Corneal diseases constitute a significant cause of visual impairment and curable blindness worldwide, especially in developing countries like India [1,2]. The visual impairment study (2010) estimated that 285 million people are visually impaired, out of which 39 million people are blind [3]. Corneal blindness accounts for 12% of the global blindness and the majority population of the corneal blind is from India [4,5]. The waiting list for corneal transplants is huge. Therefore, in India, it is the need of the hour to increase awareness about eye donation for the procurement of donor corneas. The first corneal transplantation took place successfully in India in 1948 [6] Corneal transplantation for sight restoration is the available treatment modality for the corneal blind from corneal diseases. Advanced surgical technology has improved the success rate of corneal transplants to approximately 95%. The statistics on eye donation in India shows that there is a considerable and constantly growing backlog of corneal transplantation. A large proportion of corneal blindness is curable [7]. Eye donation, an act of charity, is totally voluntary and purely for the benefit of society. Even after death, the donor lives in the eyes of the recipient. Corneas retrieved from a dead person can be utilized for more than one corneal blind for the restoration of sight of more than one corneal blind, apart from its use in research [8].

As future doctors, medical students can take up the role of promoting eye donation by planning, educating, sensitizing, and motivating the general public to pledge for eye donation. But because these newly admitted medical students may lack relevant basic knowledge, information about eye donation and are influenced by personal attitudes, and biases [9,10]. For this reason, the assessment of their knowledge and awareness about eye donation is very crucial.

Setting: All the freshly admitted students for the first year of MBBS in the Academic year 2019 batch of Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli were enrolled (150 students) after explaining the purpose of the study.

Duration of Study: 2 months (1^st December 2019-31^st January 2020)

Table-7: Reasons given for not willing to donate eyes (42 responses)

Medical students of first MBBS were assessed for their awareness and knowledge on eye donation. A total of 137 students attended the test .70 male students 67 female students wrote voluntarily the pre-tested questionnaire (Table 1). Sources of information for eye donation were asked. The students got information from various sources like T.V. (24.08%) Newspaper (23.35%) Internet (27.73%) (Table 2)71 (51.82 %) students know that eyes should be enucleated within 6 hours of death (Table 3). 48 (35.03 %) students knew that cornea is used after eye donation (Table 3). 50 (36.49 %) students were knowing that kin of a deceased person can pledge eyes for donation even if the deceased person has not signed a will (Table 3) 77 (56.20 %) students were aware of the organ donation legislation act, while 59 (43.06%) were unaware of it. (Table 4) 73 (53.28 %) students are ready to donate their close relative's eyes upon their untimely death, same time 17 (12.40 %) students are of the negative opinion to donate the eyes (Table 4).

128 (93.43 %) students out of 137agreed about shortage of eye donors (Table 4).and120 (87.59 %) participants were willing for eye donation (Table 5). Reasons for willingness to donate eyes by the students were as mentioned in, namely, 85 (62.04 %) would like something positive from their death,15 (10.94 %) as a social commitment (Table 6). Reasons were given by the students for not willing to donate eyes were namely fear of misuse of eyes by 24 (17.51 %), do not want to be mutilated by 15 (10.94 %) (Table 7).

Arranged in table format as per suggestions by reviewer

Blindness from corneal disease is a major ophthalmic public health problem in India [11]. According to the estimation, there are to be 1.2 million corneal blind persons in India. There are an addition of 25,000-30,000 cases of corneal blindness every year [12] Prevention is always better than cure. Measures of prevention of corneal blindness by giving comprehensive eye care from womb to tomb are cost-effective. But for some of the patient’s corneal transplantation is the only treatment option for their visual rehabilitation. Corneal transplantation is the most common type of human transplant surgery done to regain the quality vision in the corneal blinds [13]. It is estimated that 270 000 donor eyes are required to perform100 000 corneal transplants per year in India [14] This disparity in need and supply of donor human corneas poses a challenge to public health programs in India. To tackle this problem, the exact incidence, nature, and etiology of corneal blindness of the population under care should be known [15]. But illiteracy and rural residence are the main cause of ignorance about eye donation [16].

Meaning of the word “Enucleation” is the removal of the whole eyeball from the donor was known to (40%) in the study by M K Bharti et al [18] compared to 64 (46.71 %%)of medical students out of 137 knowing the meaning in the present study. The only cornea can be removed from the donor and it has been practiced also in some parts of India.

Also, it was noted by Gupta A.et in students of nursing college 160 (85.1%) of 188 were either willing or had already pledged to donate their eyes as compared to 120 (87.59 %) participants were willing for eye donation in the present study. AlL 159 (84.5%) of 188 participants agreed that there is a shortage of eye donors [19] in another study by Singh MM 170 (94.4%) of 180 participants agreed that there is shortage of eye donors [20] compared to 128 ( 93.43 %) students out of 137 agreed about shortage of eye donors in the present study.

In a study by Gawali A et al [21] 30% students knew that ideal time of donation was within 6 hours of death as compared to 71 (51.82 %) students out of 137 know that eyes should be enucleated within 6 hrs of death in the present study

A single eye donation can be used for multiple recipients was known to (74.08 %) students in a study by Mutukrihnan Vallinayagam [22] compared to 58 (42.33 %) students from the present study.

A study conducted at Hubli by Nekar MS [23] showed that 62.2 % of medical students believed that the whole eyeball is transplanted, compared to 35 students (25.54 %) in the present study

The perception about whether there is a disfigurement of the face of a donor after eye donation reported in a study among nursing staff in a hospital in South India by Hegde V.[24] was as 8 (14.5%) said yes, 39 (70.9%) said no and 3 (5.5%) said don’t know out of 55, compared with the responses in the present study the responses were 14 (10.21%) said yes, 110 (80.29%) said no and 14 (10.21%) said Don’t know. Thus in the present study, 110 (80.29 % ) students out of 137 were sure about non-disfigurement of face of the donor after eye donation In the same study by Hegde V [24] the main reason behind donating eyes among majority(76.3%) was giving sight to the blind followed by nobility of the task (7.2%).and in the present study the students response was something positive to come from the death 85 (62.04%) Social commitment 15 (10.94%).

Future strategies can be built from this study to strengthen the eye donation movement in India.

Dr. Rajesh Gotekar: Preparation of the Questionnaire, Arrangement for the conduction of test, collection of data, preparation of the manuscript for introduction, material methods and Compilation of References

Dr. Ajit K. Joshi: Data analysis, Preparation of results, Preparation of manuscript for discussion, correspondence with editor.

Acknowledgment: The authors express their sincere thanks to all the students for sparing their time to participate in this study.