EyeWorld India March 2016 Issue

48 EWAP CATARACT/IOL March 2016 by Sanduk Ruit, MD The fight against cataract blindness in Nepal—challenges and opportunities T he prevention of blindness program in Nepal is considered a very successful story despite all of the political and natural challenges. This program is based on the national survey conducted to assess the magnitude and distribution of blindness. I am going to highlight issues in our fight against cataract blindness. The mission was to create a sufficient, successful, and sustainable cataract surgical program. a) Successful cataract surgery should be taken more as a delivery system incorporating smooth flow system, quality assurance, cost recovery, and surgical technique. The concept of cost recovery by instituting a pricing tier has enabled cataract surgery to be financially sustainable. This model is now quite popularly applied in many other countries. b) Team building. It is very important to create a team that is highly motivated and a qualified paramedical work force to support the ophthalmic surgeon. The ophthalmic assistant program in Nepal was beneficial in supplying good technicians for anesthesia, investigation, and assisting in the operating theater. This adds to productivity, efficiency, and quality maintenance. c) Use of modern, high quality, manual small incision cataract surgery (MSICS) at the community level has helped to increase the cataract surgical rate (CSR). In the last 20 years, the CSR has increased from a mere 700 to more than 5,000. The quality of visual outcome and low cost have enabled the cataract program to be financially sustainable and free from government intrusions. The randomized clinical trial comparing MSICS with phacoemulsification has given strong credibility for the need for MSICS. d) Quality assurance – The surgical flow system, surgical technique, and visual outcomes are strictly monitored, including proper biometry and surgical audit. Great emphasis is given to medical inventory and supplies from companies with an established track record. e) The manufacture of low- cost and high-quality CE- marked IOLs at Tilganga has complemented the program by providing a sufficient supply of high-quality, low-cost intraocular lenses. Tilganga Institute has taken a pioneering lead in this. f) Screening and diagnosis – This is to find patients with impaired vision due to cataract at the grassroots level. This program has been conducted in Nepal by ophthalmic assistants in a highly successful way to retrieve most patients for surgery. g) Systems and surgical training – This program in which surgeons learn the technique of MSICS is conducted for surgeons from around the world. The program also enables surgeons to understand the system’s delivery, the financial quality assurance, and productivity issues. They also understand the usage of appropriate surgical instrumentation and equipment. Editors’ note: Dr. Sanduk Ruit is Medical Director of Tilganga Institute of Ophthalmology. Contact information Ruit : +977-1-4493775; sruit@tilganga.com.np Sanduk Ruit, MD Index to Advertisers Alcon Page : 2 www.alcon.com Feather Safety Razor Page: 27 www.feather.co.jp OCULUS Optikgeräte Page: 17 www.oculus.de Rayner Page 15 www.rayner.com ASCRS Page 20 , 64 www.ascrs.org APACRS Page 5, 7, 13 , 25 , 29 , 49 , 52 www.apacrs.org ESCRS Page 44 , 45 www.escrs.org EYEWORLD Page 33 , 37 www.eyeworld.org ISCEV 2016 Page 56 www.iscev.org WOC 2018 Page: 63 www.icoph.org/woc2018