In 2016, when the call went out from Operation Sight for volunteers to provide free cataract surgeries during the inaugural National Sight Week, Maria C. Scott, MD, jumped at the chance to engage her Annapolis, MD, ASC.

“I said to my staff, ‘Let’s do this.’ I wanted to make a more significant impact for those who could not otherwise afford cataract surgery,’” says Dr. Scott, founder and medical director of Chesapeake Eye Care and Laser Center and vice president of the Outpatient Ophthalmic Surgery Society (OOSS). “We perform charitable surgeries from time to time, so I thought, why should this be a big deal?”

As Dr. Scott, her partner, Heather A. Nesti, MD, and their staff at the Chesapeake Eye Care and Laser Center soon learned, mobilizing to perform more than a dozen charitable cataract surgeries was a very big deal.

“It’s a daunting task,” says Anna Nardone Hayden, director of marketing and public relations for Chesapeake Eye Care and Laser Center. “There were so many nuances that we hadn’t considered.”

The lessons learned — in some cases, the hard way — inspired Dr. Scott and Ms. Hayden to write a guide for other surgeons and surgical centers that perform charitable surgeries independently or in conjunction with Operation Sight and other organizations. The guidebook, which Dr. Scott developed for the American Academy of Ophthalmology’s Leadership Development Program, will be available later this month on the OOSS University website (university.ooss.org ).

“We hope this manual will supplement the great work that Operation Sight and other charitable organizations offer and also give surgeons and ASCs a sort of checklist to make their processes as efficient and effective as possible,” says Dr. Scott.

Background: Operation Sight

Operation Sight, the American Society of Cataract and Refractive Surgery (ASCRS) Foundation’s domestic charitable cataract surgery program, provides support services, including eligibility vetting for cataract candidates and surgery scheduling, as well as stipends, to help offset the cost of medicines and materials. The ASCRS Foundation adopted and expanded the original Operation Sight program, which was started by South Carolina ophthalmic surgeon Kerry Solomon, MD, with the goal of developing a nationwide network of volunteer surgeons.

Since 2014, Operation Sight volunteers have performed more than 1,300 cataract surgeries, free of charge. The organization’s network stretches from coast to coast and includes more than 325 surgeons in 45 states. The ASCRS Foundation expects to have at least one Operation Sight volunteer in every state within the year.

Stephen Lane, MD, who co-chairs the ASCRS Foundation and heads its domestic initiatives, estimates that Operation Sight surgeons will perform 750 free cataract surgeries in 2017, many of them during this year’s National Sight Week, October 15-21.

“There are only winners here,” says Dr. Lane, a Minnesota ophthalmic surgeon and chief medical officer for Alcon. “The doctors and their staffs have the gratification of being able to perform surgery and give back; industry is able to provide resources to support a humanitarian effort; and the patients — many of whom are legally blind — regain their sight.”

Bradley C. Black, MD, OOSS president emeritus and chair of OOSS Gives, the society’s charitable committee, agrees.

“Many of our surgeons at OOSS already provide volunteer and humanitarian services,” says Dr. Black, of the Vision Surgical Center in Jeffersonville, IN. “We thought an affiliation with Operation Sight would make it easier for our OOSS member facilities to participate in charitable surgeries.”

A Glimmer of Hope

Cataracts are the leading cause of blindness worldwide, and according to the National Eye Institute, from 2000 to 2010, the number of cataract cases in the U.S. rose by 20%, from 20.5 million to 24.4 million. Although no one knows precisely how many people in the United States need cataract surgery but can’t afford it, extrapolations based on the percentage of uninsured Americans put the count in the hundreds of thousands — a staggering number of people with correctable vision loss.

“We have the privilege of having this training and the ability to help people see better,” says Y. Ralph Chu, MD, immediate president of OOSS, whose Minnesota surgery center participates in the Operation Sight program. “Using our skills to help people and give back to society at large is one of the most gratifying things that we can do.”

Most patients who qualify financially for the charitable surgeries under the Operation Sight program are too young for Medicare, generally 55 to 64 years old; uninsured or underinsured; ineligible for Medicaid; and have incomes of less than 200 percent of the federal poverty level, which for a single person is $24,120 a year. Cataract surgery can cost upwards of $2,900 for a single-focus lens for someone who doesn’t have insurance or government assistance.

As Hayden found, a few of the people screened for surgery at the Chesapeake Eye Care and Laser Center had Medicare coverage, but did not have the means to pay their minimums for Medicare and had incomes less than 200% of the federal poverty guidelines. Many also were uninsured immigrants who did not speak English and had not seen an ophthalmologist in years, if ever. Most had cataracts that were extremely dense, similar to those found in patients in undeveloped countries.

“The vast majority of our patients were legally blind,” says Dr. Scott. “Some were light-detection only or motion only. Their surgeries really were life-changing.”

James Chilcoat learned that he had cataracts when he tried to renew his driver’s license and failed the vision test. A former volunteer firefighter, Chilcoat was retired from a series of jobs, and living on a limited income.

“Things were really tight,” he recalls. He signed up in the hope of qualifying for surgery after seeing an advertisement about free services. After surgery, Chilcoat marveled at the bright colors on his television screen and was astonished that he could read street signs and drive without corrective lenses.

“I didn’t realize how bad my eyes were,” says Chilcoat. “I’d just gotten used to everything being foggy and blurry. It was like a blind man getting his sight back. I’m so grateful that I am to be able to see again.”

Breaking Down Barriers

The surgeries, while nothing short of miraculous for the patients, require the careful coordination of myriad moving parts. In her operating manual, Dr. Scott addresses every step of the process, from laying the groundwork for a successful campaign by coordinating months ahead of time with local social service agencies and healthcare providers to making sure patients have support and supervision after surgery. Dr. Scott and her staff found that many of the potential candidates actually had other vision problems. Some needed eyeglasses, while others had large pterygiums — prompting her recommendation for prescreening by an optometrist. Many also had comorbidities that needed monitoring, and one patient developed a retinal tear during surgery, requiring immediate intervention. Fortunately, Dr. Scott had a retina specialist on standby.

Initially, Drs. Scott and Nesti planned to perform up to 40 surgeries for 20 patients, but they found that identifying qualified patients in a short amount of time was more difficult than they anticipated. Ultimately, they performed 14 surgeries, but they expect to perform more this year.

As mentioned previously, many of the candidates did not speak English. Hayden and her staff quickly translated materials into Spanish and scrambled to find translators to help with the cataract evaluation, scheduling, and possible needs in the operating room and for pre-and post-op instructions. The experience prompted the Chesapeake Eye Care and Laser Center to expedite their bilingual initiative to serve the Spanish-speaking patients in their community by hiring bilingual staff, including an optometrist, technicians, and front desk and call center employees.

Several low-income patients lacked transportation; some lived alone; others had memory and/or mental health problems that threatened their post-operative care. In these cases, Hayden enlisted the help of social service agencies, the local hospital’s outpatient clinic, and volunteers to ensure that patients complied with post-op instructions and returned for follow-up exams. Hayden also arranged for donated meals post-surgery and breakfast for patients at the center before their day 1 post-op exams.

The Chesapeake Eye Care and Laser Center initially did its own financial vetting, but discovered that the Operation Sight process could save them time and effort and ensure that the most qualified patients were approved.

There were also numerous coordination issues between departments already tasked to the max with their usual duties. By developing flow charts and checklists, Dr. Scott hopes to help other surgery centers define duties, streamline their charitable surgeries, and plan for the challenges inherent in scheduling and patient follow-up.

The ultimate goal, as Drs. Scott and Lane note, is to remove barriers and simplify the process of providing charitable surgeries so that as many surgeons as possible can join the effort to combat preventable blindness in their local communities.

“It is so satisfying when patients come in and they’re seeing for the first time in a long time,” says Dr. Scott. “To see the look on their faces when they’re able to see again and to experience their gratitude — well, it just makes you want to do more.” ■