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.