Older Corneas Prove Suitable for Transplantation

Corneas donated by people as old as 75 years of age should be made available for transplantation, according to findings from a new study. Corneal transplants from older donors were found to have similar rates of survival to those from younger donors.

The cornea is a clear dome-shaped surface that covers the front of the eye to protect it and help focus entering light. More than 33,000 corneal transplants are performed each year in the United States. While the supply has been adequate for the past 10 years, recent changes in U.S. Food and Drug Administration (FDA) regulations will likely cause a decrease in the supply of donated corneas.

Many eye banks have set the age limit for donors at 65 years or younger. Researchers with the Cornea Donor Study, which was coordinated by the Jaeb Center for Health Research in Tampa, Florida, believed that corneas from older people might be suitable for transplants. Funded by NIH's National Eye Institute (NEI) and several other sources, their study involved over 1,000 participants and 105 surgeons at 80 sites across the country. The participants, between 40 and 80 years of age, all had a corneal disease that put them at moderate risk for graft failure. Donor corneas were provided by 43 participating eye banks. All met the Eye Bank Association of America's standards for human corneal transplantation, with ratings of good to excellent quality.

After the transplant surgery, the researchers followed up with the participants for 5 years. Transplants were considered a failure if a repeat corneal transplant was required or if the cornea was cloudy for at least 3 months.

In the April 2008 issue of Ophthalmology, the researchers reported that the 5-year transplant success rate was the same—86%—for corneas from donors ages 12 to 65 years and from those ages 66 to 75. If eye banks were to accept such older donor tissue, the study authors estimate, the donor pool could grow by as much as 20-35%.

"Surgeons and patients now have scientific evidence that older donor corneas are suitable for transplantation," said Dr. Edward J. Holland, professor of ophthalmology at the University of Cincinnati, director of the Cornea Service at the Cincinnati Eye Institute and co-chair of the study.

"This new research has come at a good time," said Dr. Paul A. Sieving, director of NEI. "The pressure on eye banks to provide corneas is increasing. The results of this study will expand the available donor pool and should persuade surgeons to use corneas from older donors. These changes will greatly benefit the growing number of individuals who need corneal transplants."