Eyeworld

ASCRS NEWS by Ellen Stodola Editorial Co-Director Relevant disclosures Chang: Alcon, Carl Zeiss Meditec, Forsight Robotics, Johnson & Johnson Vision Contact Chang: dceye@earthlink.net 26 | EYEWORLD | SUMMER 2024 Charles D. Kelman, MD, Innovator's Lecture D avid F. Chang, MD, gave the Charles D. Kelman, MD, Innovator's Lecture at the 2024 ASCRS Annual Meeting on "frugal innovation," highlight- ing this as "the key to tackling our greatest challenges in cataract surgery." We tend to think of innovation in terms of new cutting-edge, advanced technologies, Dr. Chang said. However, the Hindi term "jugaad" de- scribes frugal innovation, which in the engineer- ing world refers to an inexpensive and creative alternative to a more expensive technology. How would frugal innovation be applied to healthcare systems? "It would mean achieving the same outcomes in much larger populations by employing more cost-effective solutions that are sustainable long term," he said. To illustrate the concept of jugaad, Dr. Chang asked the audi- ence to imagine that for decades we had to rely on a femtosecond laser to perform the anterior capsulotomy. Then a creative individual discov- ered that you could achieve the same outcome more efficiently using a $0.15 bent needle as an irrigating cystotome. In his 2009 Cornelius D. Binkhorst, MD, Lecture, Dr. Chang highlighted why the increas- ing global backlog of cataract blindness was the biggest challenge facing cataract surgeons. He said this was due to insufficient numbers of ophthalmologists and resources in low-income countries (LIC) around the world. In 2024, that burden continues in LIC, but we now foresee the looming problem of access to cataract surgery even in high-income countries (HIC). "This will be due to insufficient manpower to keep pace with increasing demand, while we consume and waste resources at rates that are financially and environmentally unsustainable," he said. Dr. Chang used the Aravind Eye Care System (AECS) to illustrate the benefits of frugal innovation in cataract surgery. Starting with his first visit in 2003, he and colleagues at AECS have published 2 dozen papers to share these lessons with ophthalmologists in HIC. He described five frugal innovations: manual small incision cataract surgery (MSICS); a high-vol- ume, assembly line surgical model; developing a square-edge PMMA IOL; developing low-cost intraocular moxifloxacin; and methods to reuse surgical supplies and devices that are discarded after one use in HIC. MSICS enables low-cost surgery with PMMA IOLs in the charity population at AECS. The astigmatic outcomes are comparable to phaco because of the sutureless temporal inci- sions. One study found that phaco had a much higher complication rate for inexperienced sur- geons, such as many of those practicing in LIC. MSICS might be a safer option to begin with in those settings. By standardizing instrumentation and supplies across all 14 hospitals, by manu- facturing most supplies in-house, and by reusing surgical gowns, gloves, phaco cassettes, I/A tub- ing, irrigation bottles, blades, sutures, and intra- ocular drugs, a single surgeon can perform 10 or more MSICS cases per hour while spending less than $15 per case in supplies for the charity patient population. Paying patients receive pha- co, and this subsidizes the charity care, which amounts to 60% of the nearly 450,000 cataract operations performed annually at AECS. Aravind also developed a square edge for its PMMA IOLs at a cost of $1 per lens, which dramatically reduced posterior capsular opacifi- cation in their MSICS population. They devel- oped a 0.5% intraocular moxifloxacin solution costing $1 per vial, which is approved in India and reduced their endophthalmitis rate by 3.5- Dr. Chang gives the Innovator's Lecture at the Annual Meeting. Source: ASCRS continued on page 28

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