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EW CORNEA 82 August 2017 by Rich Daly EyeWorld Contributing Writer But even where donor corneas are widely available, keratoprosthe- ses serve critical functions. One challenge of donor trans- plants is a high incidence of astig- matism. This leads to many corneal transplant recipients being fitted with a contact lens. However, older donor cornea recipients often have drying of the ocular surface, which limits their ability to use contact lenses. "You get people who have had corneal transplants and the trans- plant is clear, which is great, but they can't see because they have a lot of astigmatism," Dr. Aquavella said. "For this population, with a The dominant U.S. approach is the use of donor corneas, but about 53% of the world's population has no access to corneal transplantation. To address this challenge, more eye banks should be encouraged, but it is also essential to develop alterna- tive solutions, Dr. Akpek said. "In the developed world, arti- ficial corneas are used only when the donor cornea is not going to work out because the recipient is too badly damaged," Dr. Akpek said. "But outside of developed countries where the blindness is, we need a truly artificial cornea to satisfy the need because there is no eye bank." here but clearly it's not here yet," said James Aquavella, MD, distin- guished professor of ophthalmology, University of Rochester Medical Center, Rochester, New York. Massive need An estimated 10 million people are bilaterally blind due to various corneal conditions. Although kerato- plasty remains the most frequently performed transplant surgery in the world, the demand still far exceeds the supply, noted Esen Akpek, MD, Bendann Family Professor of Ophthalmology and Rheumatology, Wilmer Eye Institute at Johns Hop- kins, Baltimore. True artificial corneas remain under development while patients continue to rely on donor-assisted options D espite a continued need—especially in the developing world—for true artificial corneas, such technology remains in the research stage, and surgeons remain dependent on donor-assisted approaches. "It's an event that's a long time coming, and we wish it were Artificial corneas still needed Device focus Keratoprosthesis in place for several years Source: James Aquavella, MD Slit lamp picture of Boston type 1 keratoprosthesis in situ Source: Esen Akpek, MD The latest version of the device Source: Claes Dohlman, MD