Case study finds methods used to assess corneas for transplants may be improved

Improving the training and standardizing the procedures used by the nation’s eye banks to assess corneal cells may help to select corneas with optimal health for transplantation, according to new study led by Jonathan H. Lass, MD, principal investigator of the study and chairman of the department of ophthalmology at University Hospitals of Cleveland and Case Western Reserve University School of Medicine.

This study is reported in the current (March) issue of Ophthalmology, the journal of the American Academy of Ophthalmology. The National Eye Institute and the Eye Bank Association of America funded this research.

The study, which is part of a larger Cornea Donor Study of 1,101 patients, was designed to evaluate the quality of the microscope images of the donor cornea and the number of donor cornea’s endothelial cells because those two parameters may help to determine the long-term (at least ten years) survival of a transplanted cornea. (Endothelial cells form the back cell layer of the cornea that pumps water out and keep the cornea clear.) When researchers measured the image quality and density of endothelial cells in the cornea, they were performing the same type of assessment that eye banks perform to ascertain whether a cornea is healthy enough for a transplant.

“Our results found that, over all, the current system for assessing quality and density of cells is good in the nation’s eye banks,” Dr. Lass says. “But there is room for improvement in some eye banks’ assessment procedures, both in terms of enhancing image quality of the microscope image of the corneal cells and improving the accuracy of counting cells, parameters used to assess the health of a cornea.”

More than 35,000 corneal transplants are performed annually in the United States, most of them on patients who undergo a corneal transplant because they have swelling due to cataract surgery or they have Fuchs’ Dystrophy, a condition in which the endothelial cells deteriorate. Eye banks play a crucial role in cornea transplantation. According to the Eye Bank Association of America, eye banks supplied the corneal tissue for 32,144 transplants in 2003.

“Often, the eye bank cell counts were off by more than 10 percent,” Dr. Lass says. “We believe these data will trigger the development of new methods, improved training and universal standards to ensure that healthier corneas are being transplanted.”

University Hospitals Health System's 947-bed, tertiary medical center, University Hospitals of Cleveland (UHC), is the primary affiliate of Case Western Reserve University (Case). Together, they form the largest center for biomedical research in the State of Ohio. The System provides the major clinical base for translational researchers at the Case Research Institute, a partnership between UHC and CWRU School of Medicine, as well as a broad and well-characterized patient population for clinical trials involving the most advanced treatments. Included in UHC are Rainbow Babies & Children's Hospital, among the nation's best children’s hospitals; Ireland Cancer Center, designated by the National Cancer Institute as a Comprehensive Cancer Center (the nation’s highest designation); and MacDonald Women's Hospital, Ohio's only hospital for women.

Committed to advanced care and advanced caring, University Hospitals Health System offers the region’s largest network of primary care physicians, along with outpatient centers and hospitals. The System also includes a network of specialty care physicians, skilled nursing, elder health, rehabilitation and home care services, managed care and insurance programs. For more information, go to


About Case Western Reserve University

Case is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work.