Cataract Blindness and Simulation-Based Training for Cataract Surgeons

Cataract Blindness and Simulation-Based Training for Cataract Surgeons: An Assessment of the HelpMeSee Approach

James R. Broyles
Peter Glick
Jianhui Hu
Yee-Wei Lim
Copyright Date: 2012
Published by: RAND Corporation
Pages: 136
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  • Book Info
    Cataract Blindness and Simulation-Based Training for Cataract Surgeons
    Book Description:

    Cataracts cause about half of all cases of blindness worldwide, largely in developing countries. HelpMeSee Inc. is developing a simulator-based method for rapid cataract surgical training that RAND researchers determined could significantly help to close the backlog of cataract cases, expected to be 32 million globally by 2020. For this to occur, challenges in the areas of outreach, quality monitoring, and public acceptance must be met.

    eISBN: 978-0-8330-7727-1
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xx)
  7. Acknowledgments
    (pp. xxi-xxii)
  8. Abbreviations
    (pp. xxiii-xxiv)
  9. CHAPTER ONE Introduction
    (pp. 1-4)

    Cataract accounts for about half of all cases of blindness worldwide, with an estimated 20 million people suffering from bilateral cataracts (World Health Organization website, undated). The overwhelming majority of these cases are in developing countries, where blindness and visual impairment (VI) can have enormous negative impacts on the quality of life, as well as reducing life expectancy. The vast majority of the blind in these countries are unable to work, leading to an association of blindness and poverty (Kuper et al., 2010).

    The great majority of cataract-caused VI can be cured by inexpensive surgical procedures with very high success...

  10. CHAPTER TWO Global Cataract Problem and Cataract Surgery Backlog
    (pp. 5-10)

    Recent statistics (WHO, 2011) indicate that about 284 million people worldwide are visually impaired, among which 39 million are blind and 245 million have low vision (see box). Developing countries account for the overwhelming portion—about 90 percent—of this disease burden. Among the six WHO regions, Southeast Asia and the Western Pacific alone account for 73 percent of moderate to severe VI and 58 percent of blindness. In a recent study (Rao, 2011), the prevalence of blindness among study populations in developing countries reaches as high as 7.7 percent, well above the WHO threshold that states blindness should be...

  11. CHAPTER THREE Existing Models of Cataract Surgery Training and Delivery
    (pp. 11-18)

    The HelpMeSee model is conceived as a response to concerns that existing approaches will not be able to close the global gap between the need for cataract surgery and the supply of surgical capacity. Still, in many respects, particularly the emphasis on specialization, high volume, and low surgical unit cost, HMS draws on existing models. To put the HMS approach in perspective, we outline the key characteristics of several of the most prominent models in cataract surgical training and delivery in the developing world: Aravind in India, Tilganga in Nepal, and Project Vision and He Hospitals, both in China.¹ We...

  12. CHAPTER FOUR The HelpMeSee Approach
    (pp. 19-26)

    The HelpMeSee (HMS) initiative is an innovative system for cataract surgery training and delivery.¹ It aims at eliminating cataract-related blindness in developing countries by (1) providing intensive MSICS instruction to a large number of surgeon trainees in a comparatively short period of time, and (2) helping them to set up their own private practices in areas where cataract surgeries are most needed and to deliver high-quality cataract surgeries in sufficient volumes in these areas. With this initiative, HMS’s goal is to train about 30,000 new MSICS cataract surgeons worldwide over a period of 12 to 15 years starting in 2014,...

  13. CHAPTER FIVE Forecasting the Burden of Cataract
    (pp. 27-38)

    This chapter describes our modeling approach for predicting future prevalence of blindness and low vision caused by cataracts, and presents estimates of current and future cataract prevalence by region. In addition to prevalence, we also present projections of future costs in terms of DALYs and economic (productivity) losses associated with cataracts—two standard approaches to measuring the burden of disease or disability. We project each of these outcomes to the year 2040.

    Our projections are of interest in terms of understanding the scope of the cataract problem, but they also lay the groundwork for analysis of the potential impacts of...

  14. CHAPTER SIX Modeling the Impacts of HelpMeSee
    (pp. 39-58)

    In this chapter we examine the potential impacts of the HelpMeSee approach. We consider the following outcomes: number of trained MSICS specialists; surgical capacity, or the total number of surgeries per year that can be performed in the HMS system; and actual surgeries performed and the impacts on cataract-caused VI. The last of these, of course, is the key variable of interest—the ability of the HMS approach to substantially close the cataract surgery gap over time relative to the status quo scenario presented in the previous section. We consider the same 2012-2040 time frame as in the previous section,...

  15. CHAPTER SEVEN Analysis of Costs and Cost-Effectiveness
    (pp. 59-68)

    This section considers the costs of the HelpMeSee program and provides estimates of cost per surgery under different assumptions about uptake. We make use of detailed cost information provided to us by HMS. It is important to note that the findings depend on the validity of these cost assumptions. We compare HMS unit costs to those for Aravind, using information provided to us by Aravind for one of its main hospital centers, in Coimbatore, Tamil Nadu. We than calculate cost-effectiveness for HMS by combining the cost information with estimates of DALYs averted by the intervention.

    Costs of HMS include startup...

  16. CHAPTER EIGHT Potential Challenges to the HelpMeSee Approach
    (pp. 69-78)

    The modeling analysis in the previous two sections showed that, under HelpMeSee’s assumptions about costs and training capacity, the program would have the capacity to rapidly scale up cataract surgical capacity. Under optimistic assumptions about uptake, this capacity can largely close the backlog of surgical cases, and even under less optimistic assumptions, it can significantly lower prevalence of cataract-caused VI relative to the status quo.

    It is equally important to consider possible obstacles to the success of the HMS approach, and we now turn to this topic. With the exception of the problem of excess surgical capacity that may emerge...

  17. CHAPTER NINE Summary of Findings and Conclusions
    (pp. 79-84)

    HelpMeSee is developing an innovative system for cataract surgery training and delivery in developing countries, with the objective of eliminating or greatly reducing cataract-related blindness. It is distinguished from existing systems of cataract surgery in several significant ways: (1) the use of high-fidelity simulators, adapted from commercial aviation training systems, and specialized courseware to rapidly train large numbers of MSICS cataract surgeons; (2) surgical training not just of ophthalmologists but, when necessary, nondoctors; and (3) a system of independent MSICS practitioners who will operate on their own with HMS technical assistance, technical support, and oversight (although not all graduates will...

  18. APPENDIX A Modeling Approach, Methodology, and Data Sources
    (pp. 85-96)
  19. APPENDIX B Sensitivity Analysis—Practitioner Attrition and Trainee Intake
    (pp. 97-98)
  20. APPENDIX C Detailed Input Costs and Methodology
    (pp. 99-106)
  21. References
    (pp. 107-112)