In partnership with Vision Share and the Cheikh Zayed Foundation, Eversight – a global nonprofit aimed at eliminating corneal blindness by developing eye banks around the world – is spearheading the launch of the Cheikh Zayed Foundation Eye Bank (CZFEB) in Rabat, Morocco’s first regional eye bank.
The Ophthalmologist reached out to Global Development & Surgical Innovations Director of Eversight, Heather Nuskind, to learn more about the initiative.
Can you talk a little about Eversight's collaboration with Vision Share and the Cheikh Zayed Foundation in setting up this eye bank?
Vision Share originally began working with Cheikh Zayed University over a decade ago – they deliver cornea tissue to them to help reduce their surgical wait list for corneal transplantation. And then the Cheikh Zayed Foundation, which is the overarching foundation, wanted to look towards building their own eye bank. That's where Eversight came in. We are providing technical guidance – everything from facility design, education, to providing subject matter expertise to help them build the eye bank.
What does the introduction of an eye bank represent for a country like Morocco?
Eye health is an essential part of healthcare that contributes to the overall wellbeing and socioeconomic health of a society. Eye health does not just live in a bubble – visual impairment and blindness are associated with reduced economic opportunities, reduced educational opportunities, as well as an increased risk of comorbidities and even death.
Specifically, corneal disease affects a younger population than diseases like cataracts, glaucoma and macular degeneration, so it can be really impactful having access to corneal transplantation services. In many countries around the world, we know that when you are visually impaired or blind at a young age, then you are taken out of the workforce, or you're taken out of school early and the family may have to care for you. It’s really impactful not just for the individual and their family, but also for the economy and society as a whole.
We're hoping that this eye bank is going to be a catalyst for change, and that it will have a ripple effect, helping to alleviate corneal blindness not just in Morocco, but throughout Northern Africa. The goal of the eye bank is to become a center of excellence – they're going to become a regional tissue distribution center, as well as acting as a training center throughout the region. By becoming this center of excellence, the Cheikh Zayed Foundation Eye Bank (CZFEB) may serve as a model for other eye banks in the region.
How were Eversight’s existing training frameworks used to meet the specific needs of the Rabat-based eye bank technicians and healthcare infrastructure in Morocco?
Eversight has a really robust training program in place that has been shaped by more than 75 years of eye banking expertise and adheres to the strictest medical standards. What we did is we took this training program and adapted it for Morocco. We took out some of the US-centric terminology and examples, but most of the regulatory guidelines and framework are actually very similar across countries.
Sustainable eye banking requires skilled professionals. The bulk of the training is focused on donor recovery and donor eligibility – who can donate, what's needed, how you donate, what’s a rule-out and what’s not – and that is pretty general. When we're looking at communicable diseases, transmissible diseases, that doesn't really change.
When we start to dig deeper and get more specific, that’s when we can make determinations with Professor Mohammed Belmekki, the medical director of Cheikh Zayed hospital, based on their country’s specifics. This is similar to how many eye banks operate. We have general standards and guidelines set by the EBAA and FDA, and within these guidelines, there are many determinations which are at the discretion of the eye bank's medical director.
Are there any particular program milestones that stand out to you?
The program is a combination of synchronous and asynchronous learning. We put the curriculum together and for the first couple of weeks we were planning to meet the Rabat-based technicians remotely, check in, and run through a few things each week. But after the first few weeks, we realized that the remote asynchronous check-ins were not really working as well as we had hoped. We spoke with our partners at Vision Share and together decided to regroup and restructure the training sessions to become much more interactive, and engaging as possible, keeping in mind that we are remote learning. We then started to see that the technicians were getting through the material and picking everything up a lot easier than before. So, that was the first big milestone of our training.
Another exciting milestone was the remote tissue recovery labs we implemented after the first few weeks of didactic learning. The Moroccan team set up a full lab with globes, while Dana Owens, our Director of Tissue Recovery, connected remotely and directed them on how to start recovering corneoscleral rims.
This was just an early introduction on how to perform the recoveries and get used to handling the tissue. They set their cameras up to show what they were doing, and we were able to do several weeks of these remote recoveries. Some weeks were better than others, but it was really exciting because this was a new training experience for both us and them, and it was really inspiring to watch the improvements week to week.
Is there some face-to-face training still to come?
Yes. The technicians will also have several weeks of in-person training in Michigan on the recovery and evaluation of the tissue. Our team will also spend time in Rabat working to better enhance and refine skills. The recovery training in Michigan will aim to help get the team better adept at handling and cutting the tissue without damaging the endothelium. They’ll also be trained on donor and tissue evaluation. We are already starting to provide education and training on these topics – an introduction, but it’s complex, there’s a lot to learn, and much has to be done in person.
One of the most time-consuming and advanced topics is tissue evaluation – they will be learning how to view the tissue through the slit lamp and how to evaluate it, spot any indices, scars, diseases which may rule out donation They are currently getting tissue right now from Vision Share, so, as much as possible, we are encouraging the team and Professor Belmekki to learn how to view the tissue through the slit lamp. But it is a complex and challenging thing to learn, and we certainly don’t expect them to learn this in the short training module we’ve set up. This is ongoing learning, giving them a basic introduction to the overall process, and then our team – including Dana Owens, our Director of Tissue Recovery, and Nicholas Hicks, our Director of Tissue Processing – will go out to Morocco and provide follow-up training at the eye bank itself.
What is next for Eversight’s global development work? Do you have similar projects in the pipeline?
We have been working with several leading eye institutions in Pakistan including Islamabad, Lahore, and Karachi, to develop eye banks which will hopefully serve the entire country.
Pakistan has a national registration ID program, where every Pakistani citizen – regardless of whether they’re living in the country or not – has to sign up for a national ID card. A huge milestone in the country, which has recently been implemented, is a donor registration ID is now part of this program. So when you sign up you have to say whether you want to be a donor or not. Even if only 1% of the population says yes to being a donor, that's going to be enormous.
Training and education are critical pieces for expanding access to care and addressing the global burden of corneal blindness. When you set up an eye bank anywhere, it's not done in a bubble – you need advocacy, awareness and public trust for it to function effectively. It's not a “build it and they will come” situation. You must have the advocacy part built in for it to work.
Additionally, the government in Punjab province, the most populous province in Pakistan, has recently made eye banking a major priority. The project there has really taken some huge leaps forward.
We also have two other projects – one in South Korea where we are working with the Korean Federation of International Lions Associations, as well as some leading cornea transplant institutions, to develop eye banks across the country. This is hopefully going to serve as a model across East Asia that currently don't have fully developed programs.
Ukraine is another project. We have been providing tissue to Ukraine, but in the next two years we're hoping to develop an eye bank there, and to train surgeons. We recently brought over three Ukrainian surgeons to our Ann Arbor office to provide training in eye banking.
98% of people globally who are corneal blind live in low- and middle-income countries. The United States is one of only five countries globally that have self-sustained eye banking infrastructure. So, the need for eye bank development and eye donation programs is vast in most areas of the world. Eversight’s eye bank development approach is based on four pillars: people, place, education, and community. Whether you are a healthcare leader, government official or philanthropist, readers of The Ophthalmologist can be part of the solution that gives the gift of sight and transforms communities for generations to come.
The Ophthalmologist reached out to Global Development & Surgical Innovations Director of Eversight, Heather Nuskind, to learn more about the initiative.
Can you talk a little about Eversight's collaboration with Vision Share and the Cheikh Zayed Foundation in setting up this eye bank?
Vision Share originally began working with Cheikh Zayed University over a decade ago – they deliver cornea tissue to them to help reduce their surgical wait list for corneal transplantation. And then the Cheikh Zayed Foundation, which is the overarching foundation, wanted to look towards building their own eye bank. That's where Eversight came in. We are providing technical guidance – everything from facility design, education, to providing subject matter expertise to help them build the eye bank.
What does the introduction of an eye bank represent for a country like Morocco?
Eye health is an essential part of healthcare that contributes to the overall wellbeing and socioeconomic health of a society. Eye health does not just live in a bubble – visual impairment and blindness are associated with reduced economic opportunities, reduced educational opportunities, as well as an increased risk of comorbidities and even death.
Specifically, corneal disease affects a younger population than diseases like cataracts, glaucoma and macular degeneration, so it can be really impactful having access to corneal transplantation services. In many countries around the world, we know that when you are visually impaired or blind at a young age, then you are taken out of the workforce, or you're taken out of school early and the family may have to care for you. It’s really impactful not just for the individual and their family, but also for the economy and society as a whole.
We're hoping that this eye bank is going to be a catalyst for change, and that it will have a ripple effect, helping to alleviate corneal blindness not just in Morocco, but throughout Northern Africa. The goal of the eye bank is to become a center of excellence – they're going to become a regional tissue distribution center, as well as acting as a training center throughout the region. By becoming this center of excellence, the Cheikh Zayed Foundation Eye Bank (CZFEB) may serve as a model for other eye banks in the region.
How were Eversight’s existing training frameworks used to meet the specific needs of the Rabat-based eye bank technicians and healthcare infrastructure in Morocco?
Eversight has a really robust training program in place that has been shaped by more than 75 years of eye banking expertise and adheres to the strictest medical standards. What we did is we took this training program and adapted it for Morocco. We took out some of the US-centric terminology and examples, but most of the regulatory guidelines and framework are actually very similar across countries.
Sustainable eye banking requires skilled professionals. The bulk of the training is focused on donor recovery and donor eligibility – who can donate, what's needed, how you donate, what’s a rule-out and what’s not – and that is pretty general. When we're looking at communicable diseases, transmissible diseases, that doesn't really change.
When we start to dig deeper and get more specific, that’s when we can make determinations with Professor Mohammed Belmekki, the medical director of Cheikh Zayed hospital, based on their country’s specifics. This is similar to how many eye banks operate. We have general standards and guidelines set by the EBAA and FDA, and within these guidelines, there are many determinations which are at the discretion of the eye bank's medical director.
Are there any particular program milestones that stand out to you?
The program is a combination of synchronous and asynchronous learning. We put the curriculum together and for the first couple of weeks we were planning to meet the Rabat-based technicians remotely, check in, and run through a few things each week. But after the first few weeks, we realized that the remote asynchronous check-ins were not really working as well as we had hoped. We spoke with our partners at Vision Share and together decided to regroup and restructure the training sessions to become much more interactive, and engaging as possible, keeping in mind that we are remote learning. We then started to see that the technicians were getting through the material and picking everything up a lot easier than before. So, that was the first big milestone of our training.
Another exciting milestone was the remote tissue recovery labs we implemented after the first few weeks of didactic learning. The Moroccan team set up a full lab with globes, while Dana Owens, our Director of Tissue Recovery, connected remotely and directed them on how to start recovering corneoscleral rims.
This was just an early introduction on how to perform the recoveries and get used to handling the tissue. They set their cameras up to show what they were doing, and we were able to do several weeks of these remote recoveries. Some weeks were better than others, but it was really exciting because this was a new training experience for both us and them, and it was really inspiring to watch the improvements week to week.
Is there some face-to-face training still to come?
Yes. The technicians will also have several weeks of in-person training in Michigan on the recovery and evaluation of the tissue. Our team will also spend time in Rabat working to better enhance and refine skills. The recovery training in Michigan will aim to help get the team better adept at handling and cutting the tissue without damaging the endothelium. They’ll also be trained on donor and tissue evaluation. We are already starting to provide education and training on these topics – an introduction, but it’s complex, there’s a lot to learn, and much has to be done in person.
One of the most time-consuming and advanced topics is tissue evaluation – they will be learning how to view the tissue through the slit lamp and how to evaluate it, spot any indices, scars, diseases which may rule out donation They are currently getting tissue right now from Vision Share, so, as much as possible, we are encouraging the team and Professor Belmekki to learn how to view the tissue through the slit lamp. But it is a complex and challenging thing to learn, and we certainly don’t expect them to learn this in the short training module we’ve set up. This is ongoing learning, giving them a basic introduction to the overall process, and then our team – including Dana Owens, our Director of Tissue Recovery, and Nicholas Hicks, our Director of Tissue Processing – will go out to Morocco and provide follow-up training at the eye bank itself.
What is next for Eversight’s global development work? Do you have similar projects in the pipeline?
We have been working with several leading eye institutions in Pakistan including Islamabad, Lahore, and Karachi, to develop eye banks which will hopefully serve the entire country.
Pakistan has a national registration ID program, where every Pakistani citizen – regardless of whether they’re living in the country or not – has to sign up for a national ID card. A huge milestone in the country, which has recently been implemented, is a donor registration ID is now part of this program. So when you sign up you have to say whether you want to be a donor or not. Even if only 1% of the population says yes to being a donor, that's going to be enormous.
Training and education are critical pieces for expanding access to care and addressing the global burden of corneal blindness. When you set up an eye bank anywhere, it's not done in a bubble – you need advocacy, awareness and public trust for it to function effectively. It's not a “build it and they will come” situation. You must have the advocacy part built in for it to work.
Additionally, the government in Punjab province, the most populous province in Pakistan, has recently made eye banking a major priority. The project there has really taken some huge leaps forward.
We also have two other projects – one in South Korea where we are working with the Korean Federation of International Lions Associations, as well as some leading cornea transplant institutions, to develop eye banks across the country. This is hopefully going to serve as a model across East Asia that currently don't have fully developed programs.
Ukraine is another project. We have been providing tissue to Ukraine, but in the next two years we're hoping to develop an eye bank there, and to train surgeons. We recently brought over three Ukrainian surgeons to our Ann Arbor office to provide training in eye banking.
98% of people globally who are corneal blind live in low- and middle-income countries. The United States is one of only five countries globally that have self-sustained eye banking infrastructure. So, the need for eye bank development and eye donation programs is vast in most areas of the world. Eversight’s eye bank development approach is based on four pillars: people, place, education, and community. Whether you are a healthcare leader, government official or philanthropist, readers of The Ophthalmologist can be part of the solution that gives the gift of sight and transforms communities for generations to come.
