How Cataract Surgery Went From $500 to Under $2
Around 241 million visually impaired people around the world earn less than the equivalent of $1,045 a year. But 80 percent them could be cured if they had the money and access to the right doctors.
Statistics like these can feel permanent, but those numbers were unacceptable to Larry Brilliant (yes, that's his real name), co-founder of the Seva Foundation, which focuses on eliminating blindness worldwide. His organization's work on correcting visual impairment in poor countries the focus of a new HBO documentary Open Your Eyes, which debuts on July 18.
Open Your Eyes follows a three-day period in which a Nepalse wife and husband, both severely visually impaired for more than a decade, undergo surgery correcting one of their eyes. The wife cannot remember what her husband's face looks like and has never seen her grandchildren. But the film also follows another, broader story: one of the technological advancement that allowed the cost of cataract surgery to fall from $500 to $2.
Brilliant, who prefers going by Larry, founded Seva in 1978, taking its cues from the Northern California culture just starting to recognize technology's role in changing global problems (Steve Jobs was an early advisor, and gave the Foundation an Apple II to analyze eye care survey results).
It was a dose of brutal honesty that helped Larry realize how technology and public health must intertwine. He once told a colleague that Seva was going to give poor people with vision problems back their sight. "He yelled at me, in front of his class. 'That's not f**king appropriate technology! It costs $500 to do that!'" Larry says. "And I said, 'What if it was two dollars? Would that make appropriate?'" Brilliant realized his goal would be driving down the cost of eye surgery so somebody making 50 cents a day could use it.
Larry's work began with Harold Ridley's intraocular lens (IOL), one of the 20th century's unsung marvels, which is still used to treat cataracts. The IOL emerged out of the chaos of World War II. Ridley was a doctor in the British Royal Air Force, and during one sortie, a fellow pilot forgot to wear his flight goggles. A German bullet hit his plane, and splinters of acrylic plastic lodged in his eyes. Ridley, a surgeon before the war, operated once the mission was over. He noticed that the acrylic plastic caused no inflammation in the eye-it was not rejected as a foreign object as happens with wood or metal.
After the war, Ridley tried to put that discovery to use. But his early efforts with IOLs were mostly failures. By the 1950's, there was a joke that Ridley's lenses worked better as IUDs than IOLs. As the technology changed, better lenses emerged. The IOL improved but it remained expensive. David J. Apple and John Sims, ophthalmologists writing in Survey of Ophthalmology, wrote in 1996 that "implantation of lOLs on a wide scale in the rural areas of these [developing] countries is still an impossible dream, mainly for socioeconomic reasons."
When Seva began its mission to make this technology more affordable, the first step was to change where the products were produced. The group bought a factory in Florida. "We took it apart in Florida, shipped it-many of us carried parts it-to southern India," says Brilliant. Waiting for him there was Dr. Govindappa Venkataswamy, known as Dr. V. Venkataswamy had become known for starting the Aravind Hospitals, which used paying patients to subsidize poorer ones. Aravind was also known for its aggressive expansion; Dr. V openly spoke of McDonald's as an inspiration.
"That's not f**king appropriate technology! It costs $500 to do that!"
"The folks at Aravind were amazing," Brilliant recalls. "They were the cleanest, most meticulous. They had a zero infection rate in their hospital." That reputation has remained consistent throughout the years. "Aravind is now the largest, and I would say best, eye hospital in the entire world," Brilliant says. Larry credits Ridley with inventing the IOL, but he credits Dr. V with bringing it to scale.
"We started off by bringing one manufacturing plant that could make a pretty thick piece of plastic that you could put in the eye, that was a tremendous improvement," Brilliant says. "We started getting tens of thousands of patients." And when Aravind and Seva bought more manufacturing plants, that brought another major change. "We got the foldable ocular lens," say Brilliant. "You just put it in with a needle and then the eye would puff up." Thanks to its manufacturing scale, Aurolab, Aravind's manufacturing wing, has been able to bring down the cost of a lens to around $1.60, Brilliant estimates.
Open Your Eyes deals with the consequences of this history. These cost reductions allow a hospital in Nepal, which neighbors India, to have one day of free surgeries a month. These surgeries allow for the Neplese husband and wife to travel to the hospital and see each other for the first time in over a decade.
As director Irene Taylor Brodsky notes, what's really striking about correcting someone's vision is how it allows people to see themselves. "It really shifted their perspective and understanding of their age and understanding of their lives. They both joked that, after all these years, they have the hands of a dead men," she says. "You want to see other people, but you also want to see yourself."
