COVID-19 & the eye

EDITOR'S NOTE, July 2021: The Eversight-led research discussed throughout this post has been peer reviewed and published in The Ocular Surface. The scientific knowledge surrounding COVID-19 continues to grow and evolve. Based on available data, Eversight discontinued post-mortem SARS-CoV-2 testing in July 2021. Visit eversightvision.org/covid-19 for a comprehensive overview of our commitment to patient and tissue safety.

By Onkar B. Sawant, PhD, Director of Research

Oct. 15, 2020 — From the start of the COVID-19 pandemic, all of us involved with eye donation, cornea transplantation and vision research have taken every precaution to keep patients safe.

With so many unknowns surrounding SARS-CoV-2—the virus that causes coronavirus disease 2019 (COVID-19)—individuals are disqualified from donating eye tissue for sight-restoring transplants if they are known or suspected of having COVID-19 at the time of death, or are known to have had contact with someone with COVID-19.

That is because the risk of COVID-19 transmission has been unknown—and determining that risk is critically important for the millions of people globally in need of sight-restoring transplants.

In June 2020, our team at the Eversight Center for Vision and Eye Banking Research in Cleveland organized a study to systematically evaluate the presence of SARS-CoV-2 RNA and proteins in postmortem ocular tissues of COVID-19-positive donors.

Collaboration is key

Joining me on the research team are lead investigator and study co-first-author Sneha Singh, PhD, of Wayne State University, and investigators and corresponding authors Ashok Kumar, PhD, Wayne State University; Parag A. Majmudar, MD, Chicago Cornea Consultants and Rush University; Shahzad I. Mian, MD, Kellogg Eye Center and the University of Michigan Medical School; and my Eversight colleague Michael S. Titus, CEBT, Vice President of Clinical Operations. 

The rest of the team includes Kayla M. Jones, CEBT, with the Eversight Center for Vision and Eye Banking Research, Eric Hicks and Eugene Dennis of Eversight’s Department of Clinical Operations; and Robert Emery Wright III, Wayne State University.

With grant support from the Eye Bank Association of America (EBAA), the National Eye Institute and the National Institute of Allergy and Infectious Diseases, we embarked on our work in Cleveland, Chicago, Ann Arbor and in New Jersey—regions all heavily impacted by COVID-19—just before hospitals, surgery centers and surgeons slowly began resuming sight-restoring corneal transplants under comprehensive COVID-19 precautions.

Our research focus is threefold:

1. Determine the prevalence rate of SARS-CoV-2 in human eye tissue.
2. Determine the effectiveness of post-mortem COVID-19 testing in the field of corneal transplantation.
3. Determine whether povidone-iodine (PVP-I) effectively inactivates any SARS-CoV-2 presence in eye tissues donated for transplantation. PVP-I is an antiseptic that inactivates wide-spectrum microorganisms. Based on research showing its effectiveness against viruses similar to SARS-CoV-2, a double PVP-I soak is used when eye tissues are recovered for possible transplantation to mitigate risk of contamination.

We evaluated the eye tissues of 33 donors who passed initial screenings to donate for transplantation but later were determined ineligible to donate due to 1) positive or inconclusive COVID-19 test results, 2) demonstrated high risk or 3) confirmed close contact with someone diagnosed with COVID-19 in the previous 28 days.

Separately, we also evaluated additional 10 donors with active COVID-19 and whose deaths were reported to state agencies as COVID-19 deaths. We examined these donors’ eye tissues for SARS-CoV-2 RNA and blood samples for antibodies, as well as corneal tissues for envelope and spike proteins—key biological indicators that a virus is present.

Our study showed a small but noteworthy prevalence of SARS-CoV-2 in ocular tissues from COVID-19 donors.

We’ve shared our pre-publication manuscript, Prevalence of SARS-CoV-2 in human post-mortem ocular tissues, with the scientific community for feedback, and will present our findings in November at the 2020 Cornea and Eye Banking Forum, jointly organized by EBAA and the Cornea Society.

At the same time, our findings so far align other research to date that a risk exists—and it’s clear in our minds that post-mortem testing for COVID-19, PVP-I disinfection and thorough screening of potential eye tissue donors must continue to mitigate the potential risk of transplanting tissue with SARS-CoV-2 particles.

Many partner organizations and individuals have worked with us to make this important research possible, including our organ procurement organization (OPO) partners Gift of Life Michigan and New Jersey Sharing Network; Miracles in Sight (Winston-Salem, N.C.) and Transplant Services Center-UT Southwestern Medical Center (Dallas), as well as staff of Eversight’s Donation Support Center (DSC).

Most importantly, we must thank and recognize the donors and their families whose gifts of donated eye tissue and consent for research has advanced the science and understanding of COVID-19 to benefit all those in need of safe transplantation and the gift of sight.

We look forward to sharing more as our work continues.