High-volume cataract surgery & training model as the cornerstone to strengthening national systems of eye care

Avoidable blindness is a global epidemic with tragic consequences and identifiable solutions. Thirty-six million people are blind worldwide, another 246 million struggle with low vision. Yet 80% of this burden is treatable or preventable. Ninety percent of the afflicted live in low- to middle-income countries with an estimated 60% of blindness experienced by women. The tragedy of inadequate eye care reverberates throughout a society: lives are shortened, dependency is created both to family and the state, communities are robbed of laborers, and children are denied an education. In these economies, lost productivity from blindness causes $49 billion annual loss. Blindness was not included in the UN Millennium Development Goals, leading to inadequate global focus and insufficient capital investment. Globally, cataracts are the leading cause of blindness, where they contribute to this endemic cycle of poverty. The global backlog of cataract blindness is at risk for increasing due to lack of funds, aging populations, a severe shortage of ophthalmologists, barriers to access, and low-quality care, stunting development of eyecare systems in low-income nations. However, cataract surgery is one of the most cost-effective health interventions in medicine -- comparable to immunizations for immediate and permanent impact. With a material cost of $25, cataract surgery can restore sight and life to a blind person in 10 minutes. This is not a temporary fix – it is a permanent cure. Few medical interventions exist that have as immediate, enduring, and transformative an impact.

HCP|CureBlindness’ solution to reversing avoidable blindness uses the elimination of cataracts as the cornerstone to strengthening national eyecare. We are presently accelerating the expansion of our community- and systems-based approach to training, equipping and providing sight-restoring surgery. It combines a low-cost, low-tech, high-volume surgical method with a multi-tiered training approach for all levels of ophthalmic personnel, focusing on high-volume surgical exposure. Addressing traditional barriers (personnel shortages, volume and quality of care), we are scaling across distinct geopolitical and national systems - private (i.e., Nepal), public (i.e, Ethiopia) and public-private (i.e., Ghana, India) so we ensure solutions are replicable in any country context. High-volume, high-quality surgery creates synergies necessary for scale, lowering cost per surgery and allowing high-yield, mentor-based skills transfer to occur concurrently at all levels. In this way, volume drives capacity development and quality, while increasing economic efficiency. Financially viable and self-sustaining healthcare must be anchored around centers of excellence (COE) that provide the highest standard of clinical care and training, while also generating revenues essential for growth. For example, our flagship partner, Tilganga Institute of Ophthalmology in Nepal, generates profits from patient care, intraocular lens manufacturing, and its refractive surgery center. These profits are reinvested in training capacity and hospital expansion while also subsidizing charitable care. Quality cataract surgery, with premium options for paying patients, drives demand and cost recovery. The unique marriage of high-volume, low-cost systems with profit structures that subsidize care for the poor is the foundation for the compassionate capitalism model. HCP|CureBlindness’ South Asian partner institutions train visiting personnel who then become trainers in their home countries. Indeed, ophthalmologists who trained under programs at these Nepali and Indian institutions now direct residency programs in Ethiopia and Ghana. Training at scale also occurs in-country. Surgical teams from the USA, India and Nepal provide exposure training and direct skills transfer at both hospital-based workshops and high-volume surgical outreaches. HCP|CureBlindness has grown steadily since the 1990s, increasing our investment in targeted, strategic growth. Our decentralized operating model minimizes administrative overhead and efficiently focuses resources on program activities. Since 2016, our partner networks have grown by 91% in Ethiopia, 225% in Ghana, and 13% in Nepal. Surgical volumes have risen by 19.8% and training by 69%. Further investment is critical to the revolutionary scale of our goals. Studies have shown a 400% return on every dollar invested in eliminating blindness. With further investment, we can reach a tipping point where low- and middle-income countries can address the vision problems of their citizens and serve as leaders for others.

HCP|CureBlindness and its partners have screened 11,101,500 individuals, performed 970,596 sight-restoring surgeries, trained 18,000 eye care professionals (552 ophthalmologists) from 43 countries, and established 3 dedicated eye hospitals/training institutes.