India Has The Corneas, But Getting Them To Patients Remains The Challenge: AIIMS Ophthalmologists

For someone living with corneal blindness, the difference between darkness and sight can sometimes depend on something as simple as whether a family agrees to donate the eyes of a loved one after death.

Yet, while India has made considerable progress in eye banking and corneal transplantation, the country is still some distance from ensuring that every patient who can benefit from a transplant gets one in time.

“The cornea is the transparent front layer of the eye that allows light to enter and helps focus it. When it becomes scarred or loses its clarity because of infection, injury or disease, vision can be severely affected. In many such cases, transplantation can restore sight,” explains Dr Radhika Tandon, Chief and Professor of Ophthalmology at the R.P. Centre and associated with the National Eye Bank.

For thousands of people who lose their sight because of corneal disease, the problem is not confined to the eyes. It can mean being unable to work, study, earn a livelihood or live independently during some of the most productive years of life, she adds.

The 24-49 age group, in particular, represents a crucial phase of economic and social productivity. Yet corneal blindness can take away these years, leaving patients dependent on their families even though their condition may be treatable through a corneal transplant.

More than a lakh people are estimated to need corneal transplants every year, but the number of transplants performed remains far below the requirement. With the gap continuing year after year, the backlog of patients waiting for vision-restoring surgery keeps growing.

“24 to 49 years is a productive age group. There are many more years of life ahead of them. If corneal blindness is a major cause of vision loss in this age group, we have to do something about it,” adds Dr Rajesh Sinha, Prof. of Ophthalmology in Cornea, Lens & Refractive Surgery Services, RP Centre, AIIMS, Delhi.

The shortage, however, is not necessarily because people are unwilling to donate, he says, noting that a major challenge is creating greater awareness about who can become a corneal donor and ensuring that families know that donation is possible soon after death.

Importantly, wearing spectacles or having certain eye or retinal conditions does not automatically rule out corneal donation. If the cornea is healthy and clear, it may still be suitable for transplantation, clarifies Dr Tondon.

One donor can potentially help more than one person. Depending on the quality and suitability of the donated tissue, a single cornea can be used to restore sight in one or, in selected circumstances, more than three recipients. This makes every donation potentially valuable to several families.

The impact therefore extends far beyond the recipient. Restoring sight can allow a person to return to work, resume education, become independent and reduce the burden on caregivers. In that sense, corneal donation is not merely an act of giving tissue; it can restore productivity and dignity.

This is why awareness remains central to the effort to tackle the country's corneal blindness burden. The recently concluded National Eye Donation Awareness Fortnight (August 25-September 8) is aimed at taking this message to the public and encouraging more people to pledge their eyes and, more importantly, helping families understand the importance of donation at the time of death.

No doubt, India’s eye banking system has come a long way. From a model largely centred on retrieving and storing whole eyes, eye banks have evolved into sophisticated systems involving donor screening, tissue evaluation, processing, preservation, allocation, documentation and research.

According to Eye Bank Association of India data cited in recent reviews, 47,676 corneas were retrieved in 2023, but only 29,057 were used. That translates into a utilisation rate of about 60%. Against this, the estimated requirement is around 1 lakh corneal transplants a year to clear the existing backlog.

The numbers underline an important point: collecting more corneas alone will not solve corneal blindness. Tissue has to be suitable for transplantation, processed correctly, allocated fairly and reach a facility where trained surgeons can use it, as per a study published in the IJMR.

The National Eye Bank at the AIIMS Delhi has been working to reduce the gap between donation and transplantation through a combination of hospital-based retrieval, awareness, technology and better utilisation of donated tissue, said the doctors.

Dr Namrata Sharma, National Eye Bank Chairperson said that the centre collected 2,167 corneas in 2025 and carried out 1,775 transplants, a utilisation rate of 82%, against a national rate of 50%.

Of those 2,167 corneas, 1,863 came through hospital corneal retrieval programmes rather than voluntary donation drives. Only 69 could not be used for transplantation, and Sharma said even those were not wasted. “Even these tissues do not go to waste,” she said. “They are used for medical research and training purposes.”

Dr Tandon also pointed to the change in the waiting-list situation. The aim, she has said, is no longer merely to reduce the waiting list but to eliminate the backlog of treatable corneal blindness.

She said that AIIMS has also begun looking at the logistical barriers that can cause precious donor tissue to be lost or delayed. In 2025, the National Eye Bank introduced drone-assisted corneal transport in collaboration with the Indian Council of Medical Research and Dr Shroff’s Charity Eye Hospital. The idea is to use technology to move corneal tissue more quickly, particularly where traffic and distance can affect timely transplantation.

The centre has also introduced a 100% online death-notification system and an online eye-donation pledge platform to streamline the process. It has conducted sensitisation programmes, including training for eye-donation counsellors and nursing staff. Such measures address one of the weakest links in the donation chain — timely identification of a potential donor and communication with the family.

Awareness remains crucial. Eye donation is often surrounded by myths, hesitation and a lack of understanding about what donation involves. The decision is generally taken by the family after death, making awareness among relatives and hospital staff as important as individual pledges.

But the future of corneal transplantation is also moving beyond dependence on human donor tissue.

At AIIMS, work is being pursued on artificial and biosynthetic alternatives. The R.P. Centre has been involved in research into bioengineered corneal implants, while alternatives such as biosynthetic corneas and keratoprosthesis are being explored.

Talking about his recent work examining intrastromal keratoplasty using biosynthetic corneas in patients with advanced keratoconus, comparing the approach with human donor corneas, Dr Sinha said the idea is to explore ways in which engineered materials and newer techniques could reduce dependence on donor tissue.

“This does not mean that artificial or biosynthetic corneas can immediately replace donor transplantation. They are emerging technologies, and their role will depend on clinical evidence, safety, affordability and wider availability,” he said.

Surgical techniques themselves have also changed dramatically. Corneal transplantation is no longer synonymous with replacing the entire cornea. Depending on the disease, surgeons can replace only the damaged layer. Procedures such as anterior lamellar keratoplasty, Descemet stripping endothelial keratoplasty and Descemet membrane endothelial keratoplasty allow surgeons to tailor transplantation to the affected part of the cornea.

India has nearly 400 registered eye banks, but only a small proportion are believed to meet high-volume operational standards. This creates a system in which some centres have sophisticated retrieval, processing and transplantation capabilities while others struggle with manpower, infrastructure, tissue utilisation and awareness, as per a review published in the Indian Journal of Medical Research.