Cataracts are the leading cause of blindness globally, and three programs in the developing world seek to help people blinded by cataracts to regain their sight.
At the recent annual meeting of the American Society of Cataract and Refractive Surgery (ASCRS), eye surgeon David F. Chang, MD, described how the Aravind Eye Hospital system in southern India, the Tilganga Eye Center in Kathmandu, Nepal and Project Vision in China are seeking to restore the vision of poor and aging populations in remote and under-served areas of the world.
Acccording to Dr. Chang, a clinical professor of ophthalmology at the University of California, San Francisco, based on the World Health Organization (WHO) definition of blindness as best-corrected visual acuity (BCVA) of 20/400 or worse, more than 18 million people worldwide are blind in both eyes due to cataracts.
That number grows to 54 million when considering how many people have BCVA worse than 20/200 (frequently called “legal blindness”) and balloons to 144 million if you include people with BCVA of 20/60 or worse due to cataracts. This final category describes people with low vision, who typically cannot see well enough to obtain an unrestricted driver’s license in the United States.
But while cataracts affect virtually all aging populations, there are many obstacles to the surgical treatment of cataracts in developing countries. These obstacles include the expense of surgical equipment and intraocular lenses (IOLs), a shortage of ophthalmologists in these regions and a lack of training programs for cataract surgeons and surgical staff in the developing world.
Dr. Chang described three programs that are providing safe, fast and low-cost cataract surgery for the poor in under-served regions of the world:
- The Aravind Eye Hospital System in southern India has been providing charitable eye care and cataract surgery on a large scale for more than 30 years. It was founded by Govindappa Venkataswamy, MD. Patients in remote villages are screened for cataracts on a Sunday, are transported by bus to a regional Aravind eye center that same evening and have cataract surgery the following day. On a typical Monday, 300 to 400 cataract surgeries are performed. “To maximize efficiency, every step of the preparation and procedure is standardized, and doctors and staff perform their roles with military precision,” said Dr. Chang. The Aravind hospital system controls costs by manufacturing its own supplies, including IOLs. Outcome studies have demonstrated that this high-volume surgical approach is safe and effective, and of the approximately 200,000 cataract surgeries performed each year at Aravind’s five regional hospitals, 70 percent are performed at no cost to the patient.
- The Tilganga Eye Centre in Kathmandu, Nepal was founded by Sanduk Ruit, MD. Along with Geoffrey Tabin, MD, Dr. Ruit also founded the Himalayan Cataract Project (HCP) in 1995. The goal of the program is to eradicate cataract blindness in Nepal by establishing outreach eye clinics in rural villages outside Kathmandu. The HCP uses portable generators and surgical equipment and transforms places such as open-air classrooms into temporary operating rooms. IOLs for the procedures are manufactured at Tilganga Eye Centre, which also sells the IOLs to 60 countries in the developing world. The center is also opening a new wing to train cataract surgeons from other countries.
- Project Vision in China was founded by Dennis Lam, MD, chairman of ophthalmology at Chinese University of Hong Kong. The project is a collaboration between the university, private philanthropy in Hong Kong, a training center in China and the Chinese government, according to Dr. Chang. Seventy percent of China’s population, or 900 million people, live in rural villages with limited access to medical care. In addition, most of the Chinese population cannot afford cataract surgery. Project Vision provides surgical equipment and training to nine county-level hospitals throughout rural China. In exchange, the hospitals agree to lower their charges for cataract surgery to $90 (USD) per case.
Concluding his ASCRS presentation, Dr. Chang noted that these three model programs prove that “there is hope” of overcoming the formidable challenge of cataract blindness in the developing world.
Source: Three programs offer hope. Ophthalmology Times. May 1, 2009
Tags: cataract, Cataract Surgery, cataracts