2023 Eye Banking Statistical Report—Executive Summary

Abstract

2023 ANALYSIS OF SURGICAL USE AND INDICATIONS FOR CORNEAL TRANSPLANT The 2023 Eye Banking Statistical Report of the Eye Bank Association of America (EBAA) includes information on all EBAA member eye banks (55 US and 11 international) and EBAA accredited entities (1 US) reporting data for the 2023 calendar year and represents an essentially complete picture of eye banking activity in the United States. Data on utilization are provided for all tissue recovered by EBAA eye banks, and indications for surgery are provided for all tissue used for transplant. Details of This Year's Analysis Starting in 2017, the summarized data for Indications for Transplant were segregated by where the tissue from domestic eye banks was used—domestically or internationally. Before then, the analysis of corneas supplied by US eye banks included information from both indications from both domestically and internationally used corneas. However, the validity of the conclusions drawn from tissue utilization and indications for transplant was compromised by the large number of unknowns from corneas distributed internationally. Although the percentage of unknown indications for use in US tissue shipped internationally for transplant has improved in recent years (61.7% in 2021, 58.9% in 2022, and 57.8% in 2023, Table 1), the large number of unknowns makes it difficult to draw reasonable conclusions about what the tissue was used for or what the indication for surgery was. For this reason, the indications for transplant data (Table 2) are presented only for domestic utilization of corneas supplied by US eye banks; the unknown utilization percentage for domestic grafts was 7.2% in 2023. Because 32.5% of US tissue was shipped internationally for penetrating keratoplasty (PK), anterior lamellar keratoplasty (ALK), or endothelial keratoplasty (EK) procedures in 2023, the international unknowns represent a large subset of data on utilization of tissue recovered by US eye banks that is missing. TABLE 1. - Indications for Corneal Transplant, Reported by US Banks, 2023 Domestic Use International Use Total Indications for PK 2023 A. Postcataract surgery edema 865 6.0% 514 3.1% 1379 B. Ectasias/thinning 1939 13.4% 1416 8.6% 3355 C. Endothelial dystrophies 875 6.0% 649 3.9% 1524 D. Repeat corneal transplant 3273 22.6% 752 4.6% 4025 E. Other degenerations or dystrophies 725 5.0% 329 2.0% 1054 F. Refractive 49 0.3% 29 0.2% 78 G. Microbial keratitis 390 2.7% 181 1.1% 571 H. Mechanical or chemical trauma 449 3.1% 201 1.2% 650 I. Congenital opacities 271 1.9% 279 1.7% 550 J. Pterygium 20 0.1% 5 0.0% 25 K. Noninfectious ulcerative keratitis or perforation 1196 8.3% 188 1.1% 1384 L. Other causes of corneal dysfunction or distortion 1601 11.1% 582 3.5% 2183 M. Other causes of endothelial dysfunction 1183 8.2% 569 3.4% 1752 Z. Unknown, unreported, or unspecified 1650 11.4% 10,821 65.5% 12,473 Total indications for PK 14,486 16,515 31,001 Indications for ALK B. Ectasias/thinning 247 41.3% 224 28.0% 471 D. Repeat corneal transplant 32 5.4% 14 1.8% 46 E. Other degenerations or dystrophies 74 12.4% 33 4.1% 107 F. Refractive 0 0.0% 0 0.0% 0 G. Microbial keratitis 20 3.3% 10 1.3% 30 H. Mechanical or chemical trauma 12 2.0% 8 1.0% 20 I. Congenital opacities 16 2.7% 9 1.1% 25 J. Pterygium 1 0.2% 0 0.0% 1 K. Noninfectious ulcerative keratitis or perforation 39 6.5% 18 2.3% 57 L. Other causes of corneal dysfunction or distortion 119 19.9% 73 9.1% 192 Z. Unknown, unreported, or unspecified 38 6.4% 411 51.4% 449 Total for ALK 598 800 1398 Indications for EK A. Postcataract surgery edema 3632 10.8% 894 14.5% 4526 C. Endothelial dystrophy 19,097 56.6% 934 15.1% 20,031 D. Repeat corneal transplant 4012 11.9% 420 6.8% 4432 M. Other causes of endothelial dysfunction 5152 15.3% 1570 25.5% 6722 Z. Unknown, unreported, or unspecified 1822 5.4% 2350 38.1% 4172 Total for EK 33,715 6168 39,883 Total number of PK, ALK, and EK procedures 48,799 23,483 72,282 TABLE 2. - Domestic Indications for Keratoplasty Reported by US Eye Banks in 2023 Surgical Diagnosis PK ALK EK Total Endothelial cell failure A Postcataract surgery edema 865 19.2% — — 3632 80.8% 4497 C Endothelial dystrophies 875 4.4% — — 19,097 95.6% 19,972 M Other causes of endothelial dysfunction 1183 18.7% — — 5152 81.3% 6335 Subtotal 2923 9.5% 0 0.0% 27,881 90.5% 30,804 20.2% of PK 82.7% EK 63.1% of grafts Stromal or full-thickness (nonendothelial) disease B Ectasias/Thinnings 1939 88.7% 247 11.3% — — 2186 E Other degenerations or dystrophies 725 90.7% 74 9.3% — — 799 F Refractive 49 100.0% 0 0.0% — — 49 G Microbial keratitis 390 95.1% 20 4.9% — — 410 H Mechanical or chemical trauma 449 97.4% 12 2.6% — — 461 I Congenital opacities 271 94.4% 16 5.6% — — 287 J Pterygium 20 95.2% 1 4.8% — — 21 K Noninfectious ulcerative keratitis or perforations 1196 96.8% 39 3.2% — — 1235 L Other causes of corneal dysfunction or distortion 1601 93.1% 119 6.9% — — 1720 Subtotal 6640 92.6% 528 7.4% 0 0.0% 7168 45.8% of PK 88.3% of ALK 14.7% of grafts Regraft D Repeat corneal transplant 3273 44.7% 32 0.4% 4012 54.8% 7317 22.6% of PK 5.4% of ALK 11.9% of EK 15.0% of grafts Unknown/Unspecified Z Unknown, unreported, or unspecified 1650 47.0% 38 1.1% 1822 51.9% 3510 11.4% of PK 6.4% of ALK 5.4% of EK 7.2% of grafts Total for each procedure 14,486 598 33,715 48,799 Donations and Tissue Supply In 2023, donors were up 12.8% and total corneas donated were up 12.4% in 2023 compared with 2022 (Table 3). Total corneal grafts (transplanted or long-term preserved) using tissue from US banks were up 9.9% in 2023 compared with 2022. Intermediate-term preserved corneas, which included all refrigerated tissue stored in hypothermic corneal storage solution used for full thickness and lamellar procedures, increased 8.7% from 71,835 in 2022 to 78,112 in 2023. TABLE 3. - Total Donations and Distribution of Tissue in 2023 2021 2022 2023 % Change Donations Eye banks reported 57 56 56 0.0 Total whole globes and corneas donated 126,623 122,472 137,697 12.4 Total number of donors 64,048 61,747 69,637 12.8 Use of donated tissue Total corneal grafts 79,641 79,126 86,986 9.9 Intermediate-term preserved corneas 72,038 71,835 78,112 8.7 Total domestic transplants 49,110 49,597 50,925 2.7 Total international transplants 22,928 22,238 27,187 22.3 Sclera 5614 2247 2195 2.3 Long-term preserved corneas 12,626 4580 5362 17.1 Research 14,222 13,943 13,983 0.3 Training 7425 6614 8239 24.6 Domestic transplants increased 2.7% and international transplants (using tissue from the US banks) was up 22.3% in 2023. Both domestic and international transplant numbers are close but still lag slightly behind pre-COVID numbers (Fig. 1).FIGURE 1.: Corneal transplants supplied by US banks, 2019 to 2023.The storage solution supply crisis in 2022 that resulted in a fewer corneas recovered in intermediate storage solution and shipped internationally was resolved by 2023, resulting in the increase in international tissue from 2022 to 2023. Corneas distributed in long-term preservation medium increased 17.1% in 2023; however, it is still less than 50% of the high in 2021 (Table 3). Most corneas distributed in long-term storage medium are used for glaucoma drainage devices. Overall, this downward trend is likely contributed to the significant increase in use of microinvasive glaucoma surgery (MIGS) devices by ophthalmic surgeons in the recent years. The total numbers for domestic and international transplants provided by US eye banks for the past 33 years can also be seen in Figure 2 and Table 4. In 2023, US eye banks collectively exported approximately 31% of tissue recovered in the United States to international surgeons. This trend, averaging approximately 30% over the last 12 years, demonstrates the continuing commitment of US eye banks to help international eye banks reduce global blindness because of corneal disease.FIGURE 2.: Total corneal transplants supplied by US eye banks in intermediate-term storage medium, 1991 to 2023, stratified by domestic and international use. TABLE 4. - Corneal Transplants Supplied by US Eye Banks, 1991 to 2023 Year Total provided by US Performed in US Performed Internationally 1991 39,515 35,831 3684 1992 39,973 35,525 4448 1993 40,215 35,173 5042 1994 41,539 34,842 6697 1995 42,740 35,300 7440 1996 43,711 34,668 9043 1997 43,492 35,209 8283 1998 45,579 35,861 9718 1999 45,765 33,020 12,745 2000 46,949 33,260 13,689 2001 46,532 33,035 13,497 2002 46,440 32,559 13,881 2003 46,436 32,240 14,196 2004 46,841 32,106 14,735 2005 44,329 31,952 12,377 2006 45,035 33,962 11,073 2007 50,122 39,391 10,731 2008 52,487 41,652 10,835 2009 59,784 42,606 17,178 2010 59,271 42,642 16,629 2011 67,590 46,196 18,307 2012 68,681 46,684 19,546 2013 72,736 48,229 20,213 2014 76,431 47,530 24,483 2015 79,304 48,792 25,832 2016 82,994 49,869 26,057 2017 84,297 50,934 26,645 2018 85,441 51,294 27,913 2019 85,601 51,336 28,402 2020 66,287 43,873 16,123 2021 79,641 49,110 22,928 2022 79,126 49,597 22,238 2023 86,986 50,925 27,187 Table 4 shows that US eye banks have exported approximately 30% of transplantable tissue recovered in the United States for international use for the past 20 years. Table 4 shows the data from which Figures 2 and 3A, B are plotted. Keratoplasty tissue usage in the United States dropped approximately 20% in 2020 from COVID-19 but has approximated pre-COVID levels in 2023.FIGURE 3.: A, Total corneas transplanted, US Eye Banks, 1991 to 2023. B, Percent of corneas from US eye banks used domestically.Figure 3A shows the data from Table 4 graphically displayed to show the increasing percentage of US recovered tissue that is shipped internationally. The drop in tissue exportation in 2020 resulted from COVID-19 epidemic, which adversely affected both tissue recovery and corneal surgery in the United States, leaving less tissue to share with other countries. Figure 3B shows the domestic data in Table 4. The percentage of corneas from US eye banks used domestically has decreased as more tissue is shipped internationally. Tissue Utilization From US Eye Banks Table 5 shows combined domestic and international utilization of tissue supplied by US eye banks over the past 5 years. In 2023, there was an increase in all keratoplasty procedures except keratolimbal allograft (KLA). Total grafts in 2023 increased 9.9% from 79,126 in 2022 to 86,986 in 2023. PK numbers increased 7.9% from 28,728 in 2022 to 31,001 in 2023. Although PK procedures worldwide have been on a decreasing trend since 2005, PK grafts in 2023 were higher than any of the previous 3 years. Tissue used for EK procedures, including both Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK), increased 10.3% from 36,173 in 2022 to 39,883 in 2023, the highest number of annual EK procedures to date. ALK procedures increased 13.7% to 1398 in 2023 from 1230 in 2022 but has not reached pre-COVID numbers. The number of corneas used for KLA decreased again, 10.7% from 122 to 109 in 2023. Corneas used for keratoprosthesis increased 14.7% to 156 from 136 in 2022. The 2023 number is less than half the 344 K-Pro procedures performed in 2017. The number of corneas used for ALK, KLA, and K-Pro procedures remains relatively small and is essentially unchanged over the past 5 years: Table 5 shows these 3 procedures combined used just 1.9% of the total tissue supplied by US eye banks for combined domestic and international use in 2023. TABLE 5. - Utilization of Tissue Supplied by US Eye Banks for Domestic and International Use, 2019 to 2023 Use of Donated Tissue 2019 2020 2021 2022 2023 Corneal grafts total 85,601 66,278 79,641 79,126 86,986 Penetrating keratoplasty 35,919 25,023 30,412 28,728 31,001 Anterior lamellar keratoplasty 2146 1072 1307 1230 1398 Endothelial keratoplasty 35,555 29,947 35,532 36,173 39,883 Keratolimbal allograft 110 119 134 122 109 Keratoprosthesis (K-Pro) 267 174 175 136 156 Glaucoma shunt patch or other nonkeratoplasty use 1018 873 839 920 1082 Other keratoplasty (experimental surgery) 44 11 25 31 27 Unknown or unspecified 4679 2777 3614 4495 4456 Sclera 5999 3151 5614 2247 2195 Long-term preserved corneas 8614 9093 12,626 4580 5362 Keratoplasty 126 125 82 134 306 Glaucoma shunt patching 8420 7037 10,283 4444 5045 Other surgical uses 68 1931 2261 2 11 Research 13,743 11,336 14,222 13,943 13,983 Training 9487 6504 7425 6614 8239 US eye banks also provided 22,222 ocular tissues for research and training, demonstrating continued support of cornea education and surgical training to promote development of future therapy and procedures. Domestic Use of Keratoplasty Tissue From US Eye Banks Trends in the domestic use of tissue (supplied by domestic eye banks in intermediate-term storage medium and used in the United States) are shown in Table 6. The number of penetrating grafts performed in the United States using intermediate-term preservation medium decreased 8.5% from 2022 to 2023 to Domestic PK numbers have decreased over the previous years from a high of in TABLE 6. - Domestic Use of Tissue From US Eye Banks, 2014 to 2023 Domestic Use 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Penetrating keratoplasty 14,486 Endothelial keratoplasty 33,715 Anterior lamellar keratoplasty 598 Keratolimbal allograft 82 68 109 107 K-Pro 279 122 EK procedures in 2023 increased from in 2022 to 33,715 in 2023 and have pre-COVID and numbers are (Table The number of corneas used domestically for EK has increased year since in 2005, PK in 2012 (Fig. TABLE - US Eye Banks, Domestic EK 2017 to 2023 Domestic Use 2017 2018 2019 2020 2021 2022 2023 Total EK procedures 33,715 procedures or procedures 21 4 0 5 3 Other EK 11 1 11 endothelial Domestic PK EK ALK surgery 2005 to procedures in the United States increased from in 2022 to 598 in 2023. anterior lamellar keratoplasty procedures in 2022 were the number since but the 2023 increase was still pre-COVID KLA and K-Pro procedures have been essentially in the United States over the past 10 years. ALK, KLA, and K-Pro up 1.7% of intermediate-term preserved tissue use in the United States in 2023. The percentage was essentially the as in 2022 and essentially the in both domestic and international Figure 4 is the in cornea The of PK, and ALK procedures performed in the United States over the last years can be seen in Figure 4. PK grafts have decreased since in 2005 because of the increased use of EK to endothelial In the number of EK procedures EK numbers in this both and and as Descemet stripping endothelial keratoplasty or endothelial Figure 5 shows the domestic use of intermediate preserved tissue in the United States. Most corneas in the United States are used for PK, or ALK, KLA, and K-Pro up about of all corneas used in intermediate storage of these procedures a for Domestic use of intermediate-term corneas, shows that in 2023, for the was the keratoplasty procedure performed in the United States. In 2023, there were more of both and procedures performed than Domestic PK, and surgery 2014 to shows PK and are and is increasing over the past 4 years. The of decreased in activity in and 2020 was because of In 2022, the number of PK, and procedures performed was essentially The number of PK, and procedures performed in the United States using tissue from US eye banks is shown for the last 5 shows that in 2023, for the procedures The more procedures in the past has for the annual increase in EK numbers since numbers have over the past years, but more procedures for the in total EK procedures for endothelial procedures increased from in 2022 to in 2023 procedures increased in that but for the of the total number of procedures in 2023. a for tissue from donors and over of Data for EK were in Most surgeons but in 2023, the number of procedures tissue increased from to 8.7% (Table Although surgeons to use percentage of procedures tissue decreased from in 2022 to in 2023 (Table surgeons to but there is not data to any from these on TABLE - US Eye Bank Use of Tissue for 2023 Total of Percent of Total 8.7 Tissue for Glaucoma Use of eye tissue to glaucoma shunt procedures is shown in Table Corneal tissue is the glaucoma surgeons use to shunt but there has been a 50% in the number of procedures using long-term preserved corneal tissue since the high in 2021 (Table The increase in use of devices by ophthalmic surgeons over the last 4 years has to a in the number of TABLE - Tissue for Glaucoma Data From Both Domestic and International Use of Tissue From US Eye Banks Corneas in long-term storage up approximately of all ocular tissue used for glaucoma shunt The fewer performed is for the usage of corneas preserved in long-term storage (Table Figures 8 and 9 show the data from Table 9 in Corneas stored in long-term preservation are the ocular tissue used to glaucoma shunt procedures, but the total number of shunt procedures has decreased in the past 2 years because of the increased use for Tissue used for glaucoma shunt 2014 to 2023.FIGURE Corneal tissue used for glaucoma shunt patching in for Keratoplasty The indications for the 3 keratoplasty procedures performed using corneas provided by US eye banks, both for domestic and international are shown in Table 1. The large number of has been a with international tissue and the validity of conclusions that can be drawn from that For 65.5% of tissue shipped internationally for PK has However, unknowns for US PK procedures decreased from in 2022 to 11.4% in 2023. For this reason, only domestic data are used for analysis of indications for surgery in Table 2. A of the information in Table 1 is shown in Figure and Figure the large number of for international use in 2023. The international procedures a in 2022 were A number of ALK are performed internationally because of endothelial of tissue for indications that be for PK Surgical indications for 2023 domestic and international tissue for the high number of A, Postcataract surgery B, endothelial corneal other or chemical ulcerative or other unknown causes of corneal or other causes of endothelial unknown or 2 is 4 for which keratoplasty is endothelial cell 2) or full thickness (nonendothelial) and The or indication for is each Endothelial disease is still the indication for domestic A total of 30,804 of 48,799 keratoplasty procedures in the United States in 2023 were performed for endothelial failure endothelial surgery and other causes of endothelial cell For the of endothelial 90.5% of grafts were EK and 9.5% were Repeat transplants in 2023, 15.0% of all were the were PK EK and ALK all with last Stromal disease 14.7% of all was the of indications for transplant in 2023. Stromal disease includes and dystrophies and corneal from and other causes of corneal all keratoplasty procedures that were performed for or full-thickness 92.6% were PK and 7.4% were were the The Association and EBAA have on the of the of the large of unknown information and a small number of eye banks are for a large of unknown This year the number of unknown indications for transplant decreased from 11.4% in 2022 to 7.2% in 2023. eye banks are to and to information on transplant to the validity of information in this Overall, dystrophy was the for keratoplasty in the United States in 2023 as has been the for the last 9 years. 95.6% of with dystrophy EK and 4.4% were the provided 15.0% of all and causes of endothelial was the indication of all Postcataract surgery corneal edema was were and and was and was the indication for transplant in 2022 as continuing an trend of keratoplasty procedures for from a high of in PK to be the surgical procedure for of corneal by 8 to 1 were PK and 247 ALK procedures for in 2023. The of ALK and over to this essentially unchanged for the past years, ALK procedures increased from in 2022 to 598 in 2023. of by and improved in are likely for the decreasing number of keratoplasty procedures for corneal A for the in PK, and ALK surgical indications over the past 11 years is shown in the 3 for PK, and 3 show a in the number of procedures because of COVID-19 in but a in 2021 and 2022. The number of PK procedures has dropped each year to In the number of PK for been decreasing for 10 years and for the the number of for (Fig. Before was the indication for PK, and it remains the for In 2023, there were 1939 PK grafts for and 3273 2022, the numbers were PK grafts for and PK for both and for surgery corneal edema have both been decreasing for the past 10 years. The in with is because of and PK for surgery corneal edema has also dropped both because of fewer of surgery corneal edema as surgery and surgical to and because more surgeons are with in surgical indications for is a large of with PK from the last years that still and Although the number of PK for endothelial dystrophies is a percentage of have and are with a full-thickness than endothelial there are still likely to be that from PK in the Figure 12 shows that endothelial dystrophy is the indication of EK and The number of remains but because more are the and the procedure is more the of is over in surgical indications for in surgical indications for ALK indication for ALK has been and other corneal in the but as fewer keratoplasty for the number of ALK procedures has downward over the last 9 years (Fig. for this the of because is not as as PK, and the of and in the for surgery in with The of tissue recovered and in 2023 pre-COVID levels in 2023 the keratoplasty procedure performed (Fig. The indication for keratoplasty in 2023 was endothelial disease of Table Corneal surgeons tissue 8.7% of the and tissue of the PK procedures in the United States have from a high of in 2005 to 14,486 in 2023. PK is the procedure used for corneal but PK for has for the past 9 years because of and (Fig. 11 and Table ALK procedures increased from to 598 in 2023 but still up only 11.3% of keratoplasty for corneal The number of ALK, KLA, and keratoprosthesis procedures have been essentially over the last 10 years. 3 procedures combined up approximately of all keratoplasty procedures performed in the United States (Table Corneas in long-term storage solution are the ocular tissue used by glaucoma surgeons to glaucoma drainage devices (Fig. but the number of corneas used to drainage devices decreased by more than 50% from 2 years because of the increased use of devices in glaucoma (Table was for of US eye tissue shipped internationally in 2022 and in 2023 (Table 1 and but the number of domestic unknowns decreased from 11.4% in 2022 to 7.2% in 2023. Eye banks still to to information on tissue used both domestically and and tissue to other eye

Topics & Concepts