An eye banking program for selecting donor corneas for surgical distribution.

Since fewer donated corneas have become available for surgery, we sought to chart the reasons to exclude them for surgical use over time. Those excluded from surgical use (1991-1994) were plotted using an algorithm based on the reasons for exclusion. Four general categories (universal contraindications [UC], national/local medical criteria [NLMC], serology, and morphology) yielded 13 possible areas. UC and NLMC exclusions for 1993-1994 were higher compared with 1991 and 1992 (p < 0.001). The proportion of corneas excluded for serological reasons decreased (p < 0.001) from 1991 to 1994. Exclusions due to morphology remained the same for all 4 years (p = NS). NLMC eliminate older donors but also exclude younger donors before the tissue reaches the eye bank (p > 0.001). Three of four of the youngest tissues ( < 30 years) are used for surgery, whereas one of five of the oldest ( > 70 years) is used. A quality control algorithm provides a heuristic and logical paradigm for noting changes from year to year. Heightened regulation has counteracted many gains in corneal donation fostered by favorable laws.

The impact of state legislation on eye banking.

Corneal transplantation, the most common transplantation procedure done in the United States, requires access to a sufficient number of donor eyes. We examined how laws governing tissue donation affect availability of corneal tissue by reviewing records of the Lions Eye Bank of Texas, Houston, from 1961 through 1990 (43,696 eyes from 21,898 donors). Relevant Texas statutes included the Uniform Anatomical Gift Act of 1970, the Justice of the Peace/Medical Examiner Law of 1977, and the Routine Inquiry Law of 1988. Before 1970, the mean (+/- SD) number of donated corneas was 72 +/- 38 per year; enactment of each statute above was associated with increased mean annual donations of 215 +/- 87, 1329 +/- 562, and 1958 +/- 33 corneas, respectively. The Justice of the Peace/Medical Examiner Law yielded significantly younger donors (who died of trauma), and the Routine Inquiry Law increased the number of hospitalized donors. Data from this eye bank were compared with current state laws nationwide. Effective legislation is a means to meet national ophthalmic surgical needs.

Morphologic changes of K-Sol preserved human corneas.

Supplementation of tissue culture medium with chondroitin sulfate has been shown to enhance donor corneal preservation. We assessed the efficacy of one of these chondroitin-supplemented media (K-Sol) in comparison with McCarey-Kaufman (MK) medium in maintaining corneal cellular morphology. Thirty-six human corneas, obtained within 8.6 h after death, were placed into K-Sol medium for up to 20 days preservation, and five paired control corneas were placed into MK medium for up to 6 days preservation. Specular photomicrographs were obtained every second to third day for a predetermined storage interval, then studied morphologically in a masked protocol by light microscopy, transmission electron microscopy, and scanning electron microscopy. Endothelial cell loss by specular microscopy averaged 5.8% after 1 week (6 to 8 days) and 7.4% after 13 days in K-Sol medium. Epithelial changes were erratic throughout the 20 day K-Sol preservation period. However, substantial keratocyte changes occurred after 10 days, and endothelial morphology uniformly deteriorated after 17 days. The morphologic data suggest that human corneas may be able to be preserved in K-Sol medium at 4 degrees C for up to 10 days but should be cautiously used thereafter.

Eye banking in Texas.

Texas is providing corneal tissue in the 1980s that is quite adequate to meet the needs of all Texas patients. Infrequent maldistribution is corrected by tissue-sharing between eye banks, facilitated by a toll-free number in Dallas (800-433-6667) for Texas eye banks to call when they cannot meet a local need. With distribution of tissue through eye banks, no patient need wait when tissue is abundantly available. The most important law aiding corneal tissue procurement has been the 1977 Medical Examiners/Justice of the Peace Act, that permits removal of corneas under controlled conditions. This has been implemented in almost all jurisdictions where medical examiners are active, although only a few counties have the services of a medical examiner. The implementation of this law, particularly in Austin, Dallas, El Paso, Fort Worth, Houston, and San Antonio, has increased previous donations by more than double.

Eye banking: 1944 to the present.

Through the efforts of Dr. Townley Paton, eye banks were founded in New York in the early 1940s. Since that time there has been steady growth in both the supply of and demand for donor material. A number of factors have contributed to the success of eye banks in the U.S.A., including improvements in eye banking techniques and administration, increase in corneal surgery, legislation facilitating corneal donations, and growing confidence of patients and ophthalmologists in the success of corneal tissue transplantation.

HIV antibody screening of corneal donors.

Because of the risk of transmitting the acquired immune deficiency syndrome through corneal transplantation, health officials have recommended donor screening. We prospectively studied the seropositivity rate for human immunodeficiency virus infection among ocular tissue donors at our eye bank during 1986. Of 1,517 corneal donors, 5 (0.3%) were repeatedly reactive by enzyme immunoassay. For comparison, 131 (0.06%) of 206,415 blood donors in Houston were similarly seropositive during this same 1-year period. Routine serological testing can be successfully implemented by eye banking personnel to potentially reduce the risk of viral transmission by keratoplasty.

Two treatments of eye bank donor corneas.

The many published studies on sterile procedures used by eye banks have included none until now on ways to optimize sterile handling of corneas procured in the morgues of forensic pathologists. The present study sought to discover if fewer positive cultures would be reported at the time of surgery from corneas which had been treated with an entire bottle of antibiotic (10 ml), as opposed to the more usual method of instilling 10 to 12 drops of antibiotic prior to the corneal excision. The result showed a marginal improvement of 3.1% fewer positive cultures when the entire bottle of antibiotic was used. The findings bolstered the theory that thorough and vigorous washing of the conjunctival sac prior to corneal removal is important and that positive cultures are no more likely when the cornea is shipped away from the eye bank than when used locally.

Evaluating the impact of a conference.

A comprehensive five-phase evaluation of the first Conference on Citizen CPR was implemented to measure its educational value and impact on attitudes regarding key issues in the lay CPR movement. Pre- and post-conference surveys of 480 members of the national CPR community and 165 conference participants along with an on-site evaluation of 152 participants indicated that participants felt that new and relevant information was presented and the conference resulted in little change in the attitudes of either participants or members of the national CPR community. The data reaffirm the educational value of conferences as new information was disseminated easily. However, the data raise questions about the impact conferences have upon attitudes, as only minor changes were reported. Weaknesses in the evaluation design are discussed, and recommendations for future conference evaluations are presented.

Indicators of response to a mass media CPR recruitment campaign.

Respondents to a mass media cardiopulmonary resuscitation (CPR) recruitment campaign in Harris County, Texas were more likely than non-respondents to be White, female, and under 45 years of age, to have had previous CPR training, experienced an incident in which knowledge of CPR might have been useful, or to have a friend or relative with a relevant medical history. The majority of the respondents were housewives, and professionals or technical workers, particularly in the health field. Findings can be used to identify audiences for future mass media CPR campaigns.

Communicating health information to urban Mexican Americans: sources of health information.

Data from a six-week hypertension campaign aimed at urban Mexican Americans were analyzed to document how they receive their health information and to identify the communication channels most likely to reach different segments of the Mexican-American community. The nine sources of information examined were doctor, nurse, pharmacist, family, friends, radio, newspaper, television, and magazine. The most common source of health information reported was doctor, followed by television, newspapers, magazines, family, and radio. Interview language (Spanish or English) was a significant predictor of the amount of health information received from all nine sources. Sex, family income, education, and age also were shown to affect the amount of health information received from various sources. Profiles of respondents most likely to use each source of health information are presented and implications for health educators are discussed.

Runners and meditators: a comparison of personality profiles.

Although both running and meditating have been considered as healthful and enlightening, no data have yet been published comparing the personality profiles of the two groups. A sample of 48 runners and 43 meditators, all males between the ages of 40 and 60, were given the Cattell 16 PF Test Profile and the results were compared. The meditators were significantly more assertive and enthusiastic than the runners. They also appear as Significantly less conscientious and controlled than the runners, as well as more experimenting and suspicious.