Why, how the eye bank has evolved

No longer just a retriever of tissue, today’s bank hosts researchers and has its own labs.

By Robert Calandra, contributing editor

Becoming an eye banker wasn’t written in Eric Meinecke’s career plan.

Not that he had a career plan. A recent college graduate, armed with a history degree, Eric Meinecke had little reason to think his future would soon come into focus.

But it did, thanks to a corpse’s eye and his brother.

His sibling, who worked for the Rocky Mountain Lions Eye Bank, got permission to take Eric to a morgue one night for a recovery.

Dan Schellenkamp, CEBT, uses an OCT microscope to examine a cornea. Examination by OCT is just one technique used to evaluate corneas for suitability for transplantation.

“I thought, ‘This is a little different being in a morgue in the middle of the night with a body.’ But I got hooked.”

Today, 15 years later, Mr. Meinecke is president and CEO of the Georgia Eye Bank in Atlanta, founded in 1961, the same year as the Eye Bank Association of America.

Modern methods

To say that Mr. Meinecke has witnessed some historic changes in eye banking — which includes the method to recover the corneal tissue — is an understatement.

That night in 2000 when the brothers visited the morgue, they recovered the tissue with a complete eye enucleation. Then, they returned the eye to the eye bank where the cornea was removed.

Fifteen years later, recovering tissue remains the eye bank’s bread and butter task. But, according to Mr. Meinecke, in 95% of today’s retrievals, the technician performs a corneal site incision, leaving the rest of the eye in place.

“That was a big tipping point in our profession,” Mr. Meinecke says. “Previous to that, there were families that were not very excited about us taking their loved ones’ whole eye.”

The corneal site incision advancement is but one of the many sophisticated services provided by modern eye banks. The 21st century eye banker no longer simply fetches, preserves and cuts tissue for researchers and surgeons. These professionals are an active part in providing the gift of sight.

“The eye bank’s body of knowledge has continually been advancing over the years,” says Eugene Gabianelli, MD, surgeon and managing partner of Georgia Eye Partners. “The big change from the eye bank’s point of view is that they were doing one sort of thing for a while and now they kind of have three different ‘flavors’ of tissue they can provide.”

Those new flavors are emerging from the growing collaboration among researchers, surgeons and eye banks. The upshot has been faster tissue recovery times, improved processing and preservation of tissue and new, innovative surgical techniques.

“Going forward, I think that the historical separation of the eye bank and researchers or research institutes will disappear and that partnership will become closer aligned,” says Greg Grossman, MD, director of research at Eversight in Cleveland, Ohio. “Research is what is going to uncover the unknown. And research is what is going to find the cures and new therapies.”

The push to find new cures and therapies is well under way. Many eye banks have either begun transitioning or have already morphed into first-class laboratories and bio-repositories. Some eye banks are already imaging the next level of innovation in sight-saving technology.

That next level is going to be the eye bank’s involvement in the cellular level, says Jason K. Woody, president and CEO of Lions Eye Institute for Transplant and Research in Tampa, Fla. “We will be doing the same function but we won’t be distributing the whole cornea anymore. We will be distributing cells.”

History

The first successful human cornea transplant took place in December 1905, in what is today the Czech Republic. A farm laborer with lime burns in both eyes received a full-thickness corneal transplant from an 11-year-old boy who suffered a penetrating sclera injury.

According to the British Journal of Ophthalmology, the graft was kept moist by placing it between “two pieces of saline-moistened gauze and holding it over a steaming container of hot, sterilized water.”¹

Almost four decades later, Townley Paton, MD, and John MacLean, MD created the first eye bank at New York Hospital in New York City. Another 17 years passed before the Eye Bank Association of America was established.

The first eye bankers were usually ophthalmologists summoned after someone died. They retrieved the whole eye but used only the cornea for transplanting. Because the tissue deteriorates quickly, the cornea had to be used within a day.

That changed in the 1970s when the University of Florida’s Herbert Kaufman, MD, and Bernard McCarey, PhD, developed a formula for storing corneas for up to four days (death to surgery).

“Eye banks with castoff tissue that was not used for transplant offered it to researchers,” Mr. Woody explains. “That’s how eye banks started to provide research tissue.”

Since then, the preservation of tissue and surgical techniques has steadily progressed, leading to new research and surgical techniques. Until relatively recently corneal transplants were only done full thickness. In partnership with eye banks, surgeons introduced procedures like Descemet’s stripping endothelial keratoplasty (DSEK). “Most of the corneal tissue cut for a DSEK today in the country is cut by eye banks,” Mr. Woody says.

Jane Crider uses a slit lamp microscope to backlight a cornea for evaluation. Examination by slit lamp is one of the techniques used to determine if donor tissue is suitable for transplantation.

Eye banks’ role expands

For Mr. Meinecke, eye banks went from entrusted couriers to valued partners in 2005 when the FDA issued regulations for good-tissue practices. Until then, Mr. Meinecke says, most eye banks had someone in charge of tissue quality, but laws didn’t require it.

“Now every eye bank has a quality assurance department,” he says. “We have to do process validations and verifications. We’re very much laboratories. We are held to a very high standard.”

This led some eye banks to create state-of-the-art research laboratories. Lions Eye in Tampa, for example, grows, collects and distributes disease-specific human tissue. Now, they also do the preliminary processing before sending it out. So if a researcher is studying the trabecular mesh, the Lions Eye lab will dissect it and put in the preservation solution the researcher requests. If the researcher is studying, Lions Eye can also provide that tissue.

“If researchers are growing it for cells, we can put it in a cell culture media,” says Mitch D. McCartney, PhD, scientific director at Lions Eye Institute for Transplant & Research, Inc. “If they are looking at the DNA and RNA we can put it into a solution that protects that. So what we are doing is decreasing the death preservation time significantly.”

David Morton, CEBT, uses a surgical microscope in a biological safety cabinet to begin the process of preparing a cornea for transplantation. Eye banks are capable of preparing DSAEK and DMEK tissue so it is ready for transplant by the surgeon.

Decreasing that time is important, Dr. McCartney says, because researchers don’t have to factor out degenerative byproducts. With years of experience preparing tissue, Lions Eye Tampa can help researchers understand what type of tissue they need. The eye bank even invites researchers to its onsite facilities.

“We have had researchers actually come and do their experiments in-house here,” Dr. McCartney says. “When they come, we prioritize the tissue that they need. The feedback we have gotten from people who have done that is that they basically do months of work in four or five days.”

The company is working on setting up in-house research models that will make data available to outside scientists.

Supplying researchers with specific tissue for studies is also the aim of Cleveland-based Eversight. What researchers need, says Dr. Grossman, is donor eye tissue that comes with as complete a medical history as possible.

“We have identified, by speaking with hundreds of researchers across the country, that they need really specific tissue with the correct medical history,” Dr. Grossman says. “And they need that tissue to be recovered in a timely manner.”

To expedite recovery time, Eversight is building a donor registry and bio-bank. Donors who sign up will have their entire medical record automatically downloaded to a data repository. When a donor dies, recovery technicians dedicated to the bio-repository will be immediately dispatched to recover the tissue.

“Research-specific technicians will be waiting in house and the second they get a call respond to that one case,” Dr. Grossman says.

Eversight’s future repository will also house a laboratory where researchers, fellows and residents can conduct studies. Dr. Grossman believes that the continued evolution of eye banks will require an even closer relationship with physicians and the research community. “By bringing them into our house, it brings their skills to us and they can have an impact on eye banking practices.”

Georgia Eye Partners is collaborating on studies with surgeons who are working at the eye bank’s in-house laboratory.

“We have advanced equipment and we have surgeons trying out new things, investigating new techniques of processing tissue, and how we can raise the level of care to improve vision for a recipient faster and faster,” Mr. Meinecke says.

The future

The partnership between eye banks, researchers and surgeons will grow stronger in the coming years, Mr. Meinecke says. To seal that bond and remain a valued partner, eye banks must continually raise their level of knowledge and technical sophistication.

“Surgeons will increasingly demand more from their eye banks,” he says.

But whatever the future holds for eye banks, they will always retrieve tissue.

“For us to continue our fantastic eye banking system in America, we need to continue to recover the amount of tissue that we do,” he says. “It enables us to care for our needs and then we can help other countries — that’s a beautiful thing. That’s what it’s about, providing the gift of sight.” OM

REFERENCE