Four days after Ria was born with blue irises, the paediatrician told her parents, Mofizul Islam and Rahima Sultana, not to worry about the baby's eyes.
"Rather, you should feel lucky that your daughter will look very pretty", the paediatrician said with hope in his voice. Mofizul, a constable of Bangladesh Jail Police, hoped so.
The light of hope dimmed when Ria lost her vision at the age of 13. Despite several interventions, Ria's vision could not be restored fully because of the unavailability of cornea.
Cornea – the transparent membrane of the eye that covers the iris, pupil, and anterior chamber – functions like a window that helps our eyes to focus light so that we can see.
Against an annual demand for 20,000-25,000 corneas, Bangladesh's lone eye bank under the voluntary organisation Sandhani Eye Hospital can collect only 25 to 30 corneas.
Despite a social campaign on posthumous eye donation launched in the country nearly four decades ago, thousands of corneal patients, mostly young and representing poor communities, continue to suffer from the curse of visual impairment or blindness as not enough people are interested to pledge to eyes post-mortem.
The curse of blindness
After several visits to a Munshiganj-based ophthalmologist, Mofizul brought his daughter Ria to National Institute of Ophthalmology (NIO) in Dhaka. There, doctors examined Ria's eyes and prescribed cornea transplantation for both of her eyes.
NIO – the tertiary level eye institute – having no eye bank, referred Ria to the Sandhani Eye Hospital.
Between 2017 and 2021, Ria received two corneas from Sandhani, after waiting two years for each. However, the grafted cornea on Ria's left eye expired by 2021 and there was no new cornea preserved for her at Sandhani. By this time, epiphora (excessive tearing) developed in her right eye.
This year in February, from a private hospital, Ria received an imported cornea for Tk 1 lakh. Spending Tk70,000 more on the treatment of her right eye went in vain. Recently, the private hospital said Ria's right eye's sight is blurred by cataract.
"Her right eye sometimes swells with severe pain. How can a low-income service person like me manage the high cost of eye treatment? But it is hard to see my beautiful daughter suffering as well," Mofizul told this writer, weeping.
How does Ria, now 20, feel? People with eyesight would never really know. But the worried face of 30-year-old Rasheda Akhter, lying on a bed of the private-run Bangladesh Eye Hospital before undergoing cornea transplantation on 25 July, can give us some clues.
Grabbing the hands of the corneal surgeon Dr Md Amiruzzaman, Rasheda begged, "Please do something so that I can see again."
That evening, four corneas arrived from the US. Rasheda received one of those precious things.
The right eye of the Noakhali-resident housewife Rasheda was severely injured one year ago. Treatment at several hospitals in Chattogram brought no improvement. Meanwhile, bacteria from the injured eye infected the other one, damaging both.
With unavailability of cornea at Sandhani, Rasheda's family chose an expensive cornea at the private hospital with hope that at least she would see through one eye.
The lone eye bank and unavailability of cornea
Ria and Rasheda should consider themselves lucky to have received corneas when there are countless patients in the country left outside coverage.
Four decades ago, Sandhani National Eye Donation Society launched a campaign to build an eye bank in the country.
Founded in 1977, Sandhani first initiated cornea transplantation in 1984. That year, Sri Lanka Eye Donation Society's founding President FG Hudson Silva visited Bangladesh with a pair of corneas. A poor and blind girl named Tuntuni was the recipient.
So far, 39,575 people have pledged eye donations to Sandhani.
Till 25 May this year, Sandhani collected 4,118 corneas and transplanted 3,471. Of the corneas transplanted, only 124 came from pledgers while 181 were collected through counselling of the deceased's family. The rest were collected from unclaimed dead bodies.
Supported by ORBIS International, Sandhani International Eye Bank launched in 2004 under a four-year project. During the project phase, the eye bank grew well as the average rate of cornea collection and transplantation increased to 309 and 249, from 94 and 87 respectively.
Under the same project, a skill building fellowship programme for emerging corneal surgeons was run at Islamia Eye Hospital. US-based non-profit Vision Share supplied corneas free of cost for research purposes.
However, Sandhani failed to keep pace after the expiry of the project. Supply of free-of-cost cornea from the US stopped as well.
Import of cornea is not enough
Mir Moshiur Rahman was among the people involved with the project. Five years after the project expired, he founded a non-government organisation Chokh and started collaboration with Vision Share and some other eye banks in the US to import cornea.
Since 2015, Moshiur has imported more than 5,000 corneas from the US.
There are a few ophthalmologists who have also collected cornea from Nepal.
"If there is no supply of cornea from abroad, the patients under treatment would have remained blind or afforded a similar service from Indian hospitals," Moshiur said.
In the US, preservation of a cornea graft costs more than $1,200 and there are additional costs for transshipment.
Some patients under private hospitals said they paid Tk1,00,000-Tk1,50,000 for cornea transplantation. Whereas, the same costs at least Tk 5 lakh in india.
Senior cornea surgeon Amiruzzaman said transplantation of imported cornea at Bangladeshi hospitals are of international standard, but they lack fresh tissues.
"The sooner the cornea is collected from dead bodies, the better the quality is preserved. In India, patients can receive comparatively fresh tissue as there are many eye banks. But in Bangladesh, we don't," Amiruzzaman said.
Eye banks are a must
For Bangladesh, India can be a good example, as the rate of cornea procurement is high in the neighbouring country.
According to the 2016 Global Survey of Corneal Transplantation and Eye Banking, India has 238 eye banks out of the 742 available globally.
Professor Dr Mohammad Tosaddeque Hossain Siddiqui, president of Sandhani National Eye Donation Society, observed that due to lack of public awareness, posthumous eye donation campaigns are not gaining momentum in Bangladesh.
"In many cases, the Sandhani team returned from the pledger's home empty-handed as family members of the deceased did not allow cornea collection.
"In general, people lack a philanthropic mindset. They cannot understand how a cornea donation helps a blind person retain a normal and happy life," Tosaddeque said, adding that government support is crucial to make the eye donation campaign popular.
"Every year, around 10 lakh people die in Bangladesh. If we can collect corneas from at least 2 percent of them, the annual demand will be met," the surgeon concluded.