Restoring Sight to the Cataract-Blinded Poor
Cataract Surgery Developing World
NEW YORK — In China or Ethiopia, Rwanda or Nepal, the scenes are the same: crowds of patients waiting in the open air, bandages over their eyes. Each has been blind for months, years, decades, because of cataracts, the hardened, clouded lens tissue that causes most of the world’s blindness. Each underwent a ten-minute microsurgery barely 24 hours earlier, in temporary field hospitals where medical teams worked with assembly-line efficiency: making tiny slits in eyeballs, delicately removing cataracts, and inserting artificial lenses.
As the bandages come off, some people exclaim in joy, or do a little dance. Others have a wondering look, as they see the landscape, or the faces of family members again.
The two surgeons responsible for these scenes met in the Himalayas. Geoffrey Tabin, an American doctor educated at Yale and Harvard, was a passionate mountain climber when he met Sanduk Ruit, who had grown up in a poor Nepalese village, a ten-day walk from the nearest school. Ruit had studied medicine in India before returning to Nepal and embarking on a one-man effort to restore sight to Nepalese suffering from cataracts. In the developed world, cataracts are usually removed before they cause serious visual impairment. But in poorer nations, people often lose all sight, as the cataract hardens and covers the eyeball with a white veil. Even children may be afflicted, especially high in the Himalayas, where UV radiation from the sun damages the eye.
“Worldwide, there are 18 million people who can’t see the shadow of a hand move across their face because they’re blind from cataracts,” Tabin says. In places where the margins of survival are thin, the blind are often plunged into greater poverty and even early death. Poor families cannot afford to lose a worker, or to feed and care for someone helpless. “They call it a ‘mouth without hands,’” Tabin says.
Ruit realized that modern surgery with artificial lens implantation could be done quickly, outside hospitals, at a cost of only about $25 per patient. The technique he refined allows cataracts to be removed in one motion, through a sutureless incision. Almost all have perfect vision the next day.
“He really is the genius behind our whole system of developing really top-quality cataract surgery for the poorest of the poor at very high volume,” says Tabin. Together, the two men founded the Himalayan Cataract Project in 1995. Its work has spread from Nepal to Bhutan, northern China, and northern India, in addition to about ten African countries, including Ethiopia, Rwanda, Ghana and South Sudan.
At the project’s “eye camps,” groups of visiting eye surgeons perform hundreds of the surgeries over a period of weeks in remote areas far from hospitals. Tabin says the technique is almost the same as in advanced Western hospitals, but the pace is much faster. “We have almost like an assembly-line production, where a doctor is just moving from patient to patient.” Over eleven days in February-March 2013, in Ethiopia, for example, teams performed more than 1300 surgeries.
Perhaps even more important, Tabin says, is that the camps train local doctors and medical workers in the technique, who then go on to train others. And it helps set up local, self-sustaining surgical operations.
All together, he estimates, two million people have had their vision restored through the project's efforts. He says the project’s goal, of wiping out preventable blindness through the developing world, seems increasingly attainable.
“When we started, there was a backlog of cataract blindness in Nepal. We thought it’s going to be a lifetime before we get a handle on this. But now doctors in Nepal are doing over 250,000 cataract surgeries every year, and people are coming in to have their cataracts done earlier and earlier,” Tabin says. “And Nepal, which is really the poorest country in South Asia, is now the only major developing country that’s reducing its rate of blindness now.”
Over the two decades of its existence, the project has been the subject of several documentaries. It is also the subject of a new book, “Second Suns: Two Doctors and Their Amazing Quest to Restore Sight and Save Lives,” by the late writer David Oliver Relin. In 2006, Ruit received the Ramon Magsaysay prize, often referred to as the Asian Nobel Prize, and Tabin was awarded an Unsung Hero award by the Dalai Lama.
It is the moment when the bandages come off, however, that Tabin says have been most gratifying. “When the patch comes off, there’s first this look of bewilderment, or ‘what am I seeing,’ and then recognition, and then this absolutely pure unadulterated joy,” he says. “I never get tired of seeing that.