9. Cost Effective Eye Surgery

This lens implant, used for "free" patients, costs
INR 285, equivalent to less than $5 USD

The elegance of the Aravind mission, is that they can offer surgery for “free”, to cure blindness from cataract.  Each “free surgery” incurs an expense of  INR 750 (which as of this writing is $12.25 USD).  This cost is absorbed by Aravind, while at the same time offering a value proposition to the “paying” patients, whose payments offset the expenses of the Aravind mission.  To control the cost of surgery, and to perform surgery efficiently, MSICS is the ideal procedure.  MSICS was born, after a 1990 article detailed proper wound and tunnel construction for sutureless self-sealing incision.  In fact, MSICS is a “newer” surgery than phacoemulsification.  It was developed to be safer and faster than ECCE, less expensive than ECCE and phacoemulsification, and easier to deploy in developing countries.  MSICS combine surgical features of both techniques.  Like ECCE, the cataract is delivered totally in one piece, and the surgical instruments are reusable and can be sterilized.  Unlike ECCE, the wound is self-sealing, does not require suturing, and has much less risk than ECCE.  There is no added cost of sutures to close the wound as in ECCE, and there is no capital outlay for a phacoemulsification device as phaco surgery.  There are no disposable phaco cartridge or tubing, no disposable phaco or I/A tip, that would otherwise drive up the cost of surgery.  To further keep the cost low, the surgeons at Aravind use HPMC gel (hydroxypropyl methylcellulose) to maintain the anterior chamber during surgery, and not the more expensive gels (called OVDs) used in North America.

Author and "ma'am" at Aurolab

In 1992, the founders of Aravind Eye Care System built their own manufacturing facility – a separate business called Aurolab in Madurai, Tamil Nadu – to make high quality IOLs, sutures, surgical blades, ophthalmic pharmacologic solutions and OVDs, at much lower per-unit costs than non-Indian facilities.  The cost savings result from lower labor costs, and economies of scale from high volumes of ophthalmic products purchased by the Aravind Eye Hospitals.  During my one month sojurn in India, I traveled to Madurai to tour the modern-day Aurolab.  Compared to another California pharmaceutical facility I had visited, the manufacturing plant at Aurolab is state of the art, with the requisite airflow and construction requirements deserving of its ISO & CE marks.  This bold undertaking by the Aravind founders was not easy, but its success further bolstered the success of the cost-effect eye care model.

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