What We Learned About Cataract Surgery
A cataract is the clouding of the lens of the eye, preventing clear vision. Fortunately, cataracts can be treated with minimally invasive surgery. Nevertheless, cataracts remain the cause of over half of all blindness worldwide. The global poor bear a disproportionate amount of this burden, as unfortunately, people with cataracts in developing countries often lack access to sight-saving medical services. Recognizing this gap, nonprofits have developed programs to provide cataract surgery to those who would otherwise have no choice but to live with blindness. These are often called surgical outreach camps. The ImpactMatters team sought to estimate the impact of these nonprofits and learned a few interesting things along the way.
But first, a quick breakdown of our process. We set out to determine how much it costs a nonprofit to cure a person of blindness. Our calculation is a function of the following five variables: the costs associated with a nonprofit’s surgery program, how many surgeries it performs; the efficacy rates of different surgery types, the percentage of people (though it may be small, or even zero) who would have been able to get cataract surgery anyway, and the percentage of cataract cases that would have resolved on their own without medical intervention. [This is a simplification; for a detailed explanation, read our full methodology.]
Then, we converted “a case of blindness cured” into disability-adjusted life years (DALYs) averted. In a nutshell, “DALYs averted” quantifies the suffering avoided as a result of no longer being blind. Following World Health Organization standards, a cataract surgery program is cost-effective if it averts one DALY for less than three times the G.D.P. per capita of the country in which it operates (4 stars); a program is highly cost-effective if it does so for less than the G.D.P. per capita (5 stars).
All of the cataract surgery nonprofits we analyzed were highly cost-effective, receiving 5 stars.
What we learned along the way
1. Cataract surgery nonprofits are often small, volunteer-driven operations
It could even be their size that makes them so cost-effective. When labor is donated by eye health specialists, and the nonprofit has few other expenses, it can successfully serve beneficiaries at a low cost.
2. Cataract surgeries aren’t necessarily giving people 20/20 vision
Don’t get us wrong, cataract surgery is a miracle of modern science that makes the difference between someone being blind or not. But they’re not LASIK eye surgeries. Patients often still need glasses to achieve a high level of visual acuity, and unfortunately in many of the communities where these surgeries are performed, beneficiaries don’t have access to glasses after the nonprofits have left.
3. Many cataract surgery nonprofits are motivated by religious faith
Here was something we didn’t expect to see: Many cataract surgery nonprofits directly frame their work around faith. They view restoring sight to the blind as “following in the footsteps of Jesus,” and as a connection to their own Christian spirituality.
What we still need to learn
1. Are some cataract surgery nonprofits working in more accessible areas than others?
The nature of this work is such that all of these nonprofits have to spend significant time accessing hard-to-reach populations. However, we don’t know if some nonprofits have to spend more or fewer resources reaching their beneficiaries than others. Maybe patients in Fiji are easier to reach than those in Pakistan? Maybe the infrastructure in Vietnam means you can perform more surgeries for cheaper than in Belize? It could be that this is one of the factors driving differences in impact.
2. What else causes the differences we see in impact?
Even though all of the nonprofits we analyzed receive 5 stars, some nonprofits could still stretch a dollar further than others. Why is this? It might be due to the cost of accessing their beneficiaries, as we discussed above, but there could be other reasons as well. Maybe some nonprofits just have stronger leadership than others or the donated equipment is higher quality. Right now, we’re just not sure.
3. Are temporary surgical camps the best way to reduce cataract blindness?
A lot of nonprofits that perform cataract surgeries first-hand also make cataract surgery possible in the long term by training local medical professionals in other countries or building vision centers. We steered clear of analyzing those parts of a nonprofit’s operation because they require a different analysis altogether (the equation to estimate changes in access at the beneficiary level is different from the equation to estimate whether a nonprofit can be credited with, say, adding one more ophthalmologist to serve a population). We haven’t evaluated training and infrastructure interventions, but if they work, they could potentially be a sustainable solution to cataract blindness in developing countries, as opposed to the immediate relief of surgical camps.