Showing papers in "Community eye health / International Centre for Eye Health in 2006"

Rapid assessment of avoidable blindness.

Abstract: The planning of eye care programmes requires data on the prevalence and causes of blindness. Unfortunately, programme planning is often hampered by the lack of data, because no surveys have been conducted in the area or the surveys are too old to be relevant. Programme planners are often reluctant to plan surveys, as they are believed to be expensive, time-consuming, and complicated. The Rapid Assessment of Avoidable Blindness (RAAB) has been developed as a simple and rapid survey methodology that can provide data on the prevalence and causes of blindness. So far, RAAB has been successfully undertaken in Kenya,1 Bangladesh,2 the Philippines, Botswana, Rwanda, Mexico, and China (personal communication). RAAB is an updated and modified version of the Rapid Assessment of Cataract Surgical Services (RACSS).3 The main aims of RAAB are: to estimate the prevalence and causes of avoidable blindness and visual impairment in people aged 50 and above to assess cataract surgical coverage to identify the main barriers to the uptake of cataract surgery to measure outcome after cataract surgery. Using sound epidemiological methods, these data are used to design and monitor eye care programmes in the surveyed area. RAAB focuses primarily on the prevalence of avoidable blindness, which is blindness due to cataract, refractive errors, trachoma, onchocerciasis, and other corneal scarring. This is because the aim of VISION 2020: The Right to Sight is to eliminate 80 per cent of avoidable blindness by the year 2020. RAAB is rapid, because it only includes the over-50 age group, where the prevalence is highest,4 so that sample size requirements are minimised. RAAB is simple, because it uses straightforward sampling and examination techniques, and data analysis is automatic and does not require a statistician. RAAB is relatively cheap, as it does not take a long time, does not require expensive ophthalmic equipment, and can be carried out by local staff.

Specialist outreach clinics in primary care and rural hospital settings (Cochrane Review).

Abstract: Background: Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. Objectives: To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. Search strategy: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in Specialist Outreach Clinics in General Practice (Roland 1998), and the reference lists of all retrieved articles. Selection criteria: Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Data collection and analysis: Four reviewers working in pairs independently extracted data and assessed study quality. Main results: 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple ‘shifted outpatients’ styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. Authors' conclusions: This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

The optic nerve head in glaucoma.

Abstract: The ONH can be examined using a direct ophthalmoscope, an indirect ophthalmoscope, or a posterior pole lens with a slit lamp. Many types of health professional can assess the ONH accurately after having appropriate training. Dilating the pupil makes this easier and will improve the accuracy of the examination, regardless of which instrument is used. Where the equipment is available, more sophisticated techniques such as scanning laser polarimetry, confocal scanning laser ophthalmoscopy, and ocular coherence tomography can also be used to complement the clinical examination of the ONH and provide quantitative measurements. The time available to view the ONH is often short as the examination is uncomfortable for the patient. It is therefore essential that the examiner has a strategy for making the observations needed to distinguish a glaucomatous ONH from a normal ONH. Before you start, you should first be able to recognise the characteristics of both a normal and a glaucomatous ONH, and be able to look for additional signs that could indicate a glaucomatous ONH.

How to manage a patient with glaucoma in Africa.

Abstract: How to manage a patient with glaucoma in Africa? The simple answer is: having made the diagnosis by optic disc assessment and intraocular pressure measurements (visual field tests are usually unavailable and unnecessary), perform trabeculectomy surgery using a technique broadly similar to that described by Ian Murdoch in this issue. This article discusses the reasons for this relatively universal management principle. The focus of this article is primary open-angle glaucoma, which affects the large majority of glaucoma patients across the continent. Some brief principles concerning management of other types of glaucoma in Africa are included at the end.

Knowledge and attitude of general practitioners towards diabetic retinopathy practice in South India.

Abstract: Introduction: General practitioners (GPs) are important members of the diabetic care network. Awareness levels of general practitioners are vital in planning strategies to prevent diabetic blindness. The present study was done to assess the knowledge, attitudes and practices (KAP) of urban GPs regarding the screening and management of diabetic retinopathy. Research design and methods: A questionnaire was designed to assess the GPs KAP in handling diabetic retinopathy. Questions related to referrals, direct ophthalmoscopy, and barriers to diabetic retinopathy screening. Urban GPs from Chennai were contacted through telephonic interview. GPs telephone numbers were traced from the Yellow Pages and a random digit dialing strategy was used. Telephonic survey was done for 450 telephone numbers of GPs. Results: Of the 450 telephone numbers of GPs that were dialled, only 187(41.6 per cent) responded to the questionnaire. 52 per cent of the GPs declined to answer questions. Among those who responded to the call, only 85 per cent (n =159) completed the tele-survey completely. Most of the GPs could not be contacted in the morning, as they were busy with their practice. Among those who successfully completed the survey, 46.6 per cent (n=74) of the GPs responded to the tele-survey after they were called more than five times. 33.4 per cent (n = 53) of the general practitioners responded after three to five calls and the remaining 20 per cent responded immediately. 31.3 per cent (n=50) feel that diabetics should undergo an eye examination every six months and 53.3 per cent (n=85) feel that diabetics should undergo eye examination every year. 15.4 per cent felt that eye examination every two years is sufficient for diabetics. Ophthalmoscopy was done by 1.3 per cent (2/159) of the GPs. Of the two, one GP performs ophthalmoscopy with dilation while the other performs it without dilation. The reason stated for not dilating was lack of time. Almost all GPs said that they would refer a patient with diabetes to an ophthalmologist. 84 per cent of the practicing physicians were aware of laser photocoagulation as a treatment modality for diabetic retinopathy. 54 per cent of GPs were aware of annual dilated eye examination referral guidelines for diabetics. Regarding attitudes for screening for diabetic retinopathy, only 1.3 per cent of GPs were using direct ophthalmoscope. Among them only 50 per cent were practicing dilated direct ophthalmoscopy. Barriers for doing diabetic retinopathy screening by general practitioners were lack of time, lack of ophthalmoscopes and lack of training. Discussion: This study shows the need for training GPs about diabetic retinopathy and its detection with direct ophthalmoscope. Barriers for dilated eye examination, as perceived by GPs, need to be addressed. McCarty et al.1 reported that lack of dilating drops in the practice, lack of confidence in detecting changes, concern about time taken and fear of precipitation of angle-closure glaucoma with their patients were some of the barriers expressed by GPs.1 Knowledge of the guidelines is another important factor to consider. Residency programmes should focus on providing more exposure to ophthalmoscopy practice among GPs, compared to the current low levels of exposure of only a few hours.

How to avoid mistakes in biometry

Abstract: The refractive power of the human eye depends on three factors: the power of the cornea, the power of the lens, and the length of the eye. Following cataract surgery, only the power of the cornea and the length of the eye are relevant. If both of these variables are known, it is possible to calculate what lens power will give the best refraction. Biometry is the process of measuring the power of the cornea (keratometry) and the length of the eye, and using this data to determine the ideal intraocular lens power. If this calculation is not performed, or if it is inaccurate, then patients may be left with a significant refractive error. On 8th February 1950, Harold Ridley implanted the first intraocular lens (IOL), following an earlier extracapsular cataract extraction. Post-operatively, the patient's refraction was −24.0/+6.0 × 30 degrees. Although Mr Ridley's choice of material was inspired, his patient did not enjoy the benefits of modern biometry. Over fifty years later, despite sophisticated technology and intelligent software, one frequently encounters biometry mistakes or ‘surprises’. Most are avoidable and most are due to human error. This article will examine the steps involved in biometry and the ways in which mistakes can be minimised, based on feedback from ophthalmic staff in busy units. NB Although accurate biometry represents the ideal, it is not always possible. In communities with a low prevalence of axial ametropia, an IOL of a standard power will give good results in at least half the population.1

How to assess a patient for glaucoma.

Abstract: Glaucoma affects approximately 65 million people around the world and an expected 75 million are blind due to the disease It is the second most common cause of blindness worldwide1 It is estimated that perhaps half the blindness from glaucoma in the world is caused by angle closure2 Accordingly, in order to be effective, any case detection has to include methods to detect angle closure A clinic examination is different from a screening programme in the community In the clinic the patient has sought us out and the responsibility is ours to detect and treat any pathology, including glaucoma Some short cuts that may be satisfactory in screening programmes are not acceptable in a clinic The best method to detect (and assess) glaucoma is to perform a comprehensive eye examination for all patients who attend the clinic, irrespective of the complaints they present with3

Setting the pace for VISION 2020 in Ghana: the case of Bawku Eye Care Programme.

Abstract: Ghana is a west African country bordered on the south by the Atlantic Ocean, and the north, east, and west by the Republics of Burkina Faso, Togo, and Ivory Coast respectively. It has a population of 20,771,382. Prevalence of blindness is estimated at one per cent. It currently has 52 ophthalmologists and 216 ophthalmic nurses (National Eye Care Secretariat), with nearly half of the ophthalmologists (19) located in the national capital and its environs. The health sector attracted 7.9 per cent of government budget in 2002 and 12.3 per cent in the 2006 budget. Currently there is a comprehensive national health insurance policy being implemented that covers most of the common eye operations done in the country.

Increasing the volume of cataract surgery: an experience in rural China

Abstract: Cataract: the situation in China Eighteen per cent of the world’s blind people live in China. The country is home to one of the world’s largest populations of blind people, an estimated 6.6 million. Cataract is the number one cause of blindness in China, accounting for nearly 50 per cent of all cases. China is also estimated to have the world’s most rapidly ageing population. By 2020, the country’s elderly population is expected to increase by 90 per cent and reach 240 million people. In 2005, about 600,000 cataract operations were performed in China, compared to 1.5 million LASIK operations. The cataract surgical rate (CSR) in China is around 450-460, compared to 3,700 in India.

Beyond the clinic: approaches to outreach.

Abstract: By making the elimination of needless blindness its prime objective, VISION 2020 has introduced a major paradigm shift in the planning and delivery of eye care. For many service providers and other stakeholders in this global initiative, this is both a challenge and an urgent call to move quickly from ‘reaching as many as we can’ strategies to new approaches that insist on ‘doing it right and enough to make a lasting impact’. How does one achieve this in the poorest and neediest parts of the world where service delivery is quite often synonymous with dysfunctional infrastructure, limited access to and use of existing eye care services? This is what makes current discussions on ‘reaching out beyond the clinic’ so relevant and so urgent. Daring to come out of the clinic, however, may not be enough in itself to bridge the existing gap between eye care service providers and the millions of blind and severely visually impaired people needing their services in those impoverished areas. To be optimally effective, outreach strategies must be grounded in, and guided by, a clear understanding of the inequitable nature of many eye care services, particularly, but not exclusively, in the developing world. As Figure ​Figure11 shows, those who need eye care services the most are often the last to have access to them, if at all. This may be so even when these services are brought closer to their communities, unless specific proactive measures are put in place to seek them out. Figure 1 The inequitable nature of current clinic-based and provider-centred eye care A quick overview of current outreach approaches to eye care delivery The term ‘outreach’ as it is used today covers a fairly wide range of strategies and approaches, some quite different from each other, but all aimed at providing services to those who otherwise would not come to the clinic. Table ​Table11 gives a summary of the main types, as well as their strengths and limitations. There are variants of each type and different types can be combined in the same projects. Some strategies, like the outreach surgical camps, once the pride of many institutions, have been on the decline for many years, primarily because of the high proportion of poor visual outcomes associated with them and the very limited post-surgical follow-up and refraction services available to patients. In spite of its drawbacks, this is still the preferred strategy used today by many philanthropic organisations offering free cataract surgery in many parts of Africa. Table 1 Summary of current outreach approaches to eye care service delivery Also, as is seen in Table ​Table11 (opposite), most outreach programmes can easily result in increased numbers of patients seen or offered surgery. The real challenge, however, is ensuring their administrative, organisational and financial sustainability for the long term, something that only few countries, institutions or organisations have done successfully so far.

Optical services through outreach in South India: a case study from Aravind Eye Hospitals.

Abstract: Trained staff refract the referred patients, note down their refractive error and write out the prescription. INDIA

Increasing the use of cataract services: using an existing eye care structure in Nigeria.

Abstract: Background Community-directed treatment with ivermectin (CDTI) is the main strategy of the African Programme for Onchocerciasis Control (APOC). It has enabled the programme to reach remote and underserved communities where onchocerciasis is endemic. With CDTI, the community is involved in key decisions about how the drug is distributed and selects the distributor. In this way, a relationship of trust is established between provider and beneficiary. This provides an entry point for expanding activities dedicated to the prevention of blindness. Christian Blind Mission International (CBMI) began working with the government of Nigeria in 1995 on their onchocerciasis programme. In 2003, this collaboration was broadened to address the prevention of blindness. The structure provided a way to reach the people living far from eye care facilities (in many states, these facilities exist only in the urban centres). In addition to strengthening the eye care services, efforts were made to create awareness and a demand for cataract services amongst rural dwellers. The programme described in this article aims to organise outreach programmes in northern Nigeria and falls within the authority of the Ministries of Health of the states of Kano, Jigawa, Yobe, Taraba, and the Federal capital territory, Abuja.

Creating demand for cataract services: a Cambodian case study.

Abstract: Patients waiting at the provincial eye unit of Kampong Thom, while nurse Mr Ty Seiha tests vision. CAMBODIA

What's new in age-related macular degeneration?

Abstract: Age-related macular degeneration (AMD) was regarded as unimportant in global blindness, of relevance only to the minority of the world's population that live in wealthy countries. However, increasing life expectancy, particularly in Asia, has challenged this view. The latest WHO estimates of global blindness suggest that there are over 3 million people blinded by AMD, representing 9 per cent of global blindness. Only cataract and glaucoma cause more blindness.

Professional management for eye care.

Abstract: The global initiative VISION 2020: The Right to Sight, estimates that only 25 per cent of existing infrastructure is used for eye care, while the target utilisation is set at 90 per cent. This requires a complete reorganisation. Many providers have the potential to significantly enhance their service by adopting professional management practice and new technologies in clinical services. This article addresses this opportunity from a professional management perspective. The responsibilities of a hospital administrator could be broadly classified as managing patient care, functional areas, support services, and developmental work. Eye care providers need to focus on four key areas. Strategic management to enhance the efficiency of their organisations requires: human resources management; quality management; marketing; and financial sustainability.

National-level outreach: South African Bureau for the Prevention of Blindness

Abstract: Early beginnings of the Bureau for the Prevention of Blindness The Bureau for the Prevention of Blindness was founded in 1944 as a division of the South African National Council for the Blind. From 1944 to 1952, the Bureau conducted countrywide surveys to determine the need for eye care services in our rural communities. Based on the information gathered, a mobile unit was established in 1952 with the help of the Order of St. John. This legacy has been built on over the decades and has evolved into a model which aims to increase access to eye care, particularly for disadvantaged township and rural people, while at the same time building the capacity and self-sufficiency of district level hospitals to provide eye care services within provincial health care services and budgets. Figure 1 Visit points of the Bureau in the respective provinces

The social construction of paediatric cataract: how parents make sense of their child's condition.

Abstract: Childhood cataract, congenital and traumatic, is the most common treatable cause of childhood blindness, being responsible for 10 to 30 per cent of all childhood blindness. Preventing blindness from childhood cataract requires not only high-quality paediatric surgery, but also an awareness of parents' understanding of the eye problem, and why they might not agree to surgery for their child. Several studies have examined the medical and social aspects of childhood cataract. Foster et al.1 point out that childhood blindness has huge socio-economic costs, and restoring the sight of one child blind from cataract is considered equivalent to restoring the sight of 10 elderly adults. It is therefore crucial that we understand why parents might not take up the option of surgery.

Popularising eye health services in southern Mexico: community workers meet a felt need

Abstract: Programmes for blindness prevention in southern Mexico face multiple challenges. The people in greatest need live in remote rural villages. Mountain ranges and bad roads make access to these villages difficult. Multiple languages (16 distinct languages in the state of Oaxaca alone) along with a diversity of customs and beliefs, make effective communication challenging. It is impossible for an ophthalmologist acting alone to gain the access needed to serve these communities well. Figure 1 Location of Mexico

The health for peace initiative in west Africa.

Abstract: Why health for peace? The usual understanding of the outreach concept is that a team travels from a base clinic to offer services either at another health facility or in a community, in order to increase access to services for underserved populations. Sometimes, teams travel from one country (usually developed) to another (usually far away) for the same purpose. In West Africa, this concept was expanded to include another aspect – that of Health for Peace. Sixteen countries of West Africa, with a total population of about 250 million, have formed an economic block called the Economic Community of West African States (ECOWAS), which ensures a degree of collaboration between countries, including movement of its citizens across borders. This block of countries has three official languages (French, English and Portuguese), which follow national boundaries, and several local languages that cut across boundaries. National boundaries are recent and artificial. There is a common culture across boundaries and thus a free movement of people. However, for other reasons, there have been intermittent civil conflicts and instability in the border areas of ECOWAS countries, specifically affecting GuineaBissau and Cassamance (southern province of Senegal). Displacement of populations and difficulties with disease control efforts had negative effects on the health status of citizens. The Ministers of Health of Senegal, The Gambia, Guinea-Bissau and Guinea, four countries with a total population of 19 million, decided in 1999 to work together under a Health For Peace Initiative (HFPI). Which health problems are targeted by the health for Peace Initiative? The four main intervention areas targeted by the HFPI are: • The Expanded Programme on Immunisation (EPI) • Epidemiological surveillance, epidemic management and complex emergencies • Roll Back Malaria • HIV/AIDS/STIs. Each area was the responsibility of a country; malaria was covered by The Gambia, HIV/ AIDS by Senegal, EPI by Guinea-Bissau, and surveillance by Guinea. The HFPI thus allowed cross-border joint activities such as joint immunisation days, and the sharing of experience, expertise and systems.

Reaching out: a strategy to provide primary eye care through the indigenous educational system in Pakistan.

Abstract: In Pakistan, there is a unique and indigenously established system of education called the madaris. It is the plural of madrassa, which is an Arabic word for a school system. In the context of Pakistan, it refers to an institutional set-up that runsin parallel to the conventional schooling system and is community-based. It is perhaps the oldest and the largest educational system of its kind where by the students are provided with free religious education. Some institutions offer a combination of religious learning and regular schooling. The facilities and the curricula vary from one madrassa to another. Since a majority of the students studying here belong to the poor and neglected socio-economic level of society, many offer free accommodation and food to the students in hostels, and most of these provide free education. These institutions are mostly funded by philanthropists; the standard of living of the students, however, is not always satisfactory. A few madaris provide basic health care services to their students, but most are neglected both by the government and the voluntary sectors. It is difficult to find data on the health status of these students. This article reports a study on these madaris that was carried out in 2002 in the district of Peshawar, the capital of the North-West Frontier Province (NWFP) of Pakistan which has a population of 2.5 million. It aimed to determine the prevalence of blindness and low vision among students in the age group of five to 15 years. It offers an agenda for primary eye care and highlights the importance of integrated health care reforms at the national level for this large non-government community education system that caters to an estimated half a million children throughout Pakistan.

How to manage a patient with glaucoma in Asia.

Abstract: Glaucoma affects nearly 70 million people worldwide, of which nearly half are in Asia.1 Although more people are affected by primary open-angle glaucoma (POAG) than by primary angle-closure glaucoma (PACG), the latter is more common in Asians and carries a higher burden of morbidity. An estimated 13.6 million people will suffer from PACG in Asia by 2010, of which nearly 3.5 million will be bilaterally blind.2 Unlike cataract, visual loss from glaucoma is irreversible. The methods for management of POAG are similar to those described in the other sections of this issue, therefore we will concentrate on PACG in this article. Traditional definitions of PACG have emphasised the symptomatic aspect of the disease. However, only 25 per cent of PACG is symptomatic, therefore more modern definitions rely on objective evidence of damage to the trabecular meshwork and optic nerve.3 A diagnosis of glaucoma means that there is damage to the optic nerve as shown by changes in the optic disc and a characteristic visual field defect. One important distinction is that acute angle closure, where there is a sudden rise in intraocular pressure (IOP) causing pain and blurred vision, is not considered as glaucoma. As management pathways for PACG are different to that of POAG, accurate detection as well as treatment are important when dealing with glaucoma in Asia.

Outreach eye camps: a case study from West Bengal, India.

Abstract: Our hospital is located in a village in the southern part of West Bengal. The parent organisation is Vivekananda Mission Ashram, which works mainly in the field of education. In 1994, community-based rehabilitation (CBR) for the blind started, and the eye hospital was established. Towards the end of 1995, an effort was made to attract more people to the hospital. The first step was to analyse the geographical spread of the outpatients. It was observed that more than 80 per cent came from the CBR area. We therefore decided to conduct outreach camps outside the CBR areas to increase the coverage. It was not easy at first to explain our approach and convince people about the camp process. People were familiar only with ‘makeshift’ surgical camps in school buildings and community halls. Fortunately, our organisation had a good name in the field of education, and this gave us a credible image in outreach eye care.

How I approach trabeculectomy surgery.

Abstract: The purpose of this article is to describe an approach to the most commonly performed surgical treatment for open-angle glaucoma, trabeculectomy It is important to recognise that the concept of trabeculectomy surgery can be difficult for patients to comprehend in the first place Their disease is frequently ‘thrust upon them’ by doctors; in other words, they are frequently asymptomatic in the eye that the ophthalmologist is most concerned about The therapy, at best, can only hope to maintain vision Vision may well deteriorate as a result of the therapy These concepts are vital in the consideration of any surgical intervention Preventive therapy is always more difficult to introduce This also means the surgeon is all the more challenged to produce the safest possible result A well-rested surgeon and a calm surgical environment is the start, along with a confident surgical technique The purpose of trabeculectomy surgery is to create a guarded fistula through which aqueous can drain from the anterior chamber, leading to a steady-state reduced intraocular pressure If this intervention is appropriate for a patient, drainage surgery has been demonstrated to give long-term intraocular pressure control and visual field preservation The main complication of this procedure is a failure of drainage due to a scarring response Other complications include hypotony (low pressure in the eye), infection, and haemorrhage This article describes each step and lists points for you as a surgeon to consider It is based on the assumption that the decision to operate is appropriate What matters is your results Follow-up of your surgery is vital so you know how successful your surgery is and can take steps to remedy the deficiencies you identify

Can we grow new retina

Abstract: Retinal degenerations and dystrophies, the major causes of genetically inherited blindness, are characterised by the death or degeneration of photoreceptors (rods and/or cones).1 Approaches to treating this disease include: a) replacing the defective gene; b) introducing a drug or agent that either slows down or stops the premature death of photoreceptors; c) introducing electronic chips; or d) replacing the damaged cells by cellular therapy. Gene therapy is aimed at counteracting the defective gene by substituting it with the normal gene in the target tissues. Though successful visual recovery has been reported with gene therapy in dog models,2–3 it remains a challenge to identify a safe and reliable way of introducing the corrective gene in humans, given that the genes need to act for the lifetime of the patient. Introduction of ‘a’ factors (such as growth factors) into the eye, directly or through implants, is another novel approach to preventing or slowing premature cell death.4–5 The challenge lies in delivering the drug to the appropriate site in a safe and sustained manner. Electronic chips, similar to the ones used for audio aids, have shown exciting results in some studies, but the technology is still in its infancy.6–7 As knowledge relating to stem cells has increased over the last two decades, attempts have been made to translate this research into clinical practice, particularly for ocular surface reconstruction. Certain ocular surface disorders, like chemical burns, cause damage to the corneal epithelial stem cells. The consequence of this is that the normal corneal epithelium is replaced by conjunctival epithelium, which leads to corneal opacity and vascularisation, with loss of vision. Many centres across the world,8–10 including our centre,11–13 have grown sheets of epithelial cells from stem cells, supported on amniotic membrane. These sheets of cells have then been successfully transplanted to cover the entire corneal surface in individuals with ocular surface disorders, leading to less inflammation and scarring. Though the clinical outcome of this new technique is well established, there are still many unanswered questions, particularly in relation to the long-term survival of the transplanted cells.