Groundbreaking Cataract Surgery
Restores Sight to Thousands in the Third World
by Gail Callahan

A group of Indian women who recently underwent cateract surgery pose in front of the eye clinic in Kalimpong, India.
photo: Ace Kvale / Himalayan Cateract Project

The heart and soul of the Himalayan Cataract Project, based in Waterbury, is providing high-quality, low-cost eye care to people living in some of the world’s poorest regions. In a nutshell, the group’s main mission is overcoming economic, physical, and educational barriers to help people suffering from unnecessary blindness from cataracts in countries of the developing world, among them Nepal, Ethiopia, Ghana, Bhutan, India, Myanmar, and Rwanda.

The Himalayan Cataract Project (HCP) achieves this by providing equipment and educating and training local eye-care providers across Asia and sub-Saharan Africa. HCP supports a full range of ophthalmic education, from the rigorous training of surgeons to the intensive training of workers, including nurses, field staff, and community leaders. The main training facility is at the Tilgana Institute of Ophthalmology in Kathmandu, Nepal. Once trained, these local providers can continue to offer the best eye care to residents in their home nations.

To date, HCP and its global partners have screened and examined over 5.2 million patients from across 16 countries and performed more than 445,000 ophthalmic surgeries, utilizing mobile eye clinics. The project is overseen by a board of directors and has affiliated ophthalmologists and clinical advisers. HCP is largely woman powered: of the 10 employees who work in the organization, seven are women.

A Pioneering Surgery

Two gifted and driven surgeons, Dr. Sanduk Ruit and Dr. Geoffrey Tabin, founded the organization in 1995. Ruit and Tabin initially performed cataract surgery for inhabitants of the Himalayas, an area known for its high rate of cataract blindness due to the high altitude and exposure to ultraviolet light. Powered by their goal of eradicating as much unnecessary blindness as possible, they soon expanded their work beyond the Himalayas.

Thankful post operative patients squeeze the hand of Dr. Matt Oliva, a HCP board member,
in Woldiya, Ethiopia. photo: courtesy Himalayan Cateract Project

Blindness in the developing world has a profound impact on the quality of life for the blind person and his or her community. Blindness removes the affected person from the workforce; it can take a child out of school to help a blind parent navigate the world, acting as a seeing-eye dog.

Further impacts include moving a spouse into the role as full-time caregiver for a blind member of the family, while also bearing the weight of being the sole income earner. Given the poverty that besets so many in the developing world, the loss of another paycheck can move a family from comfortably getting by to surviving day to day.

Ruit, from a village in eastern Nepal, first learned to perform a cataract microsurgery technique using an implanted intraocular lens while studying in Australia in the early 1980s.

He later pioneered an inexpensive suture-less surgical method, well suited for remote settings. Cataract operations are performed differently in the United States, where surgery is accomplished using the most modern and up-to-date medical equipment. However, Third World countries can’t afford those medical luxuries. Ruit’s manual method, which requires only a small incision, costs just $25 per eye. Over time, Ruit’s techniques have won praise and admiration. Six-month postsurgery statistics indicate that Ruit’s work succeeds at the same rate as that of his Western counterparts.

Cataracts:
Causes, Prevention, Cure

A cataract is an opaque area in the normally transparent lens of the eye. The condition occurs when clumping of cells or protein causes a cloudy area to form in the lens, a flexible structure behind the iris and pupil that changes shape to refract light.

As the opacity thickens, light rays are prevented from passing through the lens and reaching the retina, the light sensitive tissue lining the back of the eye. It seems early changes in the lens may not bother vision. But as the lens continues to change, an array of symptoms, including blurred vision, sensitivity to light and glare, and increased nearsightedness or distorted images can occur.

Cataracts have multiple causes. They are typically associated with aging, but overexposure to ultraviolet light, diabetes, hypertension, smoking, eye injury, and use of some medications, like statins and corticosteroids, can all lead to cataracts.

It’s uncertain whether cataracts can be prevented but wearing sunglasses that block UV rays can slow the their development, and some studies suggest that a higher intake of vitamins E and C, the carotenoids lutein and zeaxanthin, and omega-3 fatty acids can reduce cataract risk.

In the United States, the technique of phacoemulsification is used to remove cataracts. A small incision is made on the outer edge of the cornea, and a probe emitting ultrasonic waves is used to break up the lens into fragments, which are suctioned out. A new intraocular lens—a highly specialized clear, plastic substitute—is then inserted in the eye.

Cataract surgery is considered one of the safest and most effective treatments performed in the US with a very high success rate; the vast majority of patients experience no complications. However, like all surgeries, it does carry some risks. On the down side, occasionally additional surgery is needed. In rare cases, a patient suffers permanent vision loss as a result of complications from the procedure.

Also, there is the cost of the surgery. For patients not covered by health insurance, the bill tallies around $5,000 to $10,000 per eye. There is good news. Cataract surgery is covered by most health insurance plans. Because the vast majority of patients requiring the procedure are 65 years of age and older, Medicare usually steps in and pays for the cost of the surgery.

For patients who do have health insurance, out-of-pocket costs generally run around $1,000 or more for both eyes. If a patient carries a supplemental Medicare plan, those associated expenses might also be covered.

LASIK Surgery

LASIK, an acronym that stands for laser-assisted in-situ keratomileusis, is a type of refractive surgery that reshapes the cornea, correcting near- and far-sightedness and astigmatism.

A laser is used to cut through the topmost layer of the cornea (the cornea has five layers) and create a thin, circular, hinged flap. The surgeon folds back the hinged flap to gain access to underlying layers of the cornea, and another laser, with a UV light beam, is used to remove microscopic amounts of corneal tissue. This laser reshapes the cornea so that it focuses light better on the retina, improving vision. Afterward, the flap is placed back.

LASIK surgery is quick—it takes only six to 10 minutes per eye—and pain-free but does carry risks. Halos, decreased night vision, double vision, and starbursts are fairly common complications. Eye drops are generally prescribed, and the symptoms usually resolve. The biggest benefit for patients after the surgical procedure? For those once dependent on eyeglasses, LASIK allows them to remove their spectacles, placing them, once and for all, in the drawer of a nightstand.

The organization is committed to creating new eye-care centers or expanding existing facilities to ensure eye-care needs are met. It’s common for an available building in a village to undergo a transformation, becoming a medical ward ready to receive and treat patients. Patients come staggering to the clinics, groping their way to the medical teams providing the care. They travel from remote villages, praying to regain their sight and resume a normal life: to care for loved ones, to work, and to see a simple sunset. It’s not uncommon for medical teams to screen literally hundreds, if not thousands, of potential patients in the space of a few days.

Nepalese women bask in the wonder of their restored vision.
photo: John Welling

After a patient is wheeled into the operating theater, a local anesthetic is injected into the patient’s affected eye. A tiny incision is on the edge of the cornea, and the cloudy lens is removed. Then a tiny new lens is inserted into the eye, restoring the person’s eyesight. The whole procedure takes 10 minutes or less.

After surgery is completed, the bandages are pulled off, and the patient dons sunglasses to ease the transition to light. Results are immediate: vision is clear and crisp. Soon the patient returns home, buoyed by his or her newly regained sight. It can be overwhelming for a patient to receive sight, sometimes after years of blindness, in less time than it takes to cook a casserole in a microwave oven.

Ruit’s and Tabin’s successful organization shows that it is possible to deliver quality health care to some of the world’s poorest nations. In its early years, the organization faced many challenges, including lack of electricity and running water. However, the doctors’ perseverance and determination and their pioneering surgery have given sight back to thousands who were thought to remain sightless. Now, more than 20 years later, the doctors’ goal of providing high-quality, low-cost eye care in the developing world has been achieved.

Nothing Short of a Miracle

Emily Newick, fair haired with an easy smile, is HCP’s chief operating officer and has a master’s degree in public health policy and clinical practice from Dartmouth College. Newick was drawn to the project because of its “amazing” mission,” she said, adding that her quest to work for a nonprofit took root while in school. She sees the work of restoring sight to those who’ve lost it “as nothing short of a miracle.”

Newick said that the World Health Organization (WHO) estimates about half of the world’s blind population has lost eyesight due to cataracts, making it the principal cause of blindness worldwide. WHO further notes that close to two-thirds of the world’s blind population are women. Newick steered away from generalizing why this occurs but did note that women are often thrust into the role of caregiver in families, neglecting their own health needs while ensuring that others receive the care they need. She also said that blindness is increasingly prevalent in the developing world due to malnutrition, inadequate health care and education, poor water quality, and a woeful lack of sanitation.

Overseeing the organization’s database and donations keeps Beth O’Grady busy in her job as database and operations specialist. O’Grady, whose professional experience is in the nonprofit sector, glimpsed the job description for the project and thought it would be a good fit. “This is in line with what I want to do,” she said.

O’Grady has worked for the organization for four years. She’s impressed with the nonprofit’s dedication and fidelity to its mission. “We are, as an organization, extremely fiscally responsible,” she said. “Ninety cents on the dollar goes directly to the program.”

Charity Navigator, an American organization that highlights the work of ethical, efficient, and open charities, recently awarded HCP four out of four stars for the sixth, consecutive year for its fiscal management and commitment to accountability and transparency.The organization stresses that every donation makes a difference, changing a life. The avenues to make a donation include employer matching gifts, a one-time donation, and a gift in honor of someone. HCP points out on its website that some 18 million people who have lost their sight from cataracts are still waiting for the life-changing surgery.

 

Founder Dr. Geoffrey Tabin
operates on a patient in Mekelle, Ethiopia.
photo: Claire Wiley / Himalayan Cateract Project

After having surgery, these Nepalese women help each other in navigating their way. photos: John Welling

Transforming Lives

For Pam Clapp, the deputy director of programs, the organization’s mission to cure blindness worldwide matched her career goal of international consulting. Clapp, who, at the time of the interview, was on the verge of leaving for a trip abroad to one of the organization’s Third World clinics, recalled a visit to a clinic in Ghana, witnessing the successful results of a cataract surgery. She described the experience, detailing the joy the patient felt at culmination of the procedure.

Clapp also pointed to the story of a young Ethiopian boy, 8-year-old Mohammed Kiar Abdul Kadir. He was one of a score of children who journeyed to the cataract clinic. At age 4, Mohammed was accidentally pierced in the right eye with a sharp object, and as a consequence, a cataract developed in that eye. The resulting vision loss spelled an end to Mohammed’s education. Prior to surgery, the young boy could barely distinguish light in his right eye. After the operation performed by a local provider, Mohammed’s vision was restored and is now deemed to be “perfect.” Because of the medical intervention, Mohammed was able to return to school.

A woman is carried from her village in Nepal to an outreach surgical event.

Clapp feels that the organization is in a “growth pattern,” and she is anticipating that HCP will continue to expand its life-changing services. “We’re going to continue on that track,” she said. “We want to raise awareness about the issue in all areas of the world.”

Clapp grabbed onto one of the organization’s core beliefs: the aspiration, according to its website, to “cure the mountain of global blindness, one patient at a time.” Newick and Clapp both noted that medical teams in clinics at the literal “ground zero” of affected nations are working tirelessly to overcome barriers. But that’s only part of the story: once that care is in place, the delivery of quality, low-cost eye care must be maintained.

Newick, Clapp, and O’Grady all remarked that the organization’s mission is underscored by the joy witnessed by clinic workers and staffers of the Himalayan Cataract Project when surgery is successfully completed.

“You take $25 and completely transform somebody’s life,” Clapp said, who’s witnessed the event numerous times. “It’s wonderful at the end of the day to know you’re changing people’s lives.”

 
Gail Callahan is a freelance journalist based in Burlington.