Eyeworld

74 | EYEWORLD | SEPTEMBER 2021 C ORNEA by Ellen Stodola Editorial Co-Director About the physicians Anthony Aldave, MD Professor of Ophthalmology Stein Eye Institute Los Angeles, California Sumitra Khandelwal, MD Associate Professor of Ophthalmology Cullen Eye Institute Baylor College of Medicine Houston, Texas Shahzad Mian, MD Professor of Ophthalmology and Visual Sciences Kellogg Eye Center Ann Arbor, Michigan positive for COVID-19, no one has gotten COVID-19 from a transplant that we know of. "Because we have these certain criteria where we don't even take tissue from donors who had COVID-19, we're only looking at do- nors who could potentially have been asymp- tomatic and then tested positive," Dr. Mian said. Looking carefully at data for donors, he said that among those donors who are asymptomatic but tested positive, there is about a 15% risk of having ocular involvement. Similarly, those who were symptomatic but tested negative showed about a 15% chance of having COVID-19 in their eyes. In a study Dr. Mian participated in, 1 investi- gators found a 13% rate of COVID-19 positivity among potential donors. Then they looked at donors who had exposure but didn't have any symptoms. "In our study, we found that none of them were positive for COVID-19." They also looked at the overall donor pool to identify donors who were thought to be fine (asymptomatic, either not tested or tested early on and were negative). When retested, about 4% were positive for COVID-19. It is possible even to miss some cases when you have criteria for ruling tissue out, he added. Dr. Mian reiterated that there have not been any confirmed cases of someone getting the virus from a cornea whose donor was COVID-19 positive. Since the beginning of the pandemic, the EBAA has worked to establish detailed cri- teria for screening that has been reviewed and refined. These criteria incorporated information from the CDC and FDA and were updated as knowledge about the virus increased. The goal, Dr. Mian continued, is to "make sure that we are addressing the concern with risk of transmis- sion from donors who are COVID-19 positive or could be COVID-19 positive," he said. "But it's also important to balance the fact that we have patients blind from corneal disease who need their eye surgeries to be able to see." Dr. Khandelwal mentioned that evidence has shown that SARS-CoV-2 can be killed with a variety of agents, including betadine. "Ocular tissue, when recovered, goes through a betadine COVID-19 impact on eye banking and corneal donor tissue continued on page 76 T he COVID-19 pandemic has had an impact on the screening and use of corneal donor tissue for corneal transplants. Shahzad Mian, MD, Su- mitra Khandelwal, MD, and Anthony Aldave, MD, discussed evolving regulations, tissue eligible for use, and more. One of the first people to identify that COVID-19 was spreading in China was an oph- thalmologist. This ophthalmologist was exposed to COVID-19 while managing an asymptom- atic patient with glaucoma, became infected with the virus, and died from it, Dr. Mian said. There was concern that there was direct spread from touching the eye, which led to concern about the eye being a vector for transmission of SARS-CoV-2. It also caused concern for corneal transplants. Infection is always a concern for organ and tissue donation, Dr. Khandelwal said. The Eye Bank Association of America (EBAA) provided several guidelines for ocular tissue recovery. Although testing of the donor for SARS-CoV-2 is not required, a thorough review of the medical chart is conducted and tissue from suspect cases (even if COVID-19 is negative on patient test- ing) is reviewed by the medical director. There is not much research on the prevalence in ocular tissue because the recommendation is not to recover from donors with confirmed or suspect- ed COVID-19 for the safety of staff, Dr. Khandel- wal added, noting that there has been some lab research on SARS-CoV-2 found in ocular tissue. The decision was made that anyone who died from COVID-19 could not be a donor for corneal tissue, Dr. Mian said. "That has been in place from the beginning, and this has evolved to include that anyone who was exposed to COVID within the last month is not a candi- date to be a donor," he said. There are also criteria relating to if the potential donor was symptomatic. "There was a lot of attention paid to building a system that reduces the risk for recipients," Dr. Mian said. "Having said that, we don't actually know if it can be transmitted if someone gets a corneal transplant from a donor who had COVID-19. Though there have been some cases when a recipient has inadvertently gotten donor tissue where the donor was

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