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Year : 2003  |  Volume : 51  |  Issue : 1  |  Page : 101-104

Awareness of eye donation in an adult population of southern India. A pilot study.

Aravind Eye Care System, and Lions Aravind Institute of Community Ophthalmology, Madurai, India

Correspondence Address:
B Priyadarshini
Aravind Eye Care System, and Lions Aravind Institute of Community Ophthalmology, Madurai
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Source of Support: None, Conflict of Interest: None

PMID: 12701874

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Purpose: To determine "awareness of eye donation" and corneal transplantation in an adult population of southern India.
Methods: 507 participants chosen by systematic random sampling were interviewed using a structured questionnaire. Participants were selected among patients attending two community outreach programmes at different sites, and from patients presenting directly to the hospital.
Results: 257 participants (50.69%) were aware of eye donations. The major source of awareness was publicity campaigns (n=105). Only 22 (4.34%) participants were aware that eye donation had to be done within 6 hours of death. Four hundred and three (79.50%) participants were not aware of corneal transplantation. Illiteracy and rural residence were more likely predictors of ignorance.
Conclusion: Although multiple strategies are currently followed to increase awareness of eye donations and corneal transplants, more innovative strategies have to be developed, especially to target illiterate and rural populations.

Keywords: Eye donation, eye bank, awareness, India

How to cite this article:
Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK. Awareness of eye donation in an adult population of southern India. A pilot study. Indian J Ophthalmol 2003;51:101-4

How to cite this URL:
Priyadarshini B, Srinivasan M, Padmavathi A, Selvam S, Saradha R, Nirmalan PK. Awareness of eye donation in an adult population of southern India. A pilot study. Indian J Ophthalmol [serial online] 2003 [cited 2023 Feb 4];51:101-4. Available from: https://www.ijo.in/text.asp?2003/51/1/101/14726

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A large proportion of the huge burden of blindness in India is avoidable.[1],[2] The epidemiology of corneal blindness is dependent on endemic diseases prevalent in each geographical area.[3], [4] Corneal scarring either as a result of corneal diseases including ulcers or trauma is a major cause of bilateral or unilateral blindness and vision impairment in children and young adults.[4] A recent study from Andhra Pradesh, southern India reported the prevalence of corneal blindness as 0.13% (95%CI: 0.06-0.24). This constituted 9% of all blindness reported in this study.[5] A recent population-based study from Bhaktapur, Nepal reported an annual incidence of ocular injury at 1788 per 100,000 people and 789 of these injuries resulted in corneal abrasions.[6] Corneal ulcers have also been recognised as a major cause of blindness in developing countries.[7] The annual incidence of corneal ulcers in Madurai, Tamil Nadu is estimated at 113 per 100,000 people,[8] approximately 10 times the incidence reported from the United States.[9] Although the Madurai study cannot be considered representative of the entire country, a rough estimate of the magnitude of corneal ulcers in India may be obtained by projecting the results to the population of India. This will amount to approximately 840,000 persons developing a corneal ulcer every year in India; this is 30 times the number of corneal ulcers seen in the United States.[8]

Recognition of the fact that vision restoration through corneal grafting is possible for a sizeable proportion of the corneal blind in India has led to a sustained multi-pronged drive to raise awareness of eye donations and corneal transplants. There are currently 202 eye banks in the country involved in collection and distribution of donated eyes (data from Eye Bank Association, India - personal communication). But the current annual procurement of eyes for donation in India remains at approximately one-tenth of the annual requirement (data from Eye Bank Association, India).

The Rotary Aravind International Eye Bank was set up in 1998 as part of the Aravind Eye Care System in Madurai; Tamil Nadu, south India to cater to the need for corneas in this part of the country. This eye bank is involved in promotional activities to increase awareness, besides harvesting donor eyes. We report the results of a preliminary survey conducted to determine the level of awareness of eye donations in an adult population of the state of Tamil Nadu in southern India.

  Methods Top

Respondents for this study were randomly selected from three major groups: 1) randomly selected patients presenting directly at Aravind Eye Care System in southern Tamil Nadu, including those who paid for services and those who used the hospital's non-paying services; 2) randomly selected subjects attending a community outreach programme at Namakkal of Salem District in south-central Tamil Nadu; and 3) randomly selected subjects attending a community outreach programme at Kumbakonam in southern Tamil Nadu. The population of Namakkal and Kumbakonam is 945, 956 and 1,457,204 respectively. The Aravind Eye Care System conducts regular eye screening camps in both these areas as well as in other parts of Tamil Nadu. We chose Kumbakonam for this study because it is well served by voluntary organisations involved in creating awareness of eye donations, and chose Namakkal primarily because the eye bank is yet to develop networks in this area.

We used a structured questionnaire to elicit responses. We included questions regarding awareness of eye donation, source of information, awareness of corneal transplantation, awareness of eye banks in general and the eye bank at Aravind Eye Care System in particular. Questions were administered in the local language, and interviewers trained specifically for this study noted the responses. The interviewers also collected demographic details from respondents including age, gender, literacy and place of residence. Literacy was defined as a minimum ability to read or write one's name. Place of residence was categorised as either rural or urban based on existing census records. We administered the questions to randomly chosen subjects aged 35 and older at all sites. Privacy was ensured while administering the questionnaire; the time taken was approximately 2 to 3 minutes on an average.

We used Stata Version 7.0 (College Station, TX, USA) for statistical analyses. All bivariate analysis used either Chi-square or Fisher's exact test as appropriate. Multivariate analysis was performed using multiple logistic regression models to look for awareness of eye donations. P values <0.05 were considered statistically significant.

This study was conducted according with the principles of the Helsinki Declaration on research involving human subjects. Verbal informed consent was obtained from all subjects who participated in the study.

  Results Top

The questionnaire was administered to 507 subjects. The mean age of respondents was 52 years (range 35 - 80 years), and 278 (54%) were males. 326 (64%) respondents were literate; 188 (37%) were residents of urban areas. [Table - 1] shows the demographic characteristics of respondents to our study.

Two hundred fifty seven (50.69%) respondents were aware of eye donation. The major source of knowledge was publicity campaigns (n=105) [Table - 2]. Only 22 (4.34%) persons were aware that eye donation had to be done within 6 hours after death. Four hundred and three (79.50%) persons were not aware of corneal transplan-tation.

After adjusting for age, gender, literacy and place of residence in a multiple logistic regression model, illiteracy and rural residence were possible predictors of ignorance of eye donation [Table - 3]. Illiteracy was also a predictor for ignorance of corneal transplantation; the association between rural residence and ignorance of corneal transplantation was of borderline significance (adjusted odds 1.6, 95% CI: 1.0-2.5). Only 56 (11.04%) of the respondents were aware of the existence of an eye bank at our centre at Madurai.

  Discussion Top

Corneal transplantation offers the potential for sight restoration to those who are blind from corneal diseases. This, however, is dependent on people willing to pledge their eyes for donation, and relatives willing to honour that pledge upon the death of the person. Data from our study suggests additional efforts are needed to improve awareness of eye donation in the community. It is a matter of concern that only 50% of the persons interviewed had knowledge of eye donation, 20% knew about corneal transplantation and only 4.34% of them knew when to donate their eyes. The timing of eye donation is important, it may not be ideal to utilise eyes that are donated later than 6 hours after death for optical purposes. The low proportion of people who are aware of the optimal time to donate eyes despite awareness of eye donations suggests that a large proportion of donated eyes may not become available at an optimal time. Also a sizeable proportion of the population is not aware of how donated eyes are used, and possibly do not understand the potential for sight restoration that corneal transplantation offers. Lack of these essential knowledge and facts could be possible barriers to eye donation in many who are willing to pledge their eyes.

Data from our study suggests that alternate strategies have to be developed to evaluate the illiterate and rural population. The awareness levels were similar in Kumbakonam and Namakkal despite publicity campaigns in Kumbakonam by various organizations. The major proportion of the current awareness of eye donations has been through publicity campaigns run by various non-governmental organisations (NGOs) and other voluntary organisations, supplemented by media campaigns by the government agencies. This is probably not effective in the illiterate population. Despite a variety of strategies involving multiple partners and regular eye camps by our centre in these areas, only 11% of the persons interviewed knew of the existence of an eye bank at our center in Madurai.

Further studies are required to assess the impact of campaigns aimed at increasing awareness of eye donations and corneal transplantations. Studies are also required to identify existing barriers to eye donation.

  References Top

Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. Bulletin World Health Organization 1995;73:115-21.   Back to cited text no. 1
Mohan M. Survey of Blindness - India (1986 - 1989). Summary result. Programme for the Control of Blindness, Ministry of Health and Family Welfare, Government of India, New Delhi, 1992.   Back to cited text no. 2
Smith GTH, Taylor HR. Epidemiology of corneal blindness in developing countries. Refractive and Corneal Surgery 1991;7:436-39.  Back to cited text no. 3
Whitcher JP, Srinivasan M, Upadhyay MP. Corneal Blindness: a global perspective. Bulletin World Health Organization 2001;79:214-21.  Back to cited text no. 4
Dandona L, Dandona R, Srinivas M, Giridhar P, Vilas K, Prasad MN, et al. Blindness in the Indian state of Andhra Pradesh. Invest Ophthalmol Vis Sci 2001;42:908-16.   Back to cited text no. 5
Upadhyay MP, Karmacharya PC, Koirala S, Shah DN, Shakya S, Shresta JK, et al. The Bhaktapur Eye Study ocular trauma and antibiotic prophylaxis for prevention of corneal ulceration in Nepal. Br J Ophthalmol 2001;85:388-92.   Back to cited text no. 6
Whitcher JP, Srinivasan M. Corneal ulceration in the developing world - A silent epidemic. Br J Ophthalmol 1997;81:622-23.   Back to cited text no. 7
Gonzales CA, Srinivasan M, Whitcher JP, Smolin GS. Incidence of corneal ulceration in Madurai District, South India. Ophthalmic Epidemiology 1996;3:159- 66.   Back to cited text no. 8
Erie JC, Nevitt MP, Hodge DO, Ballard DJ. Incidence of Ulcerative keratitis in a defined population from 1950-1988. Arch Ophthalmol 1993;111:1665-71.  Back to cited text no. 9


  [Table - 1], [Table - 2], [Table - 3]

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