David F. Chang, MD, the 2009 Binkhorst Lecturer at the ASCRS Symposium on Cataract, IOL and Refractive Surgery in San Francisco, presented the audience with three hospital models that have successfully treated a high volume of cataract patients in a cost-effective manner. The title of Dr. Chang's lecture was, "The Greatest Challenge to Cataract Surgery. Needed: 5-Minute, $15 Cure for Blindness."
"In the developed world, who, other than ophthalmologists, can better appreciate just how daunting the challenge of reducing global blindness is?" Dr. Chang asked. "In developing countries, the obstacles include the high cost of phaco and foldable IOL technology, a critical shortage of ophthalmologists, and insufficient educational infrastructure to train novice phaco surgeons, let alone those skilled enough to tackle the advanced cataracts typically encountered."
Three programs—the Aravind Eye Care System in southern India, the Tilganga Eye Centre in Kathmandu, Nepal, and Project Vision in China—have overcome these obstacles by offering fast, low-tech, high-volume cataract surgery in ways that maximize the resources available in their areas. At Aravind, a single surgeon performs 12 to 16 procedures per hour. These programs "offer real hope for reducing the global burden of cataract blindness," Dr. Chang explained.
"The surgical solution is low tech—a manual extracapsular cataract extraction performed through a temporal, sutureless small incision," he said. "Equally important are the ability to manufacture affordable, low-cost IOLs, viscoelastics, and supplies and the streamlining of the surgical process through the use of standardized protocols executed by well-trained ancillary staff. Such cost containment and efficiency maximize the productivity of the system's most precious asset—the cataract surgeon."
Most importantly, the extracapsular procedure is affordable, Dr. Chang explained. For example, the five Aravind Eye Hospitals have used this technique for years to provide charitable cataract surgery at a cost of less than $15 per case. Charitable procedures account for roughly 200,000 annual cataract surgeries performed within the Aravind system. Research has shown that the complication rates for manual small-incision cataract surgery are low and that the procedure effectively restores vision in these populations.
Ophthalmologists at Aravind, Tilganga, and Project Vision are training surgeons from other developing countries on methods of performing high-volume manual small-incision cataract surgery. "We in the West need to help sustain this movement with financial and educational support," Dr. Chang advised.
In closing, Dr. Chang thanked the leaders of Aravind, Tilganga, and Project Vision "for their continually reminding me that, despite the fact that our own society, based on declining reimbursement, seems to value what we do less and less . . . good cataract surgeons remain one of the most precious and valuable assets for any society."
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