Reducing waiting times for corneal grafts using donor tissue imported from the US

Clinicians from Queen Alexandra Hospital in Portsmouth have described their use of imported donor corneal tissue from the US as part of efforts to reduce waiting times for routine corneal grafts.

Ophthalmology resident, Dr Cara Campbell, and ophthalmologists, Liam Price and Freddy Beer, presented the research at the European Society of Cataract and Refractive Surgeons Congress (ESCRS) (11-15 September, Excel London).

Since January 2025, 93 corneal transplants have been performed at Queen Alexandra Hospital using donor tissue imported from the US. Over the same period, average waiting times for routine corneal grafts reduced from more than a year to 28 weeks.

Price observed that it is becoming more common for NHS trusts to import donor tissue from the US and Europe for corneal grafts.

“Over the past five years, there has been an increase in demand and a relative stagnation or decrease in the supply,” he said.

“Whereas previously only a few trusts that did a high turnover of surgery needed to import corneas, now more of the regional trusts are using imported tissue,” Price shared.

Reflecting on the reasons for the shortfall in donor corneas within the UK, Campbell told OT an ageing population in the UK has increased demand for corneal grafts.

In terms of supply, Campbell explained that some patients who are registered as organ donors may have reservations about donating their corneas.

“Studies have shown that the eyes, in particular, are an organ that people are likely to opt out of donating,” she said.

In other cases, people who are willing to donate their corneas may not have their intention fulfilled because of issues of consent.

“They may be admitted to hospital or in a hospice, and in the days before passing away, there can be logistical reasons that mean those conversations have not been had,” she said.

She added that there are also instances where someone has consented to donate their corneas, but collection of the donor tissue does not happen within the required 24-hour time period.

Campbell highlighted that there is also strict exclusion criteria in the UK which limits the number of corneal tissue donations that are accepted.

Differences in the donation criteria between the UK and the US have meant that surgeons performing the corneal transplants have had to adapt their approach.

“One of the big differences that we found between the US tissue and the UK tissue is that in the UK they have strict exclusion criteria – only accepting eyes that haven’t had any previous surgery,” Campbell shared.

“US tissues will have had things like cataract operations, so you're then dealing with tissue that has incisions in the cornea,” she said.

Campbell highlighted that the main benefit for the trust of using imported donor corneas has been the reduction in waiting times.

She shared that this has resulted in faster visual rehabilitation for patients and a reduced risk of patients developing secondary scarring.

“Our service has been able to deal with the backlog and plan our surgical lists efficiently,” Campbell said.

She added that there are also professional development benefits.

“I’m in my final year of specialisation so having more tissue available has meant that there are more training opportunities,” Campbell shared.

Beer observed that the team of ophthalmologists providing corneal transplants at Queen Alexandra Hospital have learned from each other throughout the process.

“We’ve all learned about this new tissue that we are using, we’ve discussed it and shared our experiences,” he said.

“This paper was a unique opportunity to show what the benefits are to the NHS, to the patients, and to show the challenges that we experienced. We got through it together, and that was what was nice about it,” Beer highlighted.