It is projected that by the year 2020 there will be 452 million people worldwide with visual impairments that are not correctable by lenses. This is a global crisis, especially since, according to the World Health Organization, nearly 80 percent of blindness is avoidable.

Ninety percent of individuals with visual impairments live in the developing world, where the infectious disease called trachoma and vitamin A deficiency used to be the leading causes of blindness. Improved sanitation and nutritional changes and aid have all but wiped out these conditions, leaving cataracts as the current number one cause of preventable blindness.

HelpMeSee is a nonprofit organization whose mission is to wipe out cataract blindness in the developing world. To date it has facilitated nearly 200,000 successful cataract surgeries, at a cost of just $50 per surgery.

Cataract Treatment in Developing Countries: Why Blindness is Prevalent

The onset of cataracts usually begins in people age forty and older. By the time we reach 80 nearly half of us have developed cataracts. However cataracts are not just confined to the elderly. According to Mohan Thazhathu, cofounder and President/CEO of HelpMeSee, "Between five and seven children in every one hundred thousand are born with congenital cataracts."

Here in the Unites States, the criterion for cataract surgery is usually when vision fades to less than 20/60. "In India and other developing countries, public policies set this number as high as 20/500," says Thazhathu. In the developing world, 51 percent of blindness is due to treatable cataracts, which means there are hundreds of thousands of children and adults who are currently blind but do not need to be."

Thazhathu notes that one of the major obstacles to reducing this backlog of patients is the severe shortage of professionals who are qualified to diagnose cataracts and perform surgery. According to a 2012 RAND report, throughout much of Africa there is currently just a single ophthalmologist for every million people. "Even where there are significantly more doctors, only about half of them are trained in surgical techniques, and their skill levels vary widely. Many are still using archaic surgical techniques, opening the entire eye and then trying to stitch it shut. Their success rate hovers near zero. In fact, today in China, the leading cause of blindness is botched cataract surgeries."

A Solution

HelpMeSee takes a comprehensive approach to eliminating cataract blindness. To date the organization has evaluated and trained 192 partner surgeons spread across India, Nepal, Vietnam, China, Togo, Sierra Leone, and Peru to perform a quick, effective surgery called Manual Small Incision Cataract Surgery (MSICS).

For this technique, adults receive local anesthesia and, children are given general anesthesia. The surgeon begins by making a small, five to six millimeter incision in the sclera (the white of the eye.) The incision is cut at an extremely shallow angle, and after the opening is made, the surgeon removes the clouded-over lens and replaces it with an artificial lens. The eye's natural fluid pressure closes the incision and the overlapping edges of the angled slit do not require a single suture. The eye heals by itself within a day or two, when the bandage is removed. From start to finish, the surgery can take as little as five minutes for an adult, fifteen minutes for a child, which means HelpMeSee-trained surgeons can perform up to 100 operations in a single day with a success rate that rivals outcomes here in the US.

When it comes to children, Thazhathu reports, "In the past, the theory was that if you do not take care of congenital cataracts in the first three years of life, that child will never develop functional vision. Research done at Harvard medical school has proven this is not true, and we have definitely reaffirmed this research. We have been able to restore vision to children as old as 12 and 13."

HelpMeSee is currently completing the planning stage for a training center in Beijing, China, where it will train upwards of 100 new surgical partners every year. This training will be facilitated by a new, high tech tool: a virtual reality, haptic simulator. "Our simulator is all but indistinguishable from a patient's head while you are practicing the surgery. It includes data from all of the surgeries we have done to date, along with a haptic engine so you don't just see an image of what is happening during a simulated operation, you can actually feel everything from the pressure when the scalpel touches the eye to the resistance of the intraocular fluid as the surgeon uses the microscope's x/y control handles to remove the defective lens and replace it with the new plastic lens. The processing power and data mining capabilities we needed to create this soft tissue modeling [were] not possible just five years ago," describes Thazhathu.

HelpMeSee will also assist these new partners to obtain the standardized operating room equipment they will need in order to perform the surgeries—everything from autoclaves for sterilization and surgical microscopes to beds and, where needed, actual brick and mortar construction. To do this the organization has established a revolving capital fund that provides start-up capital of up to $20,000 per practice to assist newly trained MSICS specialists. "This is a micro-loan program, not a grant," notes Thazhathu. "Loan recipients are expected to repay their start-up funds over a period of five years through small deductions from the $50 proceeds of each surgery. This will enable the revolving fund to support establishment of even more practices."

Thirty-five dollars from each operation pays for a standardized surgical kit. These pre-sterilized, single-use kits include everything from anesthesia to an artificial lens. The remaining $15 pays for the surgeon's fee and those of his support staff, and repayment of the micro-finance loan. And if the patient can't afford $50? "We cover the fee," says Thazhathu. "Our priority is to first help those who would not otherwise be able to access or afford care."

Monitoring Results Through Data Mining

HelpMeSee practitioners input data from each surgery from start to finish into a cloud-based data monitoring system. All surgical outcomes are scored for quality, and feedback is provided directly to the surgeon as necessary. "Data mining can help us uncover things like which procedures need to be refined, or if there is a particular surgeon who is slightly off in his or her incisions and would benefit from additional training," says Thazhathu. "We also use this data to improve our simulators and make them even more realistic."

Another source of data is a new GIS (Geographic Information System)-GPS Android app which is enabling local community health workers to more efficiently locate patients, map the incidence of cataract blindness, and connect patients to partner specialists who can provide care. The app uses a voice recorder to input data, since in small, remote communities the outreach workers cannot always read. The collected data can also help define the geographic market for new clinic locations, as well as collecting demographic and epidemiologic information on the prevalence of cataract blindness in that region. "The app is also integrating with our surgical reporting system to help monitor patients and validate successful outcomes," says Thazhathu. "Thanks to these measures and the single-use surgery kits, infections and other postoperative complications are practically nonexistent."

HelpMeSee estimates that if all the patients treated in 2014 go back to work and make their country's minimum wage, they would make more than $140 million over their lifetimes. "Almost all of that would not have been earned if they remained blind," says Thazhathu.

To date, the organization's greatest success is the district of Chitrakoot, India, a city of one million where, after 10,044 surgeries, HelpMeSee was able to eradicate cataract blindness. "Now that we cleared the backlog, we are now transitioning to a market sustaining model," says Thazhathu. "Statistics say that for every one million people, we can expect to do approximately ten thousand new surgeries every year."

"Over the next several years we hope to eliminate cataracts as a cause of blindness in a large majority of the world," says Thazhathu. "We believe this is a goal we can achieve."

Contact Information

HelpMeSee, Inc. is a 501(c)(3) nonprofit tax exempt organization recognized by the IRS, and all donations to Help Me See, Inc. are tax-deductible in accordance with US tax regulations.

HelpMeSee, Inc.
20 West 36th Street, Floor 4
New York, NY 10018-8005
Telephone (toll free): 1-844-HelpMeSee (1-844-435-7637)
US fax number: 212-221-7604

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Bill Holton
Article Topic
Vision Research