Ten-Year Update of a Global Survey of Corneal Transplant and Eye Banking

Importance Corneal transplant (CT) is the most frequent type of tissue transplant worldwide. A decade after the first global survey quantified a severe supply-demand imbalance, an updated analysis is needed to test whether progress has been equitable. Objective To describe global CT and corneal procurement (CP) activity in 2022, compare findings with 2012, and characterize supply and demand by country income group. Design, Setting, and Participants This global cross-sectional epidemiological study was conducted from December 2023 to December 2024. Data were obtained from a systematic literature review covering January 2018 to December 2024 and national or international eye banking registries. The 7-category supply-demand classification used in the 2012 survey was reapplied, with additional stratification by World Bank fiscal year 2023 country income group. Main Outcomes and Measures The primary outcomes were country-level numbers and rates per million population of CTs and CPs, country income group distributions, and prevalence-based supply-demand ratios. Results This study included 122 countries representing 89.5% of the world population. A total of 214 299 CTs were performed in 122 countries in 2022, a 16.1% increase from 184 576 in 2012. A total of 312 349 corneas were procured in 70 countries, a 10.2% increase outpaced by approximately 12% population growth, yielding a declining per capita procurement rate. The median (IQR) CT rate was 13.8 (5.0-43.4) per million; median (IQR) CP rate across procuring countries was 23.3 (7.2-69.4) per million. Median (IQR) CT rates were 43.1 (21.4-66.3) per million in high-income countries, 11.2 (6.0-22.6) per million in upper–middle-income countries, 4.4 (1.8-14.0) per million in lower–middle-income countries, and 0.4 (0.3-3.4) per million in low-income countries. Countries at or above the 2012 global median CT rate performed 89.7% of 2022 global CT activity while accounting for 44.1% of the cohort population. The prevalence-based supply-demand ratio was approximately 1:26 for bilateral corneal vision impairment and 1:55 when unilateral cases were included. Conclusions and Relevance In this global cross-sectional epidemiological study, despite a moderate increase in CT volume from 2012 to 2022, the supply-demand gap remains severe, and inequity has not narrowed. Coordinated investment in eye banking infrastructure in middle-income countries is needed alongside alternative therapies.