The cornea is a
covering the front part
of the eye. As the eye’s outermost
layer, the cornea functions like a
window that controls and focuses
the entry of light into the eye.
Cloudy cornea due to infection,
eye injury, congenital conditions,
or age-related degenerative eye
disease prevents light rays from
reaching the light-sensitive portion
of the eye called the retina. This
may cause the patient to suffer
from poor vision or even blindness.
In eyes with cloudy corneas,
as long as the nerve and retina
at the back of the eye are still
healthy, patients can benefit from
a corneal transplant.
Local supply shortage
A corneal transplant involves
replacing the cloudy unhealthy
cornea with a thin layer of
healthy cornea from a donor to
offer someone the gift of sight.
The eyeball is kept intact in the
process of donation.
“A healthy donor cornea replaces
the patient’s opaque and diseased
one. When performed by a trained
ophthalmologist, the procedure has
the potential to fully restore vision,”
said Dr Anshu Arundhati, Senior
Consultant, Corneal & External Eye
Disease Department, Singapore
National Eye Centre (SNEC).
<<Dr Anshu Arundhati, Senior Consultant, Corneal & External Eye Disease Department, Singapore National Eye Centre (SNEC)>>
Close to 500 such transplants are
performed annually in Singapore.
However, the number of donors has
been on the decline in recent years
and donations fell to a five-year low
of 141 in 2019, said Dr Anshu, who
is also the Clinical Director at the
Singapore Eye Bank.
While the Singapore Eye Bank
has been able to rely on reputable
overseas eye banks, there is still
an urgent need to build up the
local supply of donated corneas to
“Thankfully, the waiting time for
a transplant has not been adversely
affected despite the shortage of
local tissue because of the overseas
pipeline we have maintained.
However, we should be cognisant
of the fact that this supply can be
disrupted at any time, particularly
during a pandemic like COVID-19,”
said Dr Anshu.
Who can donate?
Just about anyone can be a
cornea donor. There is no blood
type requirement. A person’s age,
eyesight and eye colour do not
But to ensure the safety of
the recipients and medical team,
all donors undergo stringent
screening. Individuals who have
had communicable diseases and
infections, certain cancers and
neurological conditions, eye
diseases, and other illnesses that
may compromise the safety and
quality of the corneas will not be
able to donate their corneas.
A recent review of potentially
suitable cases over the last three
years revealed some common
reasons behind why relatives decline
the donation on behalf of their
deceased family member. These
include the family wishing to keep the body intact, relatives being too
distraught when approached about
the donation, or family members
not wanting to put the deceased
through any further “suffering”.
An understanding of the
process of donation may ease
some of their concerns.
Cornea removal takes about
30 to 45 minutes, and is usually
performed shortly after death.
Under sterile conditions, the
cornea disc and a small rim of
surrounding scleral tissue (white
part of the eye) are removed and
transferred to a special cornea
storage solution, and stored at
The body of the deceased
is treated with utmost respect
throughout the entire process.
The removal of the corneas
will not result in any form of
disfigurement, allowing for an
open casket funeral service.
There is currently no acceptable
artificial replacement alternative
for a human cornea, though
several groups around the world
are actively seeking solutions to
counter the global donor shortage.
For example, clinicians and
scientists at SNEC and Singapore
Eye Research Institute are
currently working on tissueengineered
Primary human corneal
endothelial cells are cultivated,
expanded, and subsequently
transferred to a carrier substrate
for implantation. If this is
successful, a pair of donor corneas
can create up to 80 constructs and
potentially alleviate the donor
cornea supply crunch in the future.
After the passing of a loved
one, you may be too distraught
to make the call for cornea
donation, or may wish to keep
his or her body intact. If your
loved one had completed an
Organ Donor Card or previously
communicated a wish to donate
his or her corneas, the decision
may be easier for your family.
Make your intentions known
· Anyone above 18 years of age
can pledge to donate any organ
or tissue upon their death.
Fill out an Organ Donor Card
issued by the Ministry of
Health and carry it with you at
all times. Becoming a donor is
a personal decision.
· The Singapore Eye Bank
has an active Hospital Eye
Donation Programme at
Singapore General Hospital,
Changi General Hospital,
National University Hospital
and Tan Tock Seng Hospital.
· Singapore law allows the
deceased’s family to make the
decision of cornea donation on
his or her behalf. Counsellors
from the Singapore Eye Bank
will approach the family to
Remain on the Human
Organ Transplant Act
· In the event of death from any
cause, the HOTA allows for
the kidneys, heart, liver and
corneas to be removed for the
purpose of transplantation.
HOTA covers all Singapore
Citizens and Permanent
Residents aged 21 years and
above who do not have mental
disorders, unless they have
opted out of the scheme.
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