CINDY ELLEN RUSSELL / CRUSSELL@STARBULLETIN.COM
One sclera and two donated corneas are encased in sterile plastic containers at the Hawaii Lions Eye Bank. The two corneas will be transplanted into a waiting recipient within a week.
Cornea supply may grow
A surgical technique makes laser-treated eyes donor-eligible
A nationwide shortage of cornea donations may be eased in the next year by making people with laser surgery eligible for donations, says Honolulu ophthalmologist John Olkowski.
Patients with LASIK or PRK (photorefractive keratectomy) eye surgery have not been candidates for cornea donation because of the transplantation method, but a new surgical technique will change the restriction, said Olkowski, EyeSight Hawaii refractive and corneal specialist.
Olkowski said he had to cancel three corneal surgeries scheduled two weeks ago because no corneas were available.
Only about 130 corneal transplants a year are done in Hawaii on an average, said Shawn Wofford, Hawaii Lions Eye Bank executive director.
"Even if we get donors, not everyone is okay to be a donor," he said, explaining they can't have blood-borne or other diseases and next-of-kin must agree to the donation.
He urges people who want to donate corneas or other organs to tell their family.
If corneal surgery is scheduled and no corneas are available locally, Wofford said, "we will call eye banks on the mainland and bring one in from them. It can be difficult at times. Mainland eye banks are doing the same thing we are."
Three of the five largest eye banks on the mainland were asking him for corneas two weeks ago, he said.
Wofford said there is a huge demand internationally for corneal transplants: "The World Health Organization says over 1 million people in China need a cornea. Australia has a one-year wait list."
The surge of laser surgery nationally has ruled out potential cornea donors, Wofford said. But Olkowski is among corneal specialists using a new surgical technique that does not exclude cornea donors with laser surgery.
Olkowski said corneal specialists for the last hundred years have transplanted the whole thickness of the cornea because the back layer or endothelium, which is most important for clarity, does not work.
However, for about 2 1/2 years he has been using a procedure called endothelial keratoplasty, replacing only the back layer, he said.
It's much less invasive than a full-thickness transplant, with faster recovery for patients, he said. "This is almost like cataract surgery. They are back to normal activity the next day and can see fine in two to three months."
He has done a study on the technique, which he said can be used with corneas from LASIK patients once the rules are changed to allow corneas from people who have had laser surgery.
"Patients with LASIK have the treatment on the front portion of the cornea, but the back portion is fine," he said. "Usually, they are young, healthy people."
Olkowski said 10 to 15 percent of corneal specialists are using the new procedure and the number is growing.