Cataracts are a leading cause of reversible blindness in several countries worldwide. In India, at least 12 million people are blind due to cataracts,1 with onset occurring in individuals aged 40 to 64 years in the majority of cases. Risk factors related to the high incidence of cataracts in India include lower socioeconomic status, increased exposure to ultraviolet light, and protein-energy malnutrition.
In order to address the increasing rate of cataract blindness in developing countries, there must be concerted efforts from governments and nongovernmental organizations working together. This type of publicprivate partnership has been a success in India, and, as a result, approximately 6 million cataract surgeries per annum are performed. The cataract surgery network is amazingly well developed throughout the country.
Rajan Eye Care Hospital, an ophthalmic hospital and postgraduate training institute, was founded in 1995. The community ophthalmology wing of the hospital, the Chennai Vision Charitable Trust (CVCT), was launched in 1996. Through the CVCT, we treat patients in villages within a 150-km radius of Chennai (Figure 1). Over the past 18 years, we have helped several villages in Tamil Nadu and southern Andhra (a neighboring state) become cataract-free zones.
The CVCT was the first free eye camp in India to introduce the use of phacoemulsification, and, by 2002, we were performing phacoemulsification in all centers in the free eye camps. We believe that phacoemulsification is associated with fewer complications than extracapsular cataract extraction (ECCE) or manual small-incision cataract surgery. Complications such as wound gape, iris prolapse, inflammation, infection, astigmatism, and posterior capsular opacification (PCO) rarely if ever occur in patients who undergo phacoemulsification in our eye camps. Because the rate of complications is low, in many camps we follow the principle of no follow-up cataract surgery. With the advent of low-cost foldable IOLs, patients can achieve improved quality of vision and contrast sensitivity with a low incidence of PCO.
To date, we have screened nearly 2 million patients in the CVCT and organized more than 2,300 camps. We have operated free of charge on close to 100,000 patients, a majority of whom underwent phacoemulsification.
THE CVCT NETWORK AREA
Between 1996 and 2005, we performed phacoemulsification with the Ophthalmic Phacoemulsifier Galaxy Pro (Appasamy Associates) and the Universal II System (Alcon). The small, sleek, portable peristaltic phaco machines made by Appasamy Associates were routinely used in all camps during this time. They feature reusable tubing and could be transported from one operating room to another. They could also be transported to our centers in rural areas such as Thiruvannamalai, Karunguzhi, and Vellore. In 1998, we purchased the Universal II System (Figure 2), which is also a peristaltic system that is small, sleek, and capable of being transported with ease. The advantageous features of these portable machines include peristaltic pumps, reusable tubing and handpieces, low maintenance, time-tested safety and efficacy, low cost, user-friendliness, and regular pulse.
From 2005 to date, we have been using the Vizual Phacoemulsification System (Biotech Visioncare; Figure 3) and the Sovereign Compact System with Ellips FX technology (Abbott Medical Optics). The Vizual system is a small, sleek peristaltic machine with reusable tubing and handpieces. It offers excellent features such as micropulse technology and good fluidics, and it is low-cost and maintenance-free.
The Sovereign Compact System with Ellips FX technology is an affordable, full-feature phaco system in a spacesaving package. It features advanced fluidics for excellent control and chamber stability and an enhanced user interface for ease of use; easy one-touch prime and tune; fast, user-friendly programming; durable, light, and compact design; easy mobility between offices; and a small footprint. The Ellips FX technology, which optimizes cutting efficiency by simultaneously combining longitudinal and transverse motion, is specially designed for smoother cutting.
I also use the following phaco machines for both paying patients and those treated in the eye camps: Millennium (venturi system; Bausch + Lomb); Stellaris Anterior and Stellaris Posterior (both venturi systems; Bausch + Lomb); Infiniti Vision System featuring Ozil Intelligent Phaco software (peristaltic system; Alcon); and Appasamy Associates Interface Phaco Machine (venturi system). These are all advanced phaco platforms with excellent fluidics and valuable features such as Ozil hyperpulse and micropulse for so-called cold phaco. These machines are available in all of our centers to take care of patients in the free eye camps. The higher-end systems such as the Millennium and Infiniti enable us to deliver clear corneas on day 1, irrespective of the density of the patient’s cataract.
CONCLUSION
The use of portable phaco machines has enhanced our ability to expand access to eye care to patients even in remote areas. These systems enable us to offer safe and effective treatments to all of our cataract patients, and they are greatly assisting our efforts to reduce the incidence of cataract blindness in India.
Mohan Rajan, MBBS, DO, DNB, MNAMS, FMRF, MCh, FACS, is the Chairman and Medical Director of Rajan Eye Care Hospital, Chennai, India. Dr. Rajan is an Adjunct Professor of Ophthalmology at Tamil Nadu Dr. MGR Medical University. Dr. Rajan states that he has no financial interest in the products or companies mentioned. He may be reached at tel: 91 044 28340500; e-mail: drmohanrajan@gmail.com.
- Kuruvilla A, Thomas I. Human cataract prevalence study in the district of Alappuzha. International Organization of Scientific Research Journal of Dental and Medical Sciences. 2013;8(4):5-8.
