Cataract Surgery

This manual describes the step-by-step procedures by which ImpactMatters analyzes cataract surgery nonprofits. We recommend reading the program analysis methodology first.

Geography

We note the country in which the cataract surgery program operates. This information is usually found in

  • Form 990, part I, 1

  • 990, part III, 1

  • 990, part III, 4a

  • Website

  • Annual report

  • Financial disclosure forms

Note: This list of sources will henceforth be referred to as the “common areas” where information is found.

Surgeries

Number of surgeries

If the number of surgeries performed in the country we are evaluating is reported in one of the common areas, we use that number directly.

If a nonprofit has programs in multiple countries, we need to know how many surgeries are performed in each country in order to apply country-specific counterfactual rates. If a nonprofit does not break down the number of surgeries by country, we take a weighted average of counterfactual cataract surgical coverage rate across the stated countries, where the weights are each country’s respective share of program expenses. When that is not possible, we take a simple average of counterfactual cataract surgical coverage rate across the stated countries.

Type of surgery

The most common types of cataract surgery are: (1) manual small incision cataract surgery (M.S.I.C.S.); (2) extracapsular cataract extraction (E.C.C.E.); and (3) standard ultrasound phacoemulsification cataract surgery (“phaco”). The primary purpose of recording the type of cataract surgery performed is that these three types each have different efficacy rates. When a nonprofit does not report the type of surgery it performs, we average the efficacy rates for the three major types of surgeries and use that value in our calculations.

Costs

Program costs

When isolated costs of the cataract surgery program for the target country are reported in the common areas (usually form 990 section III, line 4a), we record them.

In some cases, the nonprofit does not report program expenses related only to cataract surgery (e.g., it reported expenses for all eye care services, one of which was cataract surgery). In those cases, we default to using “cost per cataract surgery” figures reported by the nonprofit, and use these values to adjust total cost, using a calculation with the following form:

Cost of cataract surgery program = Total program cost * [(Cataract surgeries * Cost per cataract surgery)/((Cataract surgeries * Cost per cataract surgery) + (Other procedures * Other procedure costs))]

However, such figures could introduce additional inaccuracy into our calculations because there is no standardized way of reporting cost-per-surgery, e.g., some nonprofits report only the material cost of surgery (value of donated goods), while others report the cost of identifying and transporting patients, coordinating and housing visiting surgeons, and providing follow-up care.

Cost of donated goods

We generally assign a cost of $0 to medical equipment, drugs and supplies donated by corporations to nonprofits. We assume that these goods have zero opportunity cost because they would have gone to waste if they had not been donated. It is possible that some of these goods could have been sold if they had not been donated. However, we assume that the benefits of donating — for instance, tax deductions and positive public image — sufficiently offset the foregone sales revenue. Practically, this means that when costs of donated goods are reported as part of program costs, we net them out.

Note that for donated services, financial statements do generally value donated services if the services either (a) create or enhance a nonfinancial asset (e.g., engineers and contractors building a facility) or (b) require specialized skills, are provided by entities or persons possessing those skills, and would be purchased if they were not donated. This means that unskilled labor (e.g., volunteers serving meals at a soup kitchen) don’t tend to be included on financial statements, but donated legal and accounting services do. In the case of cataract surgery programs, if the value of time donated by volunteer ophthalmologists has been included in financial statements, we net that value out on the assumption that volunteers benefit in important non-monetary ways like a feeling of fulfillment from helping others.

Note that the Form 990 — unlike audited financial statements — excludes donated services from revenue and expense totals. So if the 990 is used as the basis of our impact estimate, we should not need to subtract the value of volunteer time.

Partner costs

If a nonprofit reports any costs undertaken by partners (in the common areas) as part of its water purification program, we include them in our impact calculation.

Beneficiary costs

In the case a nonprofit charges beneficiaries al fee for cataract surgeries, we deduct this revenue from the nonprofit’s program cost, then add th