A review of patient demographics, indications, waiting period and patient availability for the elective corneal graft waiting list at Saint John Eye Hospital

Abstract

Aim: To analyse the corneal graft waiting list at St John Eye Hospital and assist the corneal graft team in future assessment and planning of corneal graft procedures via the following objectives: i. To describe the patient demographics and medical indications of patients on the St John Eye Hospital corneal graft waiting list ii. To describe the waiting times of patients on the St John Eye Hospital corneal graft waiting list iii. To determine the willingness of patients on the waiting list to be operated and to determine the reasons for those that are unwilling to proceed with a corneal graft. Method: A retrospective descriptive study was conducted using the available corneal graft waiting list at St John Eye Hospital as of the 1st September 2016.Patients on the final St John Eye Hospital corneal graft waiting list were contacted telephonically to determine the following: i. The availability and willingness of the patient to have the corneal transplant ii. In the event that the patient was not available or willing to have the corneal transplant, the reasons were elicited. Results: There was an almost equal gender distribution, with the female population comprising 50.56% (n=91) while the male population comprised 49.44% (n=89). The average age of patients on the transplant list was 37.16 years (Standard deviation = 18.55) while the median age was 32 years. Patients with keratoconus accounted for 54.44% (n=98) of cases. This was followed by corneal scarring at 22.78% (n=41) while pseudophakic bullous keratopathy accounted for 15.00% (n=27) of all pathologies. The average duration that patients were on the waiting list was 18.07 months (SD 27.16 months). The largest proportion of patients were those that had been on the waiting list for more than 6 months but less than a year (35.56%, n=64), followed by the group that had been on the list for 6 months or less (31.11%, n=56). The average visual acuity of the population was LogMAR acuity of 1.64 (SD 1.19) for the right eye, 1.56 (SD 1.19) for the left eye and 1.60 (SD 1.14) for both eyes. Of the 124 patients contacted, 82.26% (n=102) were still willing to have a corneal transplant. Patients that were unwilling to have a corneal transplant despite being on the transplant list comprised 14.52% (n=18), while 3.23% (n=4) were unsure. Conclusion: The waiting duration of St John Eye Hospital patients for a corneal graft is long for the period under review. The largest grouping by pathology was keratoconus, accounting for over half the cases awaiting corneal transplant, followed by corneal scarring. The majority of patients awaiting corneal transplantation had significant visual impairment, with the affected eye on average being classified as legally blind. The contactability and willingness of patients on the waiting list was relatively high. This is important for the St John Eye Hospital as they run a corneal graft service with limited resources. Easily contactable and eager patients are required to help decrease the waiting list patient load as and when donor corneal tissue becomes available