Introducing the artificial cornea (keratoprosthesis) to India

On Dr. Aldave’s first trip to India in 2002, he was overwhelmed by the significant social and economic burden of visual impairment secondary to corneal opacification in India, where it is estimated that approximately 7 million individuals suffer from corneal blindness in at least one eye. The following year, Dr. Aldave began performing artificial corneal transplant surgery at the Jules Stein Eye Institute, where he has subsequently performed over 100 procedures. Given the ability of the artificial cornea (keratoprosthesis) to restore vision to patients without the need for high quality donor tissue, and without the need to be concerned about transplant rejection, Dr. Aldave become interested in the feasibility of introducing the artificial cornea to the developing world.
In the vast majority of non-industrialized countries, donor corneal tissue is in scare supply, and thus most patients with corneal blindness are never given the opportunity to have their vision restored. For those few patients who are fortunate enough to receive a corneal transplant, rejection of the donor corneal tissue is common, and often results in worse vision than the patient had prior to corneal transplant surgery. In 2008, Dr. Aldave founded Visionaries International with the purpose of training corneal surgeons in India and throughout the world to perform keratoprosthesis surgery. As he knew well-trained, dedicated anterior segment surgeons at several major institutions across India, his concern was not whether the level of medical care or facilities available in India were suitable for developing successful keratoprosthesis programs. Rather, he was concerned about whether the hot, humid climate and limited access to care on the part of many potential keratoprosthesis candidates would result in outcomes that were not as good as those that he and he other specialists such as Drs. Deng and Pineada were obtaining in the United States. After speaking with two prominent corneal specialists in India who had expressed interest in starting keratoprosthesis programs at their institutions, it became clear that they were sufficiently knowledgeable about keratoprosthesis surgery and the critical importance of appropriate patient selection to proceed with formal training courses at their respective institutions. Therefore, in January 2008, Dr. Aldave traveled to Northern India to the R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences in New Delhi and to Southern India to the Aravind Eye Hospital in Madurai, providing didactic instruction and live surgical instruction at each location. In February 2009, Dr. Aldave returned to India to conduct a formal instruction course at the P D Hinduja Hospital in Mumbai for surgeons from all across Maharashtra, and returned to India in January 2010 to conduct a keratoprosthesis training course at the LV Prasad Eye Institute in Hyderabad. He will be returning to India again in July 2011 to lecture on and demonstrate keratoprosthesis surgery at Dr. Agarwal’s Eye Hospital in Chennai.

Doctors Deng and Pineda expand the reach of Visionaries International

Drs. Sophie Deng and Roberto Pineda joined Visionaries International in 2009 as academicians and corneal surgeons with years of experience in international ophthalmology. For more than a decade, Dr. Pineda has trained surgeons around the globe to perform various forms of corneal transplant surgery, and has developed an International Boston Keratoprosthesis Protocol. While the Protocol was originally created to standardize patient selection, the surgical procedure and post-operative management in Ethiopia and the Sudan, where he was the first to perform keratoprosthesis surgery, it has been adopted and followed by surgeons worldwide. Dr. Deng has also introdcued the keratoprosthesis to her native China, and remains actively involved in training corneal surgeons in traditional and novel forms of corneal transplant surgery, both at home and abroad.

Dr. Aldave treating patient

Training the Trainers

Put simply, the model being followed is that of “training the trainers”, who are the leading corneal surgeons in their respective countries, located in both academic centers and private institutions, who will then train other corneal surgeons in newer forms of corneal transplant surgery, including keratoprosthesis implantation. The model is working, as evidenced by the fact that surgeons who have been trained in keratoprosthesis surgery in Delhi and Mumbai have already traveled to other cities in India, such as Kolkata and Bangalore, to train corneal surgeons there. Equally important as training corneal specialists to perform these surgeries is the training of regional eye care providers to recognize patients in their practices who are candidates for these sight restoring surgeries, and to participate in the post-operative care of these patients, who may live a great distance from the corneal surgeon. Therefore, each of our members regularly lecture on corneal transplant and keratoprosthesis surgery at international meetings in countries of interest, such as the All India Ophthalmology Society. Drs. Aldave, Deng and Pineda strongly encourage the corneal surgeons who have been trained to perform corneal transplant and keratoprosthesis surgery to carefully monitor their post-operative outcomes, and to present their results at local, national and international meetings.