On Vision and the Miracle of Sight

Eye care is one of the great challenges of the 21st century. Some 50 million people in the world suffer in needless darkness. The vast majority of them will remain blind until they die. And the thing is: Ninety percent of this blindness could have been easily prevented or treated. Fully half of treatable blindness stems from cataracts where inexpensive, minutes-long surgery could restore perfect sight. Numerous studies have shown that sight restoration with cataract surgery is among the most cost-effective intervention in all of public health care. If only the blind could get access. If only someone could find a way to them.

Dr. Sanduk Ruit, co-founder of the Himalayan Cataract Project, was born in a remote mountain village at 10,000 feet in eastern Nepal. His father was a trader. At seven, Ruit left home to study in India. He eventually went on to medical school in Delhi, specializing in ophthalmology and microsurgery. Working as a medical officer on a team mapping Nepal’s northern border, he saw the staggering extent of treatable blindness. “In every village, I’d find people blinded by cataracts,” he recalls, “stranded in darkness.” The experience moved him to act. He met Australian ophthalmologist Dr. Fred Hollows, who became his mentor and helped make his life goal clear: restore eyesight to people who were unnecessarily blind.

Before the early 1990s, almost all of the cataract surgeries in Nepal consisted of a machine-intensive extraction in which the entire lens and capsule were removed from the eye, and the patient was subsequently given cumbersome thick eyeglasses that lacked peripheral vision and created distorted direct vision. The procedures were time consuming and expensive. Dr. Ruit developed a microsurgery technique that was life-changing in its efficiency and simplicity. Using nothing more than a microscope, a customized cutting tool, and a tiny, plastic intraocular lens, Dr. Ruit perfected a one-time, sutureless cataract removal that completely restored a patient’s sight in less than ten minutes — with no more follow up required than a night of bandages and the use of eye drops. The procedure could be performed in remote areas in improvised settings, with local materials, limited inputs, and extraordinary results comparable to outcomes in Western medicine.

The challenge was cost. When Dr. Ruit began his work, a single, plastic intraocular lens cost close to $200. The price made lenses — and cataract surgery — out of reach of the poor. Dr. Ruit’s research determined that the raw material needed to make each lens cost only 60 cents (USD): that their high cost came from manufacturing companies making huge profits. In 1995, with the help of Australia’s Fred Hollows Foundation, he established a not-for-profit lens factory in Nepal capable of manufacturing high-quality lenses at a cost of only $4 each. That factory now produces more than 300,000 units annually of low-cost intraocular lenses, and makes them available in more than 60 countries.

The low-cost lenses became a cornerstone of the Himalayan Cataract Project’s ability to bring affordable cataract surgeries to impoverished regions across Nepal and throughout Asia and Africa. Over time, HCP has developed a cost-recovery pricing formula for its surgeries designed to ensure that all poor patients receive cataract surgery for a minimal cost of $25 USD. In the world of public health, there are few ways to change a life more dramatically or more cheaply. To patients, the overnight transformation from darkness to light is nothing short of a miracle.