Driving Forces and Perceived Barriers for the Adoption of Novel Endothelial Cell Therapies: An International Survey of Corneal Surgeons

Purpose: To evaluate corneal transplant surgeons’ current practice pattern and their interest and adoption attitudes toward novel endothelial cell replacement via an online survey. Methods: The online survey contained 25 questions (13 single-choice, 12 multi-choice) separated in the 4 sections “General Demographics and Practice Patterns,” “New Corneal Endothelial Cell Replacement Therapies,” “Perceived Barriers,” and “Surgeon Perspectives on Graft Design for Tissue-Engineered Endothelial Grafts.” A total of 116 responses were evaluated. Results: Most respondents (97.4%, n = 113) would consider the adoption of novel, commercially available cell replacement therapies in the future. Ease of surgical handling (59.5%, n = 69), better clinical outcomes (58.6%, n = 68), and donor tissue shortages (42.2%, n = 49) were seen as the main driving forces for adoption. Although being acknowledged as an easier procedure, most respondents (82.8%, n = 96) expressed that cell injection should be restricted to corneal specialists and not be performed by comprehensive ophthalmologists. Furthermore, 74.1% (n = 86) considered standardized surgical protocols as crucial and 70.7% (n = 82) would prefer wet lab training for the new therapies. The possible high cost (64.7%, n = 75) and regulatory hurdles (60.3%, n = 70) were considered as the main obstacles for implementing the new therapies in clinical practice, whereas patient acceptance was not (5.2%, n = 6). Conclusions: The survey shows a positive attitude for adopting new endothelial cell replacement therapies among corneal surgeons although current translation to the clinic is still in the early stages. Perceived barriers and expected training requirements for the clinical adoption of the new therapies were identified and should be addressed to ensure a successful clinical translation.