Despite all that modern technology has done to advance the treatment of cataracts, our greatest challenge continues to be the large and increasing backlog of cataract blindness in developing countries.^1–5 While in North America and western Europe, intraocular lens (IOL) research and development are primarily directed towards reversing lens ageing (presbyopia), millions in developing nations with reversible blindness caused by cataracts go untreated.

Modern phacoemulsification machines are expensive to purchase and maintain, have relatively high disposable costs, and require extensive surgical training. Furthermore, for the more advanced and mature cataracts typical of underserved populations, performing phacoemulsification becomes more difficult and complication prone. What is needed is a high volume, cost effective, low technology procedure that can treat the most advanced of cataracts with a low complication rate in the shortest amount of time.

This very goal is being achieved in a handful of international programmes that are providing a hopeful paradigm for overcoming worldwide cataract blindness. I have had the privilege of visiting both the Aravind Eye Hospital network in southern India, and the Tilganga Eye Centre in Kathmandu, Nepal. Seeing first hand how their systems provide high volume, low cost cataract surgery is an awe inspiring experience for any visiting ophthalmologist.

Founded in 1976 by the now 87 year old Dr G Venkataswamy, Aravind Eye Hospital has grown into a network of five regional eye hospitals providing high level ophthalmic care to the poor population of southern India. Private paying patients …