely means we have
to get the word out to everyone. People who need corneal transplants will be able
to get corneal transplants.
I have had recent problems with what my physician called floaters. What
Floaters are symptoms of things in front of the eye when you know
there's nothing there. They are typically found inside the vitreous cavity. Most
of the time they are remnants of arteries that helped form your eye. When you get
older the vitreous jelly begins to liquefy and you can see these floaters more
easily. Most of the time, they are harmless, but patients who have new floaters,
especially associated with flashes of light, should see their ophthalmologist for
a complete dilated eye exam to rule out more serious problems such as retinal
tears, detachments, or bleeding.
What are the risks of undergoing transplant?
Risks of transplantation are numerous. The most common is that the
transplant fails to work. At the time of surgery there are the risks inherent in
surgery including infection, bleeding and leaking of the wound so that the eye
becomes too soft, but the more usual risks are that the patient will have a
rejection episode. Rejection occurs when the body recognizes new tissue that
doesn't belong there and tries to eliminate it. This happens about 1 in 7 times.
Most of the time it can be prevented or treated with special medications
including steroids. Other risks include glaucoma as mentioned earlier, and
problems with focusing afterwards such as astigmatism or being too near or
far-sighted, so that in general, the procedure is very successful with very rare
severe complications, but may need to be repeated in order to finally succeed.