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ForSight Innovation: Enabling Equitable Outcomes in Cataract Surgery

Team Members:
  • Nick Calafat
  • Daniel Myers
  • Namratha Potharaj
  • Brittany Reed
  • Joshua de Souza
  • Krithik Srithar
  • Soumyadipta Acharya, MSE, MD, PhD
  • Youseph Yazdi, PhD, MBA
  • Aditya Polsani, BDS, MS
  • Kunal Parikh, PhD
  • R.D. Ravindran, PhD
  • John Sheets, PhD
  • Martin Spencer, PhD
  • Thulasiraj Ravilla, MBA
  • Zervin Baam, PhD
  • Balaji Velayeutham, PhD
  • Samuel Yiu, MD, PhD
  • David Friedman, MD, PhD, MPH
  • Katie Solley


Approximately 94 million people worldwide have impaired vision due to cataract, with a disproportionate number living in low- and middleincome countries (LMICs). Despite a continuous rise in cataract surgical rates, there remains a backlog of up to 16 million individuals awaiting surgery. To tackle the backlog of cataract surgeries, institutions like the Aravind Eye Care System in Madurai, India, provide high surgical throughput (>300 surgeries/ day) and subsidized care for patients of low socioeconomic status. Manual Small Incision Cataract Surgery (MSICS) has become the standard of care throughout LMICs and is a safe and effective surgery that meets the cost and time demands of a high-volume eye care center. In comparison to the goldstandard phacoemulsification (phaco) procedure, which is more widely used in developed countries, MSICS can be performed twice as fast and at a quarter of the cost. However, MSICS leads to significant rates of surgically induced astigmatism (SIA), resulting in impaired postoperative visual acuity. Additionally, MSICS patients require twice the time to recover after surgery in comparison to phaco patients. This results in a loss of income for patients who are often the sole breadwinners for their families.

Through 100+ surgical observations and 35+ interviews with cataract surgeons at Aravind and the Johns Hopkins Wilmer Eye Institute, our team identified the primary root cause of poor MSICS patient outcomes to be the size of the surgical incision. While phaco uses ultrasonic energy to fragment and remove the cataract through a 2-3mm incision, MSICS requires a much larger 6-8mm incision to remove the cataract as a whole. Working side-by-side with experts at Aravind and Wilmer, our team has developed a surgical device capable extracting a cataract through a smaller incision while maintaining the time- and cost-efficiency of MSICS. Our solution translates the best qualities of phaco into a technology that is suitable for high-volume eyecare systems, thus enabling equitable patient outcomes independent of socioeconomic status.

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