|Year : 2018 | Volume
| Issue : 3 | Page : 357-358
Good quality pays rich dividends
Venkatesh N Prajna, Manisha Shah
Department of Cornea and Refractive Surgery, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
|Date of Web Publication||26-Feb-2018|
Venkatesh N Prajna
Department of Cornea and Refractive Surgery, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Prajna VN, Shah M. Good quality pays rich dividends. Indian J Ophthalmol 2018;66:357-8
“You can have the best surgeon in the world, and I think I had one” says Alan (Alan Berdahl, cornea recipient from the US). “But without that graft, without that tissue, the surgery doesn't happen. This does not happen without that donor and the people who recover the tissue.”
This profound statement by a grateful recipient emphasizes the importance of the whole concept of eye banking. The eventual success of the corneal transplant starts at the eye bank level. Ensuring a high benchmark of quality at each step of the entire process chain is the most cost-effective strategy in any business and is even more profound in the health-care context. The first step in this path toward quality is to constantly evaluate each step with the existing global gold standard. “What gets measured, gets improved” is an important maxim that one should keep in mind in this continuing journey.
The health-care industry can learn a lot from the aspirations of the Japanese car maker Toyota in its journey toward relentless pursuit of quality. Their journey termed as total quality management is based on the unchanging principles of “customer first,” (“kaizen” in Japanese meaning “customer first”) and total participation. They were also the pioneers to emphasize the fact that quality is a continuous, never-ending process and has to be the central core around which all the other performance parameters are designed. Aspiring for quality needs to be an addiction to be embraced by everyone involved in the process. The appreciation that good quality brings goodwill to the organization also builds pride among all the stakeholders including the employees.
In the article titled “Quality Indicators (QIs) for Eye Banks,” the authors have addressed an important issue dealing with the concept of quality in the context of eye banking. Corneal transplantation is the most frequently performed solid transplant worldwide, thanks to the many eye banks available. The first successful corneal transplant was done in 1903 in the present day Czechoslovakia. Since then, the demand for corneal tissue increased and so did the need for Eye Banks.
Townley Paton established the first eye bank in 1944 called “Eye-Bank for Sight Restoration” in New York City in the United States. Soon similar entities functioned as eye collection centers, and this concept continued to be driven by the motivational guidelines set up by individual people. Almost four decades later, the Eye Bank Association of America created a set of medical standards for the handling of eye tissue and a training program for technicians. In the USA, the bulk of the eye banks function as a stand-alone entity, not necessarily attached to any particular health-care facility. The tissue retrieval and tissue processing and distribution is being taken care by certified professionals who are not necessarily medical graduates. Eye banking in the US has grown steadily since its inception, especially in the past several decades. In the early 1990s, the US eye banks provided 39,515 grafts for corneal transplantation, a number that doubled to nearly 80,000 by the year 2015. Newer guidelines continue to be developed as evidenced by a recent incident. A 56-year-old caucasian woman with a history of bilateral limbal stem cell deficiency developed a donor-related melanoma after a keratolimbal allograft (KLAL). Three months after undergoing an uncomplicated KLAL, the patient presented with hemorrhagic nodules within her conjunctiva and transplanted tissue. Excisional biopsy was performed, and the pathology results revealed melanoma cells. Although the donor of the KLAL had a history of metastatic melanoma, the ocular tissue was in compliance with all eye bank requirements for donation. After reporting this case to the Eye Bank Association of America which previously accepted patients with an active or remote history of melanoma the criteria for ocular tissue donors has been reviewed. New exclusionary criterion was added, stating that ocular tissue from donors with any history of melanoma may not be released for any surgical use.
The Eye Bank Association of India was formed in 1989 with objectives to create awareness about eye donation, augment quality and quantity of corneas collected, and implement uniform medical and operational standards and practices which are on par with international standards. The eye banks in India are going through a transformational phase and are becoming more professionalized with inputs from the experiences of the developed nation.
The study titled “QI for Eye Banks” has tried to bridge the gap between the existing and required sets of indicators. The authors have recommended that the QI determined in this paper are the minimum basic requirements that must be met by all eye banks. They have elegantly shown as to how following the standard operating procedures and monitoring the deviations from the procedures can lead to an improvement in the quality of the eye bank. They have also alluded to the fact that, once the eye bank attains stability at high-quality levels, a new generation of QI will be needed. With each passing day, there are new advancements, new discoveries, and newer facts coming to light and as professionals, we must be open to change and embrace newer concepts as they unfold. Each eye bank can continue to aspire for higher and higher quality standards so that our patients get benefitted to the maximum possible extent.
| References|| |
Acharya M, Biswas S, Das A, Mathur U, Dave A, Singh A, et al
. Quality indicators for eye bank. Indian J Ophthalmol 2018;66:389-93. [Full text]
Zirm EK. Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg 1989;5:258-61.
Lambert NG, Chamberlain WD. The structure and evolution of eye banking: A review on eye banks' historical, present, and future contribution to corneal transplantation. J Biorepos Sci Appl Med 2017;5:25
Sepsakos L, Cheung AY, Nerad JA, Mogilishetty G, Holland EJ. Donor-derived conjunctival-limbal melanoma after a keratolimbal allograft. Cornea 2017;36:1415-8.
| Authors|| |
Dr. Venkatesh Prajna is the Chief of the Department of Medical Education and the Chief of the Cornea Department of Aravind Eye Hospitals. He has been conferred the fellowship of the Royal College of Ophthalmologists, London. He is a board member of the following organizations: advisory board of the ICO, examination committee of ICO, Asia Cornea Society, and international advisory member for the American Academy of Ophthalmology, Global Alliance. His special interests include ophthalmology residency education and his research interests are mainly in the field of fungal keratitis. He is also a reviewer for BJO, AJO, JAMA and Ophthalmology.