Sight is something most of us take for granted. We wake up and see the faces of the people we love, read, move around and experience the world without really thinking about what makes any of it possible. For someone with corneal blindness, however, these everyday experiences can become difficult or even impossible.
Corneal blindness occurs when congenital conditions, disease, infection, injury or other damage causes the cornea, the clear front surface of the eye, to become scarred or cloudy. This interferes with the passage of light into the eye and can result in severe vision loss. In India, corneal blindness is the second most common cause of blindness in the population aged 50 years or above, and is the leading cause of blindness in those up to 49 years of age.
For many people affected by corneal blindness, a corneal transplant can offer the possibility of restoring sight. But India continues to face a significant challenge on this front.
India has traditionally aimed to perform around 100,000 corneal transplants a year. Since only about half of donated corneas are ultimately suitable for transplantation, achieving this target would require around 200,000 donor corneas annually. Recent data show that fewer than 30,000 corneal transplants are being performed, while around 70,000 corneas are being collected annually. The numbers show that there is significant scope to increase corneal transplantation in the country.
India has the specialist capacity to support this ambition too. Achieving 100,000 corneal transplants a year would require around 1,000 trained corneal specialists. The Cornea Society of India has more than 1,000 members, although it is unclear how many regularly perform these procedures. The country has also built a substantial network to support eye donation, with 396 functional eye banks across India.
But these capabilities are only part of the equation. From my experience in corneal care and eye banking, I have seen firsthand how decisions around eye donation can be shaped by something much more personal: what happens within families. The journey from a public health need to an actual donation often comes down to family dynamics that play out in the private sphere.
A significant number of potential donations are lost because families are uncertain about what eye donation actually entails. That uncertainty is understandable. Death is an emotionally difficult time, and families naturally want to protect the dignity of the person they have lost. But when decisions have to be made quickly and are shaped by misinformation, a potential donation can be lost before medical professionals ever have the opportunity to assess the tissue.
One of the most common concerns that makes families hesitant about donation is the belief that eye donation will disfigure the face of the deceased. But this is not true. The procedure is carried out respectfully, with the cornea generally retrieved for transplantation. Once the procedure is completed, the eyes are closed, and there is no visible disfigurement of the face.
There are also misunderstandings about who can donate. Families may assume that advanced age or conditions such as diabetes, hypertension, asthma or cardiac disease automatically rule out donation. In reality, there is no upper age limit for eye donation, and these common systemic conditions do not necessarily make someone ineligible. Even individuals who have undergone cataract surgery may still be able to donate. A previous corneal transplant is an important exception, while certain infectious or high-risk conditions may also preclude donation. But the clinical assessment of whether the tissue is suitable for transplantation ultimately rests with trained eye-bank professionals.
Another misconception is that eye donation is a lengthy process that will delay funeral arrangements. In reality, the procedure is brief and generally takes only 15–20 minutes, involves no cost to the family and requires limited documentation. However, it is time-sensitive. The nearest eye bank should ideally be contacted within six to eight hours after death. Understanding this can help families see that eye donation need not disrupt funeral arrangements, provided the eye bank is informed promptly.
The most meaningful and consequential contribution a family can make is to communicate the person's wish to donate and ensure that the eye bank is informed within the required timeframe. However, a donor pledge by itself does not guarantee that a donation will take place. Eye donation happens after death, and in India, consent from the next of kin is required. The family therefore has an important role in ensuring that a person's decision to donate is honoured.
This is why eye donation needs to become part of everyday conversations, rather than something we think about only during Eye Donation Fortnight or periodic awareness campaigns. Talking about it during a person's lifetime can make the subject less unfamiliar, less taboo and give families greater clarity about what their loved one wanted. When more families are prepared to act on these wishes, more potential donations can reach the eye banks and, ultimately, the people who need them. For India, this could be an important step towards making greater progress in addressing the country's burgeoning burden of corneal blindness.
The author is a cornea, phaco and refractive surgeon at Nethradhama Super Speciality Eye Hospital and Executive Director at Shraddha Eye Bank.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
