2024 Eye Banking Statistical Report—Executive Summary

Abstract

2024 ANALYSIS OF SURGICAL USE AND INDICATIONS FOR CORNEAL TRANSPLANT The 2024 Eye Banking Statistical Report of the Eye Bank Association of America (EBAA) includes information on all EBAA member eye banks (53 U.S. and 12 international eye banks and EBAA accredited entities (1 U.S.) reporting data for the 2024 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 in the U.S. Details of This Year's Analysis Since 2017, the data for Indications for Transplant have been segregated by where the tissue from domestic eye banks was used—domestically or internationally. Before then, the analysis of all corneas supplied by U.S. eye banks combined both domestically and internationally used corneas. However, the validity of the conclusions drawn from international tissue utilization was compromised by the lack of recipient information from corneas exported outside the U.S. The percentage of unknown indications for transplant in U.S. tissue shipped internationally has been significant in recent years (61.7% in 2021, 58.9% in 2022 and 57.8% in 2023) and jumped to 64% in 2024 (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 U.S. eye banks; the unknown utilization percentage for domestic grafts was 10% (7.2% in 2023). Since 33.5% of U.S. tissue was shipped internationally for penetrating keratoplasty (PK), anterior lamellar keratoplasty (ALK), or endothelial keratoplasty (EK) procedures in 2024, the 64% figure of international unknowns represents a large subset of missing data on utilization of tissue recovered by U.S. eye banks. TABLE 1. - Indications for Corneal Transplant Reported by U.S. Banks, 2024 Domestic Use International Use Total Indications for PK A. Endo dysfunction or corneal edema due to prior surgery 1320 9.3% 593 3.5% 1913 B. Ectasias/thinning (primary) 1793 12.7% 939 5.6% 2732 C. Heritable endothelial dystrophies 730 5.2% 802 4.7% 1532 D. Repeat corneal transplant 3229 22.8% 805 4.8% 4034 E. Anterior/stromal non-ectatic degenerations or dystrophies 496 3.5% 225 1.3% 721 F. Complications of prior refractive surgery 114 0.8% 49 0.3% 163 G. Microbial keratitis 498 3.5% 209 1.2% 707 H. Mechanical (non-surgical) or chemical trauma 658 4.7% 240 1.4% 898 I. Congenital opacities 328 2.3% 342 2.0% 670 J. Post-surgical (not refractive or keratoplasty) opacification/distortion 328 2.3% 139 0.8% 467 K. Non-infectious ulcerative keratitis, thinning, or perforation 1170 8.3% 143 0.8% 1313 L. Secondary endothelial dysfunction 1131 8.0% 289 1.7% 1420 Z. Unknown, unreported, or unspecified 2348 16.6% 12,142 71.8% 14,490 Total indications for penetrating keratoplasty 14,143 16,917 31,060 Indications for ALK B. Ectasias/thinning (primary) 174 29.8% 125 11.1% 299 D. Repeat corneal transplant 42 7.2% 13 1.2% 55 E. Anterior/stromal non-ectatic degenerations or dystrophies 79 13.5% 25 2.2% 104 F. Complications of prior refractive surgery 8 1.4% 2 0.2% 10 G. Microbial keratitis 22 3.8% 11 1.0% 33 H. Mechanical (non-surgical) or chemical trauma 33 5.7% 13 1.2% 46 I. Congenital opacities 43 7.4% 16 1.4% 59 J. Post-surgical (not refractive or keratoplasty) opacification/distortion 21 3.6% 19 1.7% 40 K. Non-infectious ulcerative keratitis, thinning, or perforation 63 10.8% 14 1.2% 77 Z. Unknown, unreported, or unspecified 99 17.0% 889 78.9% 988 Total for anterior keratoplasty 584 1127 1711 Indications for EK A. Endo dysfunction or corneal edema due to prior surgery 5387 15.5% 772 11.3% 6159 C. Heritable endothelial dystrophies 16,661 48.0% 837 12.2% 17,498 D. Repeat corneal transplant 4315 12.4% 470 6.9% 4785 L. Secondary endothelial dysfunction 5895 17.0% 1886 27.5% 7781 Z. Unknown, unreported, or unspecified 2442 7.0% 2893 42.2% 5335 Total for endothelial keratoplasty 34,700 6858 41,558 Total number of PK, ALK, and EK procedures 49,427 24,902 74,329 TABLE 2. - Domestic Indications for Keratoplasty Reported by U.S. Eye Banks in 2024 Surgical Diagnosis PK ALK EK Total Endothelial cell failure A Endothelial dysfunction or corneal edema due to prior surgery 1320 19.7% — — 5387 80.3% 6707 C Heritable endothelial dystrophies 730 4.2% — — 16,661 95.8% 17,391 L Secondary endothelial dysfunction (other than dystrophy or surgical/non-surgical trauma) 1131 16.1% — — 5895 83.9% 7026 Subtotal 3181 10.2% 0 0.0% 27,943 89.8% 31,124 22.5% of PK 80.5% of EK 63.0% of grafts Stromal or full thickness (non-endothelial) disease B Ectasias/thinnings 1793 91.2% 174 8.8% — — 1967 E Anterior and stromal non-ectatic degenerations or dystrophies 496 86.3% 79 13.7% — — 575 F Complications of prior refractive surgery 114 93.4% 8 6.6% — — 122 G Microbial keratitis 498 95.8% 22 4.2% — — 520 H Mechanical (non-surgical) or chemical trauma 658 95.2% 33 4.8% — — 691 I Congenital opacities 328 88.4% 43 11.6% — — 371 J Post-surgical non-edematous corneal opacification or distortion (not due to prior refractive surgery or keratoplasty) 328 94.0% 21 6.0% — — 349 K Non-infectious ulcerative keratitis or perforations 1170 94.9% 63 5.1% — — 1233 Subtotal 5385 92.4% 443 7.6% 0 0.0% 5828 38.1% of PK 75.9% of ALK 11.8% of grafts Regraft D Repeat corneal transplant 3229 42.6% 42 0.6% 4315 56.9% 7586 22.8% of PK 7.2% of ALK 12.4% of EK 15.3% of grafts Unknown/Unspecified Z Unknown, unreported, or unspecified 2348 48.0% 99 2.0% 2442 49.9% 4889 16.6% of PK 17.0% of ALK 7.0% of EK 9.9% of grafts PK ALK EK Total Total for each procedure 14,143 584 34,700 49,427 Donations and Tissue Supply Domestic transplants increased 1.2% and international transplants (using tissue from the U.S. banks) decreased 1.7% in 2024. Both domestic and international transplant numbers are close but still lag slightly behind pre-COVID numbers (Fig. 1).FIGURE 1.: Corneal transplants supplied by U.S. banks, 2020 to 2024.In 2024, donors were up 3.1% and total corneas donated were up 2.9% compared to 2023 (Table 3). Total corneal grafts (transplanted or long-term preserved) utilizing tissue from U.S. banks in 2024 were down 1.2% (up 9.9% in 2023). Intermediate-term preserved corneas, which included all refrigerated tissue stored in hypothermic corneal storage solution used for full thickness and lamellar procedures, were essentially the same (78,291) in 2024 as in 2023 (78,112). TABLE 3. - Total Donations and Distribution of Tissue in 2024 2022 2023 2024 % Change Donations Eye banks reported 56 56 54 3.6% Total whole globes and corneas donated 122,472 137,697 141,735 2.9% Total number of donors 61,747 69,637 71,778 3.1% Distribution Total corneal grafts 79,126 86,986 85,926 1.2% Intermediate-term preserved corneas 71,835 78,112 78,291 0.2% Total domestic transplants 49,597 50,925 51,559 1.2% Total international transplants 22,238 27,187 26,732 1.7% Sclera 2247 2195 4151 87.1% Long-term preserved corneas 4580 5362 7182 33.9% Research 13,943 13,983 13,169 5.8% Training 6614 8239 9190 11.5% Corneas distributed in long-term storage solutions increased 33.9% in 2024 (Table 4). Most corneas distributed in long-term storage solutions were used for glaucoma drainage devices. A downward trend in the use of long-term preserved corneas by ophthalmic surgeons seems to have reversed in 2024. TABLE 4. - Corneal Transplants Supplied by U.S. Eye Banks, 2000 to 2024 Year Total provided by U.S. Performed in U.S. Performed Internationally 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 2024 85,926 51,559 26,732 The total numbers for domestic and international transplants provided by U.S. eye banks for the past 34 years can also be seen in Figure 2. The raw data from which this figure is compiled is shown in Table 4. In 2024, U.S. eye banks collectively exported 31.1% of tissue recovered in the U.S. to international surgeons. This trend, averaging approximately 30% over the last 12 years, demonstrates the continuing commitment of both U.S. eye banks and help international eye banks to reduce global blindness from corneal disease.FIGURE 2.: Total corneal transplants supplied by U.S. eye banks in intermediate-term storage solution, 1991 to 2024, stratified by domestic and international use.Table 4 shows the data from which Figures 2 and 3 are plotted. Keratoplasty tissue recovered in the U.S. dropped approximately 20% in 2020 from COVID-19 but has approximated pre-COVID levels since 2023.FIGURE 3.: A, Total corneas transplanted from U.S. eye banks, 1991 to 2024. B, Percent of corneas from U.S. eye banks used domestically.Figure 3A shows the data from Table 4 graphically displayed to show the increasing number of total corneas provided by U.S. eye banks over the past 34 years. Figure 3B shows the percentage of U.S. recovered tissue that is used domestically. The decrease in tissue exportation in 2020 from the COVID-19 epidemic adversely affected tissue recovery and corneal surgery in the U.S., leaving less tissue to share with other countries. The percentage of corneas from U.S. eye banks used domestically has decreased since 1991 as more tissue is shipped internationally. Tissue Utilization From U.S. Eye Banks Table 5 shows combined domestic and international utilization of tissue supplied by U.S. eye banks over the past 5 years. Total grafts in 2024 were 85,926, down slightly (1.2%) from 86,986 in 2023. PK numbers were also essentially the same in 2024 (31,060) as in 2023 (31,001). Although PK procedures worldwide have been on a decreasing trend since 2005, PK grafts in 2023 and 2024 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 4.2% from 39,883 in 2023 to 41,558 in 2024, the highest number of annual EK procedures to date. The number of corneas used for ALK increased 22.4% in 2024. The number of grafts for keratolimbal allograft (KLA) and keratoprosthesis (K-Pro) have been essentially unchanged over the past 6 years. Even with the increase in ALK, the total number of corneas used for ALK, KLA, and K-Pro procedures remain relatively small compared to the number of PK and EK procedures performed. Table 5 shows these 3 procedures together utilized just 2.3% of the tissue supplied by U.S. eye banks for domestic and international use in 2024. TABLE 5. - Utilization of Tissue Supplied by U.S. Eye Banks for Domestic and International Use, 2020 to 2024 Use of Donated Tissue 2020 2021 2022 2023 2024 Corneal grafts total 66,278 79,641 79,126 86,986 85,926 PK 25,023 30,412 28,728 31,001 31,060 ALK 1072 1307 1230 1398 1711 EK 29,947 35,532 36,173 39,883 41,558 KLA 119 134 122 109 106 K-pro 174 175 136 156 154 Glaucoma shunt patch or other non-keratoplasty use 873 839 920 1082 1346 Other keratoplasty (experimental surgery) 11 25 31 27 161 Unknown or unspecified 2777 3614 4495 4456 2195 Sclera 3151 5614 2247 2195 4151 Long-term preserved corneas 9093 12,626 4580 5362 7182 Keratoplasty 125 82 134 306 1927 Glaucoma shunt patching 7037 10,283 4444 5045 5215 Other surgical uses 1931 2261 2 11 40 Research 11,336 14,222 13,943 13,983 13,169 Training 6504 7425 6614 8239 9190 U.S. eye banks also provided 22,359 ocular tissues for research and training, demonstrating continued eye bank support for cornea education and surgical training to promote development of future therapy and procedures. Domestic Use of Keratoplasty Tissue From U.S. Eye Banks Trends in the domestic use of tissue (supplied by domestic eye banks in intermediate-term storage medium and used in the U.S.) are shown in Table 6. All grafts except EK were down in 2024 compared to 2023. The number of PKs performed in the U.S. using intermediate-term storage solution decreased 2.4% from 14,486 in 2023 to 14,143 in 2024 (8.5% decrease in 2023). Domestic PK numbers have gradually decreased over the previous 19 years from a high of 42,063 in 2005 (66.4% decrease). TABLE 6. - Domestic Use of Intermediate-Term Preserved Tissue From U.S. Eye Banks, 2015 to 2024 Domestic Surgery Use 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 PK 19,160 18,579 18,346 17,347 17,409 15,402 16,269 15,835 14,486 14,143 EK 27,208 28,327 28,993 30,336 30,650 26,095 30,098 30,812 33,715 34,700 ALK 1115 1232 1027 884 745 505 544 476 598 584 KLA 97 82 93 68 95 109 K-pro 225 161 122 EK procedures in 2024 increased 2.9% from 33,715 in 2023 to an annual high 34,700 in 2024 increase in 2023 from 30,812 in and numbers are in Table The number of corneas used domestically for EK has increased year since in 2005, PK in 2012 (Fig. 4). TABLE - U.S. Eye Banks, Domestic EK 2018 to 2024 Domestic Surgery Use 2018 2019 2020 2021 2022 2023 2024 Total EK procedures 30,336 30,650 26,095 30,098 30,812 33,715 34,700 and procedures or procedures 6 4 0 5 3 6 Other EK 11 11 93 Domestic PK EK ALK surgery 2005 to procedures in the U.S. decreased from 598 in 2023 to 584 in 2024 been a increase in 2023 from 476 in ALK procedures have in the past from a high of 1232 in 2016 to a of 476 in KLA and K-Pro procedures have been essentially in the U.S. over the past 10 years. ALK, KLA, and K-Pro up of intermediate-term preserved tissue use in the U.S. in 2024. percentage was essentially the same as in 2022 and 2023 and was essentially in both domestic and international Figure 4 is the in cornea The of PK, and ALK procedures performed in the U.S. over the last years can be seen in Figure 4. PK grafts have decreased since in 2005 due to the increased use of EK to endothelial In the number of EK procedures the number of PK procedures. EK numbers in this figure both as Descemet stripping endothelial keratoplasty and endothelial keratoplasty and Figure 5 shows the domestic use of preserved tissue in the U.S. Most corneas in the U.S. are used for PK, or ALK, KLA, and K-Pro up of all corneas utilized in storage the procedures a for Domestic use of intermediate-term corneas, 6 shows domestic PK, and ALK use in the U.S. from 2020 to 2024. The increase in EK procedures and the decrease in PK procedures over can be Domestic PK EK ALK, 2020 to shows the number of PK, and procedures performed in the U.S. 2020 and 2024 using tissue from U.S. eye banks is shown for the last 5 years. from since 2020 can be Domestic PK 2020 to 8 shows that the total number of PK, and procedures performed in the were essentially in Since has increased and been the keratoplasty procedure performed in the United States. Since have been more of both and procedures performed than PK Domestic PK 2015 to shows that in 2023 the annual number of procedures The increase in the number of procedures has for the annual increase in total EK numbers seen since numbers have over the past 4 years. procedures increased from in 2023 to in 2024 a procedures increased in that same has been with a for tissue from donors and over of Data for endothelial keratoplasty was in Most surgeons but in 2024, the number of procedures tissue increased from to in 2023 to in Most surgeons to use in 2023 and in 2024 (Table TABLE - U.S. Eye Bank Use of Tissue for 2024 Total of Percent of Total Tissue for Glaucoma Use of eye bank tissue to glaucoma shunt procedures is shown in Figure Corneas in long-term storage up approximately of the tissue used for glaucoma shunt Although corneal tissue is a that glaucoma surgeons use to shunt has been a decrease in the number of glaucoma procedures using long-term preserved corneal tissue since 2021 (Fig. Corneal tissue used for glaucoma shunt patching in Tissue used for glaucoma shunt 2015 to of to use cornea or for shunt patching is due to the of the A the use of ocular tissue to patch shunt was 5 years of of of for the same the of ocular tissue to shunt is and is to ocular tissue for Corneas in long-term storage up approximately of all ocular tissue used for glaucoma shunt patching in 2024 (Table but was in TABLE - Tissue for Glaucoma including Data From Both Domestic and International Use of Tissue From U.S. Eye Banks Corneas in long-term has been used to Descemet or in with disease of the Data from this indication is and be Indications for Keratoplasty The indications for the 3 keratoplasty procedures performed utilizing corneas provided by U.S. 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 64% of tissue shipped internationally for PK has provided in 2023). For this reason, only domestic data is used for analysis of indications for surgery in Table 2. A of the information in Table is shown in Figure and the large number of for international use in 2024. The international procedures a in 2022 were and in 2023. The number of ALK performed internationally is to international use of tissue that be for PK of decreased endothelial cell Keratoplasty U.S. eye domestic international 11 shows surgical indications for 2024 domestic and international tissue for the high number of due to prior endothelial corneal non-ectatic of prior refractive (non-surgical) or chemical (not refractive or keratoplasty) opacification/distortion ulcerative keratitis, thinning, or endothelial dysfunction or Table 2 is 4 for which keratoplasty is endothelial cell stromal or full thickness (non-endothelial) and The or indication for is each Endothelial disease is still the indication for domestic keratoplasty (Table A total of 31,124 of 49,427 keratoplasty procedures in the U.S. in 2024 were performed for endothelial failure endothelial surgery edema and other of endothelial cell For the of endothelial 89.8% of grafts were EK and 10.2% were Repeat transplants in 2024, 15.3% of all were the indication for were PK EK and ALK all to the past 2 years. Stromal disease 11.8% of all was the of indications for transplant in 2023. Stromal disease includes and dystrophies and corneal refractive from keratitis and other of corneal all keratoplasty procedures that were performed for stromal or full thickness 5385 were PK and 443 were 9.9% of all were the a small number of eye banks are for the large of unknown information in 2022 and 7.2% in 2023). The Association and EBAA have on the of the of the large of unknown recipient information and All eye banks are to and to recipient information on transplant to the and of the information in this Table 2 shows the for keratoplasty procedures. dystrophy was the for keratoplasty in the U.S. in 2024 as it has been for the last 10 years. 95.8% of with dystrophy EK and 4.2% were the provided 15.3% of all and endothelial which included other of endothelial dysfunction than or surgical was the indication of all surgery corneal edema was were and was in 2024 as it has been in the previous 2 years, continuing a trend of keratoplasty procedures for from a high of in of by and in has been to the decreasing number of keratoplasty procedures for corneal keratoplasty to be the surgical procedure for of corneal by 10 to were PK and 174 ALK procedures for in 2024. The of ALK and over to this essentially unchanged for the past 8 years, and total reported ALK procedures for all remain in the U.S. in 598 in and 584 in The number of PK procedures has dropped each year since In the number of PKs for and the number of PKs for (Fig. the for In the U.S. in 2024, were 1793 PK grafts for and 3229 PK for both and for surgery corneal edema have been decreasing for the past 10 years. The decrease in is to and PK for surgery corneal edema is performed in with stromal Although EK has the procedure of for edema to endothelial cell failure and more surgeons are with endothelial a percentage of have stromal opacification and are with a full thickness than endothelial are still to be a number of that from PK in the trend in surgical indications for 13 shows that endothelial dystrophy is the indication for endothelial keratoplasty and The number of but since more are the and the procedure is more the of is over trend in surgical indications for EK indication for ALK was and other corneal this as it has been for the past 10 years. keratoplasty for the number of ALK procedures has downward over the last years. for this the of is as as PK, and the of and in the for surgery in (Fig. trend in surgical indications for ALK surgery corneal edema increased in 2024, from with this in 2023 to 6707 in 2024. was an increase in both PK and EK procedures for these surgery corneal edema over the past and the for the significant increase this year are in 2024 was the keratoplasty procedure performed (Fig. The indication for keratoplasty in 2024 was endothelial disease of Table is the of edema due to prior as surgery corneal and endothelial dysfunction other than surgical which includes edema by or Corneal surgeons tissue of the and tissue of the PK procedures in the U.S. have from a high of 42,063 in 2005 to 14,143 in 2024. PK is still the procedure used for corneal but PK for has for the past 10 years, due to and (Fig. 11 and Table ALK procedures decreased 2.3% from 598 in 2023 to 584 in 2024 but still only 7.6% of keratoplasty procedures for stromal disease and 1.2% of all keratoplasty procedures. The number of anterior lamellar keratolimbal and keratoprosthesis procedures have been essentially over the last 10 years. 3 procedures combined up approximately of all keratoplasty procedures performed in the U.S. (Table Corneas in storage solution are the ocular tissue used by glaucoma surgeons to glaucoma drainage (Fig. but the of ocular tissue used to drainage has decreased by over the past 8 years (Table due to used to be a for ocular tissue used to but the is and surgery are less to the of ocular to The of or corneal tissue to is glaucoma was recipient for of U.S. eye bank tissue shipped internationally in 2024 (Table the highest percentage in the Eye banks still to to recipient information on tissue used both domestically and as as tissue to other eye banks.

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