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Chang shares lessons from ‘world’s greatest team of cataract surgeons’

David Chang
David F. Chang

ORLANDO — From what started out as a trip to Aravind Eye Hospital in India in 2003 to teach phaco, David F. Chang, MD, learned valuable lessons that have affected practice in the U.S. from what he called “the world’s greatest team of cataract surgeons.”

“This is the vision of one person, Dr. Venkataswamy, who at the age of 58, because of forced mandatory retirement from government service, set up his own little clinic with some family funds, 11 beds and a modest goal of curing needless blindness,” Chang said in his keynote lecture at Cataract Surgery: Telling It Like It Is. “His family members formed the core of the Aravind Eye Hospital system.”

“The problems are limited surgeons and how to make them productive to do high-volume, rapid surgery when the cataracts are so advanced and prone to complications. They also have the problems of affordability of equipment and the lenses,” Chang said.

Chang shared what he saw at the highly efficient Aravind Eye Hospital in Pondicherry, India.

“I went there to teach phaco, but then when I watched how they treat these charity patients, I came away amazed, and we’re in Orlando and this is like Disneyland for cataract surgery,” he said.

“What they have done for nearly 30 years is they have revolutionized the concept of an eye camp by bringing patients that they screen on Sunday who have cataract back to the hospital where they’re all operated on Monday afternoon. It is literally 300 to 400 cases who are all lined up like an assembly line. Each surgeon will have two beds where the surgeon is operating on one patient while the other patient is set up in the next bed and ready to go.”

Surgeons perform manual small-incision cataract surgery, and surgeries are performed in less than 4 minutes each. Because there is no turnover time, each surgeon is able to perform 10 to 16 cases per hour, Chang said. Both complication and infection rates are extremely low.

“They reuse everything they can — the [balanced salt solution] bottle, gowns, gloves, the blades — and they use flash, short-cycle sterilization.”

According to Chang, Dr. Venkataswamy found his inspiration for Aravind from McDonald’s.

“What’s special about McDonald’s is they’re able to give good value for a low price because they do everything the same. It’s standardized. You don’t get a custom hamburger, so everybody has to use the same instruments, the same steps. The nurses all learned the same way. So that’s why everybody is interchangeable in the system. You don’t get to pick your own blade; you don’t get to pick your own nurse or IOL.”

“Now they have 11 regional centers where they are collectively doing the highest volume cataract surgery annually in the world with about 350,000, with 60% entirely for free.”

Along with the standardization of cataract surgery, Aravind also developed its own standardized electronic medical record keeping system.

Chang shared that because of the tremendous number of patients treated, meticulous record keeping and homogenous surgical structure, data from Aravind have been used to complete some of the largest retrospective studies on topics such as square- vs. round-edge IOLs, the use of intracameral antibiotics, OR sterilization protocols and others that have directly affected cataract surgery practice in the U.S. and around the world.

For one example, when the U.S. was looking for data on OR sterilization protocols for cataract surgery, none existed.

“I asked them, can you generate a retrospective study, and with that database we were able to very quickly show them that over a 6-month period, 42,000 cases with short-cycle sterilization, that the [infection] rate was less than one per 10,000. It was largely with the help of this study ... that the joint commission found ... you can use short-cycle sterilization,” Chang said.

“I think the biggest lesson is to remind us that ... the biggest challenge in cataract surgery remains the increasing backlog of blindness due to cataract and the solution there is to have teams, and Aravind is leading the way,” he said. “It’s a team approach. People don’t do it different ways. There’s no concern about who has the highest volume or who gets the best OR slot. They work as a team and are doing incredible work.” by David W. Mullin

 

Reference:

Chang DF. Keynote lecture: Lesson from the world’s greatest team of cataract surgeons. Presented at: Cataract Surgery: Telling It Like It Is; February 6-10, 2019; Orlando.

Disclosure: Chang reports no financial disclosures related to this keynote lecture.

David Chang
David F. Chang

ORLANDO — From what started out as a trip to Aravind Eye Hospital in India in 2003 to teach phaco, David F. Chang, MD, learned valuable lessons that have affected practice in the U.S. from what he called “the world’s greatest team of cataract surgeons.”

“This is the vision of one person, Dr. Venkataswamy, who at the age of 58, because of forced mandatory retirement from government service, set up his own little clinic with some family funds, 11 beds and a modest goal of curing needless blindness,” Chang said in his keynote lecture at Cataract Surgery: Telling It Like It Is. “His family members formed the core of the Aravind Eye Hospital system.”

“The problems are limited surgeons and how to make them productive to do high-volume, rapid surgery when the cataracts are so advanced and prone to complications. They also have the problems of affordability of equipment and the lenses,” Chang said.

Chang shared what he saw at the highly efficient Aravind Eye Hospital in Pondicherry, India.

“I went there to teach phaco, but then when I watched how they treat these charity patients, I came away amazed, and we’re in Orlando and this is like Disneyland for cataract surgery,” he said.

“What they have done for nearly 30 years is they have revolutionized the concept of an eye camp by bringing patients that they screen on Sunday who have cataract back to the hospital where they’re all operated on Monday afternoon. It is literally 300 to 400 cases who are all lined up like an assembly line. Each surgeon will have two beds where the surgeon is operating on one patient while the other patient is set up in the next bed and ready to go.”

Surgeons perform manual small-incision cataract surgery, and surgeries are performed in less than 4 minutes each. Because there is no turnover time, each surgeon is able to perform 10 to 16 cases per hour, Chang said. Both complication and infection rates are extremely low.

“They reuse everything they can — the [balanced salt solution] bottle, gowns, gloves, the blades — and they use flash, short-cycle sterilization.”

According to Chang, Dr. Venkataswamy found his inspiration for Aravind from McDonald’s.

“What’s special about McDonald’s is they’re able to give good value for a low price because they do everything the same. It’s standardized. You don’t get a custom hamburger, so everybody has to use the same instruments, the same steps. The nurses all learned the same way. So that’s why everybody is interchangeable in the system. You don’t get to pick your own blade; you don’t get to pick your own nurse or IOL.”

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“Now they have 11 regional centers where they are collectively doing the highest volume cataract surgery annually in the world with about 350,000, with 60% entirely for free.”

Along with the standardization of cataract surgery, Aravind also developed its own standardized electronic medical record keeping system.

Chang shared that because of the tremendous number of patients treated, meticulous record keeping and homogenous surgical structure, data from Aravind have been used to complete some of the largest retrospective studies on topics such as square- vs. round-edge IOLs, the use of intracameral antibiotics, OR sterilization protocols and others that have directly affected cataract surgery practice in the U.S. and around the world.

For one example, when the U.S. was looking for data on OR sterilization protocols for cataract surgery, none existed.

“I asked them, can you generate a retrospective study, and with that database we were able to very quickly show them that over a 6-month period, 42,000 cases with short-cycle sterilization, that the [infection] rate was less than one per 10,000. It was largely with the help of this study ... that the joint commission found ... you can use short-cycle sterilization,” Chang said.

“I think the biggest lesson is to remind us that ... the biggest challenge in cataract surgery remains the increasing backlog of blindness due to cataract and the solution there is to have teams, and Aravind is leading the way,” he said. “It’s a team approach. People don’t do it different ways. There’s no concern about who has the highest volume or who gets the best OR slot. They work as a team and are doing incredible work.” by David W. Mullin

 

Reference:

Chang DF. Keynote lecture: Lesson from the world’s greatest team of cataract surgeons. Presented at: Cataract Surgery: Telling It Like It Is; February 6-10, 2019; Orlando.

Disclosure: Chang reports no financial disclosures related to this keynote lecture.

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