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September 23, 2010

Press reports on HCP doctors' presentations at APAO Congress in Beijing

OSN and Eye World Magazine's "Meeting Reporter" reported on presentations by HCP ophthalmologists at the APAO Congress in Beijing in mid-September. They reported that manual small-incision cataract surgery techniques (SICS) – employed by the Himalayan Cataract Project – are often as reliable as phacoemulsification.

HCP co-founder Dr. Geoff Tabin was quoted during a presentation as saying, "In the age of phacoemulsification, one, [manual small incision cataract surgery] is faster, less expensive, doesn't need a lot of equipment and really is the best way to reach the unreached around the world. And, two, in the age of phaco there are still cases where you need [manual small incision cataract surgery]."

Tabin noted that other presenters in the room, such as HCP's Dr. Sanduk Ruit, were able to perform high-quality, high-volume manual cataract surgery techniques to rival or exceed results with phaco, especially with the hardened, hypermature cataracts often encountered in rural areas. Read the full OSN article here.

In addition, the following report was published in an Eye World Magazine "Meeting Reporter" news e-mail:

SICS vs. Phaco

No one can question the value of phacoemulsification technology in cataract surgery. However, in developing countries, manual small incision cataract surgery (SICS) continues to have a "big role," said Ravindran Ravilla, M.D., Aravind Eye Care System, India. The procedure, he said, is most suitable for the advanced, hyper-mature cataracts seen in rural areas around the world that generally cannot be dealt with using phaco, or at least not without causing some degree of endothelial damage. Dr. Ravilla chaired a symposium Saturday which focused on SICS techniques.

Globally, around 18 million are "really blind" with visual acuities of 3/60 or worse, said Sanduk Ruit, M.D., Tilganga Institute of Ophthalmology, Nepal. Expanding the definition of cataract blind to include people with relatively better visual acuities of 6/60 and 6/18 increases the number three- and eight-fold, respectively. The problem inherent in these statistics is that the "really blind" people are also the ones who are socially, geographically, and economically deprived access to cataract surgery. These people, said Dr. Ruit, exist in a kind of cocoon, enclosed within a shell of cataract patients with better acuities who are able to access treatment. This situation makes "true" cataract blindness a public health issue; this poses specific challenges in terms of cataract surgery technique.

In developed countries, where cataracts are generally dealt with early in their natural history, there is a distinct bias towards phaco. In these countries, phaco is unquestionably considered the standard of care. However, to begin with the technology involved with phaco can be forbidding for developing countries; the logistics alone of bringing the necessary equipment for phaco to the regions of the world where most of the truly cataract blind population live are virtually insurmountable.

A program that uses phaco to eradicate cataract blindness, said Mohan Thazhatu, M.D., of the HelpMeSee organization,  would cost US$130 billion at current prices; an equivalent program using SICS would cost only US$4.5 to 5 billion.

SICS provides a safe, straightforward technique that requires no special equipment other than the most basic instruments of ophthalmic surgery; this alone makes SICS the obvious choice for any serious public health program aimed at eradicating cataract blindness. Some may wonder if cataract patients aren't being shortchanged when surgeons resort to this decidedly less advanced mode of cataract surgery. The answer, according to data presented by Geoffrey Tabin, M.D., University of Utah, is a resounding "No."

In a head-to-head comparison of phaco and SICS, with the techniques performed respectively by David Chang, M.D., and Dr. Ruit to treat 180 "typical cases"—patients with hyper-mature cataracts in Nepal—SICS was comparable in terms of safety. It also showed a distinct advantage in terms not only of cost, but also of ease, time, and visual outcomes in these cases. About 70% of the Nepalese patients who underwent phaco in Dr. Chang's hands achieved 20/60 or better vision; more than 90% achieved 20/60 or better after SICS with Dr. Ruit.

Tags: Media