Landmarks in the History of the Eye Bank Association of America

INTERNATIONAL JOURNAL OF EYE BANKING GLOBAL PERSPECTIVES The Evolution of Eye Banking in the United States: Landmarks in the History of the Eye Bank Association of America Patricia Aiken-O’Neill, JD; Mark J. Mannis, MD ABSTRACT Established in 1961, the Eye Bank Association of America (EBAA) was not only the first eye bank association in the world but also the first association to represent any group of organ or tissue transplantation profession- als. Its history is one of additional “firsts”: setting medical standards to ensure tissue safety, establishing an accreditation process for individual eye banks, and developing a certification program for eye bank techni- cians, among others. To accomplish these initiatives, the EBAA has fostered collaborations with diverse communities, including government officials, corneal surgeons, Lions Clubs members, researchers, tissue and organ banks, and international organizations, thus continuing to evolve its role in pursuit of an unchanging mission: to champion the restoration of sight. KEYWORDS: corneal transplantation, Eye Bank Association of America (EBAA), eye bank methods, eye banks, history of eye banks The Preamble to Eye Banking plasty development to North America. He became the chief proponent of pen- A date familiar to ophthalmologists and eye banking profession- etrating keratoplasty and developed ba- als alike is December 7, 1905, when Karl Edward Zirm, a young sic surgical techniques and instrumenta- physician in Moravia, performed the first successful penetrating tion, many of which remain the basis of graft into his patient.1 This single event catalyzed renewed en- contemporary surgery.3 thusiasm for the feasibility of penetrating keratoplasty. (See the From the beginning, what distin- related article in this issue, “Eye Banking in the 21st Century: guished keratoplasty from other ophthal- How Far Have We Come? Are We Prepared for What’s Ahead?”) mic procedures was the requirement for Fig. 1. Richard What ensued was the elaboration and articulation of the prin- donor tissue, a need that added a unique Townley Paton, MD, ciples of patient selection, surgical management, and postopera- dimension to the surgery. In 1933, Rich- founder of the first eye tive care. Newly refined techniques and protocols brought legiti- ard Townley Paton (1901−1984) (Fig. 1), bank in the United mate success to keratoplasty.2 (See the EBAA’s “Wall of History.”) an ophthalmology resident at the Wilmer States, the Eye-Bank The migration of Ramon Castroviejo from Spain to the United Eye Institute, became intensely interested for Sight Restoration States in 1929 effectively moved the center of modern kerato- in the potential of the procedure utilized in New York, NY. Author Affiliations: Eye Bank Association of America, Washington, DC Corresponding Author: Patricia Aiken-O’Neill, JD, 1015 18th St NW, (Ms Aiken-O’Neill, CEO 1990-2011); and Department of Ophthalmology Suite 1010, Washington, DC 20036 ([email protected]). and Vision Science, University of California, Davis Eye Center, Sacramento (Dr Mannis). Both are members of the International Journal of Eye Banking Editorial Advisory Board. International Journal of Eye Banking • vol. 1 no. 1 • Sept. 2012 • doi:10.7706/ijeb.v1i1.36 • © 2012 Regents of the University of Minnesota. All rights reserved. 1 www.eyebankingjournal.org GLOBAL PERSPECTIVES The Evolution of Eye Banking in the United States: Landmarks in the History of the Eye Bank Association of America Volunteers such as Mrs. Gison (K7UJV) of Phoenix, Arizona, responded via radio to urgent calls for tissue. Here she readies her daughter for school. Newsight, August 1964. During the 1940s and 1950s, a proliferation of new eye banks occurred across the country. These were typically not the formal organizations we know today, but rather services most often In early eye bank history, Eastern Airlines transported cor- adjunct to a local department of ophthalmology and operated neas from the Red Cross. under the auspices of the ophthalmologist who performed corneal transplants in the host institution. The proponents of corneal transplantation, now completely dependent on tissue avail- to restore sight. When he began practicing ophthalmology in ability, began to realize that separate and independent eye banks, New York City, Paton recognized the need for an infrastructure each following its own mission and working in isolation, would for the collection of suitable donor tissue that would support the not achieve consistent national success unless United States eye development of corneal transplantation. Together with Aida da banks joined to promote tissue donation and their mutual inter- Costa Breckenridge, a former patient of William Holland Wilm- ests as transplant support organizations. er who had helped to raise funding for the establishment of the By the mid 1950s, a number of prominent leaders in the field Wilmer Institute, Paton established the Eye-Bank for Sight Res- recognized the need to establish uniform medical standards and toration in New York City, chartered on February 21, 1945. practices that would “govern” the emerging subspecialty and pro- It was this singular alliance between a physician and a lay- vide an adequate supply of corneas to meet the growing demand person that set the stage for the intrinsic partnership that would for tissue as keratoplasty became more successful and more com- propel American eye banking forward. Upon this stage the pre- monly performed in the United States. These experts met during mier eye banking organization in the world developed, setting the annual meeting of what was then the American Academy the bar for similar national and international support organiza- of Ophthalmology and Otolaryngology (AAOO). During that tions. Its history presents a marvelous story, with many chapters, meeting in 1955, 27 ophthalmologists, representing 11 eye banks the overriding theme being the establishment and operation of (Table 1), formed a Committee on Eye Banks, which still func- an infrastructure to provide the corneas needed for transplanta- tions today under the sponsorship of the American Academy of tion—what we know today as the eye bank. Ophthalmology (AAO). During meetings over several years, the International Journal of Eye Banking • vol. 1 no. 1 • Sept. 2012 • doi:10.7706/ijeb.v1i1.36 • © 2012 Regents of the University of Minnesota. All rights reserved. 2 www.eyebankingjournal.org GLOBAL PERSPECTIVES The Evolution of Eye Banking in the United States: Landmarks in the History of the Eye Bank Association of America Table 1. Founding Eye Banks of the EBAA EBAA’s vision, mission, and values produced a national cooperative that has inspired respect among wide-ranging constituencies Buffalo Eye Bank and transformed the lives of countless cornea recipients. The EBAA was both the first eye bank association and the first Colorado Eye Bank organization of its kind within the larger organ and tissue com- The Eye-Bank for Sight Restoration munity. It was the first organization to establish medical stan- Eye Foundation of Delaware Valley dards, accreditation procedures, and technician certification for its members—elemental actions that have helped differentiate Hawaii Eye Bank the eye banking community as a unique enterprise. Iowa Eye Bank Reviewing the history of the EBAA to date, several practices Lions of District 22-C of Washington, DC that stem from eye banking values have been formally institu- tionalized or informally nurtured. These practices have provided Minnesota Lions Eye Bank the bedrock that has inspired the subsequent respect and success North Carolina Eye Bank that are widely recognized as the hallmarks of today’s EBAA. An Rochester Eye Bank overview of these factors will reflect the story of EBAA’s vision, mission, and values. Southern Eye Bank The Development of a National Cooperative form of their vision took shape. They identified and agreed upon establishing an “association” of affiliated but separate eye bank Throughout the 1960s, 70s, and 80s, eye banks were established organizations. As the concept matured, all eye bank represen- in many communities, with more than 1 eye bank in some, and tatives were invited to an open meeting, where the resolution the number of United States member organizations participating was approved and forwarded for approval to the Council of the in the EBAA totaled more than 120 by 1990. After a period of AAOO. The Eye Bank Association of America (EBAA), born consolidation, the number is currently 85—some of which are in 1961, emerged from this approval (Fig. 2). Forty-six mem- umbrella organizations with multiple sites.4 Although eye bank ber banks joined the new association by 1964, representing all membership in the EBAA remained completely voluntary, the American eye banks that were then qualified to join. vast majority of American eye banks became active and support- It was a semi- ive members, establishing the EBAA as their official professional Fig. 2. Official EBAA logo nal event, setting organization. Currently, the EBAA represents all eye banks in the in place a na- United States as well as a number of organizations that perform tional organiza- some, but not all, eye bank functions; the EBAA also sets and tion, which would monitors the standards to which all members adhere. Member- promote and sys- ship in the EBAA is not restricted to banks within the United tematize the prac- States, but also includes eye banks in Canada and abroad. tice of eye bank- One of the hallmarks of the EBAA has been its ability to ing. The governance of the new organization was immediately adapt and evolve, innovate and improve. Regional representation identified, with the appointment of a Board of Directors and a serves as an example: Beginning in the 1970s, EBAA member House of Delegates, with the AAOO Committee on Eye Banks organizations were grouped into regions, based on the country’s acting as a medical advisory board. A formal infrastructure geography. Each region engendered loyalty and commitment, would follow in 1985, almost 25 years later, when a national fostering tissue sharing and regional meetings, most often held office opened in Washington, DC.

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