1. The Path to Aravind

ASCRS, American Society of Cataract & Refractive Surgery, 2013, San Francisco, California:  The conference seems to be catching fire with topics and exhibitors on femtosecond laser cataract surgery.  Most headlines in industry newspapers report about the purported benefits of this new cataract surgery technology.  Alcon, Optimedica, Bausch & Lomb, Zeimer, Lensar – the list of manufacturers showing off their wares are like the who’s who of the ophthalmic industry.  Though I find the technology fascinating, I feel that as ophthalmologists, we are merely looking for ways to justify new technology on account of our penchant to play with new things.  Are we becoming more and more like marketers for new technology?  Are we becoming sales persons to our patients, while we compare ourselves to the Joneses in our ophthalmic world?  Do we now think more about “ROI” – “Return On Investment” – for every piece of equipment we want to purchase, just because another ophthalmologist has it and is talking about it on the podium?  In our embrace of newer phacoemulsification platforms or laser platforms, are we not driving up the cost of cataract surgery?  What has become of our purpose in being a medical doctor to take care of patients?

Seeking a higher purpose to this profession, I attended SEE International’s ASCRS get-together, to understand this organization that coordinates eye surgery for the developing country.  There, I met colleagues who have chosen to spend part of their time providing surgical care to third world countries.  I was previously drawn to ORBIS – the “flying eye hospital” – that reaches out to third-world countries.  But some members of the ophthalmic community comment how this high-tech "flying eye hospital" did not help these third-world countries with their needs to cure blindness, or become self-dependent, when their own resources are so limited.  At this SEE International gathering, many doctors spoke of a technique called SICS, or MSICS, depending on whom you speak to.  I quickly obtained a lecture schedule on this topic, and decided to learn something about this surgery technique while still at ASCRS 2013.

I attended a talk in a small lecture hall.  Adjoining halls were filled with ophthalmologists listening to topics on various new surgical devices for cataract, retina or glaucoma, devices that again were expensive and costly.  The talk I attended was in a room, only 1/3 full, of about 30 – 40 attendees.  The presenting ophthalmologists were from a placed called “Aravind Eye Hospital”.  The moderator was an engaging surgeon, who said he had challenged Dr. David Chang to see who could perform cataract surgery faster – him using SICS while Dr. Chang using phacoemulsification.  I watched in fascination the surgical videos of this moderator and of his colleagues from the same institution.  They were exceptional surgeons.  Like an artist admiring the work of others, I was mesmerized in the elegance of their surgical technique.  They spoke of their institution’s mission to cure cataract blindness, of efficient and cost-effective surgery.  Between video images and their speeches, thoughts raced through my head, thinking of how this surgical technique could address the rising cost of cataract surgery in our developed countries of United States and Canada.  At the conclusion of their talk, I almost leaped to my feet and clapped “Bravo!”  As the audience sauntered out of the hall, I lingered to introduce myself to the moderator – Dr. Venkatesh – and I asked to connect with him so that one day, I could observe his surgery in person.

Months later, I found myself on the most amazing experience in my life.

.....Continue to "2. At Aravind, At Last"