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Motivation needed to improve cataract treatment in Asia
Despite surgical advances, there are still more than 9 million people, mostly living in poorer, rural areas, who are blind or nearly blind.
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Cataract continues to be a major cause of blindness for millions of people in poorer, rural Asian countries, despite technical advances in cataract surgery, according to a keynote speaker.
At the International Society of Refractive Surgery/American Academy of Ophthalmology Refractive and Cataract Surgery Symposium in Beijing, Sanduk Ruit, MD, of Nepal, said about 18 million people globally are blind or nearly blind because of cataract, with more than half of that number being in Asia, and 0.3% to 0.5% of any Asian country’s population will experience cataract blindness.
Because cataract may be responsible for about 50% of total blindness, Dr. Ruit emphasized how important it is for ophthalmologists to be motivated to work together with management teams with international interests, citing a “strong initiative for sufficient, successful and sustainable cataract surgery” in the community.
Low vision vs. total blindness
Dr. Ruit said less than one-third of all cataract surgeries that doctors perform in Asia are on patients who are less than 3/60, meaning they are operating on people with low vision who are not yet blind. Although the cataract surgical rate worldwide is increasing, it is increasingly the low-vision patients who are getting the surgery.
“The real tragedy is that the conditions of these patients are often advanced, and that they’re deprived both socially and economically,” he said. “This often stems from them being cocooned by better-seeing cataract patients, who often seek surgery much earlier.”
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Image: Stiglich JM, OSN |
Dr. Ruit said the overall cataract surgical rate currently varies from as low as 200 to as high as 8,000.
“We estimate that 33% of countries have patients with less than 500 cataract surgical rate, yet only 6% have patients with more than 4,000 cataract surgical rate,” Dr. Ruit said. “The number of surgeries done globally is not equivalent to the number of sights being restored to blind cataract patients.”
Cost recovery
According to Dr. Ruit, a trend is emerging in which ophthalmologists now have the capacity to set up small eye-care centers with facilities to perform cataract surgeries almost anywhere in the world. These centers can operate as autonomous, ownership-based businesses, yet still be run using a model called an “efficient cataract surgery delivery tree,” he said.
Some of the attributes from this model that surgeons and staff need for operating a successful eye care center are good leadership, strong cell structure, social marketing, social relations, cost recovery, employee training and establishing community outreach programs.
“Training your staff to screen your patients is also important. Unless you have proper screening, you can’t get patients to follow your directives,” Dr. Ruit said.
“The cost of cataract surgery for these eye care centers is about 62% of the total cost recovery, which can greatly help a center to succeed,” he said. “Cataract surgery is the nucleus of a cost-recovery scheme. There are pitfalls, though. … There often are many bureaucratic challenges.”
That is why, he said, team structure building in cataract surgeries can be important.
“Many places in the world today still have conventional IOLs with sutures and small-incision cataract is being widely done with extremely good results, but phacoemulsification is progressing well,” Dr. Ruit said. “It is safe, and the outcomes have been great.”
For more information:
- Sanduk Ruit, MD, can be reached at Tilganga Eye Centre, GPO 561, Gaushala, Bagmati Bridge, Kathmandu, Nepal; +977-1-449-3746; fax: +977-1-447-4685; e-mail: sruit@tilganga.com.np. Dr. Ruit has no financial interest in any of the products or companies mentioned in this article.
- John Misiano is an OSN Staff Writer who covers all aspects of ophthalmology.