SINGAPORE — A newspaper advertisement to encourage senior citizens to get a free full eye check-up spurred grandfather Chia Choon Kin to book his appointment three years ago. 

Thinking it would just be a routine check at the Singapore National Eye Centre, the retiree was not expecting the doctor’s grim prognosis: the cells in his corneas were dying.

“My vision was okay and I wasn’t experiencing any pain or tearing in my eyes,” said Mr Chia, who is now 66. 

“So I was completely surprised and taken aback.”

Over the course of the subsequent year and a half, which consisted of medical appointments every six months, Mr Chia said he realised his vision was fading.  

It got to the point where he was no longer comfortable driving his granddaughter to preschool as he was worried for her safety and that of other motorists.

“I just couldn’t see very far and it was very frustrating,” said Mr Chia, who made the decision to get a corneal transplant around the middle of last year for his right eye.

Mr Chia said he was “lucky” to have had to only wait three weeks for his operation appointment. 

Last year, the average waiting time for a cornea was 69 days, or slightly over two months, said Dr Anshu Arundhati, clinical director of the Singapore Eye Bank.

With about 40 Singaporeans or permanent residents on the waitlist last year, Dr Anshu said that one of the primary reasons for the delay is the lack of cornea donors.

CAN’T KEEP PACE WITH DEMAND

While Singapore saw a record high of 276 corneal donations in 2017, it has been trending downwards since. 

In 2018, there were 173 donations and last year saw just 141 donations — almost half the donations in 2017 and the lowest in five years. 

The SEB’s Hospital Eye Donation Program provided 74 corneas last year, forming the largest source of donations. 

Donors from the Human Organ Transplant Act (Hota) and Medical (Therapy, Education And Research) Act (Mtera) made up the rest of the donations at 35 and 32 respectively. 

Under Hota, all Singaporeans and permanent residents aged 21 and above are deemed donors unless they choose to opt out. 

The converse is true for Mtrea. Both acts govern the donations of organs such as the kidney, liver, heart or cornea. 

WHY LOCAL DONATIONS ARE NEEDED

Dr Anshu pointed out that even if someone did not opt out of Hota, their corneas can only be harvested once certain criteria and guidelines are met. 

She declined to reveal how many corneas which could be harvested under Hota are deemed unsuitable in the end. 

“Appealing to people who have opted out of Hota to rescind their objection will certainly expand the pool of potential donors and increase the chances of getting suitable corneas,” said Dr Anshu.

TODAY has reached out to the Ministry of Health on the number of individuals each year who opt out from Hota. 

With about 450 to 500 transplants done each year, Dr Anshu said that “local corneal recovery just can't keep pace with that number”. 

To make up for the shortfall, she said that corneas have to be sourced either from the recently deceased or from eyebanks in the United States.

But both options have their challenges and downsides.  

Dr Anshu explained that for each of the four major restructured hospitals — Singapore General Hospital, Tan Tock Seng Hospital, Changi General Hospital and the National University Hospital — dedicated eye donation counselors (EDC) screen every death referred to them by nurses. 

“If the case is deemed suitable (and they have not pledged to donate their corneas), the EDC will approach the next-of-kin to discuss the gift of sight,” said Dr Anshu.

Getting the consent for corneal recovery from the next-of-kin is challenging, she added. 

“A lot of the next-of-kin are always worried and concerned about wanting to keep the body intact,” she said. 

“It is also a very emotional moment for them, in terms of accepting the passing of (their loved ones), so it becomes very difficult to broach the subject as well.”

Dr Anshu reassured that when one donates a cornea, the concerns about disfigurement are not true. 

“We take utmost care to make sure that does not happen,” she said.

According to the SEB’s website, only the cornea  — which is about the size and shape of a contact lens — is removed, and not the whole eye.  

It is also done shortly after the donor’s passing and will not delay funeral arrangements.

“An open-casket funeral is still feasible as corneal removal makes no noticeable changes to the face,” said the SEB.

Dr Anshu added that anyone who wishes to donate their corneas should at least discuss the topic with their loved ones, or make a pledge to do so, as it would help them to fulfill their wishes. 

As for corneas ordered from the US, Dr Anshu said that this option is not ideal as the corneas must be typically transplanted within the first seven days after being harvested. 

By the time corneas reach Singapore and are ready for transplant —  after clearing tests and paperwork — about six to seven days may have already passed. 

“So that's why there it is important we reach out to the public to emphasise the need for (local) corneal donations,” said Dr Anshu.

Transplants from local corneal recoveries, on the other hand, can be done within three to four days, said Dr Anshu. 

This means cells within the cornea are “likelier to be healthier”. 

“And at the end of the day, when you decide to donate the cornea it means donating vision to someone in need,” she said, adding anyone 21 and above can fill in a pledge card to indicate their wish to donate their corneas upon death. 

One donation, she said, could potentially help two people to see. 

“I have seen patients who have actually been depressed because they were not able to see. But once they have been given this gift of sight, their entire personality changes completely.”

Since Mr Chia completed his corneal transplant for his left eye this February, he has been filled with gratitude towards his donors because “by right he should not be able to see anything”. 

“I’m so pleased I can lead a normal life again and not be a blind bat,” he said.