Shortly before Thanksgiving 2023, an unkempt man came into the Sulzbacher Clinic for the Homeless in Jacksonville, Florida. The man lived in the woods near Jacksonville and generally avoided people, but he had come to the clinic as a last resort. He had recently lost his sight due to cataracts and needed help.
The medical director of the Sulzbacher Clinic, Julie McKay, MD, FACS, reached out to a local ophthalmologist, Jeff Levenson, MD. For many years Dr. Levenson has run a program called Gift of Sight that arranges free cataract surgeries for people in the Jacksonville area who cannot afford the procedures.
“[Dr. McKay] said this man doesn’t talk much, he’s sort of a loner, he doesn’t like people much—will you do his cataract surgery,” recalls Dr. Levenson. “Then she said, ‘he won’t come back for follow up so can you do both eyes at the same time?’ And I said, ‘sure.’ And then she said, ‘we can’t trust that he’ll use any drops after surgery, so can you do his procedure in a dropless manner?’ And again, I said, ‘sure.’”
The procedure was scheduled for a Wednesday. The patient was anxious and distant when he arrived at Dr. Levenson’s ASC, Riverside Park Surgicenter. Dr. Levenson performed the bilateral cataract procedure, and to prevent postoperative inflammation and pain, he placed two Dextenza intracanalicular implants that had been donated by Ocular Therapeutix.
A few weeks after the surgery, the man did come back for a follow up visit. “He’s like a new guy,” says Dr. Levenson. “He had gotten a haircut, they gave him some new clothes, he had shaved … and he smiled. He had not smiled at all the first time I saw him, or made eye contact, and all of a sudden it felt like he had found a new lease on life. It made me feel like I had done what I could do to make his world a better place.”
Growing Need for Charitable Care
Numerous studies have found an association between poverty and visual impairment due to cataracts, both in the United States and around the world.1,2 Despite U.S. government efforts to improve access to health insurance through the Affordable Care Act marketplace and expansion of Medicaid, today there are an estimated 27 million uninsured Americans.3 Most do not have access to health coverage through a job and cannot afford to purchase insurance. Many live in one of the 10 states that have not adopted the Medicaid expansion. In addition, undocumented immigrants are not eligible for Medicaid or ACA marketplace coverage.
Ophthalmologists go into medicine because they want to help others, and there is a long tradition of doctors providing free or reduced-cost health services for patients who are unable to afford care. In 2011, surgeons Kerry Solomon, MD, John G.P. Boatwright, MD, and Paul M. Herring, MD, decided to help uninsured members of their community gain access to sight-saving outpatient surgical procedures. So these doctors from Carolina Eyecare Physicians, a practice with multiple South Carolina locations, formed a 501(c)(3) organization called Operation Sight dedicated to restoring vision for those who could not afford care.
Their Operation Sight organization has been going strong since then, funding 80 to 100 surgical procedures each year, says Taryn J. Mason, the nonprofit’s executive director. Most are cataract surgeries, but the organization also provides surgical care for sight-threatening retinal conditions.
To receive care through Operation Sight, patients must be residents of South Carolina, between 18 and 63 years of age, and have received a diagnosis of cataract or retina disease from an ophthalmologist. Patients’ annual income must fall below the federal government’s 200% poverty guidelines. (Last year, an individual would qualify with an annual income below $29,160; a family of two adults and two children with annual income below $60,000 would also fall in the 200% poverty category.4) The nonprofit takes care of screening applicants, who can apply through the nonprofit’s website (www.operationsight.org) or are referred by a local doctor or health clinic.
“As a nonprofit organization, we are completely separate from the practice,” explains Mason. “But if one of our doctors has a patient come through that needs a surgery they can’t afford, they’re able to refer the patient to us. We get referrals from many of the free health clinics around the state that do vision services. We also work with vocational rehab centers; patients are often getting other care there and they realize that they need additional care.
“Walmart has been a great referral for us because of their vision centers,” Mason continues. “They’ll do an affordable eye exam for patients, so the patient can ask them send their medical records to us. Otherwise, a clinic or a doctor that knows about Operation Sight can just refer them directly to us. We have a physician on our board that reviews those applications.”
Care on a National Level
The success of Operation Sight in South Carolina inspired the American Society of Cataract and Refractive Surgeons (ASCRS) Foundation to establish a similar program on a national scale in 2014. Also called Operation Sight, the ASCRS Foundation’s program matches patients who qualify to volunteer surgeons in their area, who perform the procedures. The criteria for screening patients are similar to the South Carolina program: patients must be uninsured, have income at or below the 200% federal poverty level, and have a recent cataract diagnosis.
About 760 surgeons nationwide volunteer with Operation Sight, says program manager Sarah Duval, COE, COA. When matched with a patient, volunteer surgeons often evaluate the patient in their practice, then schedule the surgery in their ASC, which provides all necessary supplies as well as the staff necessary to support the surgery. The surgeon also provides follow-up appointments and care during the 90-day global period at no cost to the patient.
ASC ownership makes charitable work easier, says Duval. “It’s great when surgeons are willing to help, but if they don't own an ASC that presents some hurdles,” she explains. “Before performing the charitable procedure, the surgeon must get a green light from the hospital or the surgery center administration where they operate. The hospital may have their own charitable program, so now we may have to have the patient apply through their charitable program and see if they’ll approve it. The surgeon really must be committed to seeing this through if they don’t own their own ASC.”
Benefits Abound
Tatjana H. of Texas is one patient who recently received surgery thanks to the ASCRS Foundation’s Operation Sight and volunteer surgeon Judith Kirby, MD, of the Kirby Eye Center in Dallas. “I don’t qualify for Obamacare due to not making enough income for the tax break,” Tatjana explained in her application to the program, “and would have to pay $759 a month for health insurance and I don’t make enough to be able to afford that.... I cannot see out of my right eye and it has me driving unsafe. I live by myself in the country. I’d like to see my kids graduate from college and the police academy.... I never thought I would be in this position to beg someone for help.”
Accepted by Operation Sight, Tatjana was matched with Dr. Kirby, who removed the cataract in her right eye in October and removed a cataract from her left eye in December.
“Working with patients and helping them get their vision restored is not new to me,” says Duval, who worked in an ophthalmology practice for 18 years, including as a cataract surgery scheduler, prior to joining Operation Sight last September. “But it’s so meaningful when a patient emails me back to say that their surgery was a blessing that has changed their life. It has been amazing to go from the clinic to the charitable side of eye care. The patients are so appreciative. I would tell any surgeon to sign up to be a volunteer surgeon because these cases are a wonderful reminder of why they decided to be a doctor and a surgeon in the first place.”
How Surgeons Can Help
For surgeons who are interested in charitable care, volunteering with the ASCRS Foundation’s Operation Sight is an easy way to get started. Duval says the organization is working through a backlog of nearly 200 patients and would love to expand the program with additional volunteer surgeons. Physicians interested in participating in Operation Sight can register online at www.ascrsfoundation.org. Once they’re in the database, Operation Sight staff will contact the surgeon when there is an approved patient in their area. It’s always at the volunteer’s discretion to accept the case. If accepted, the practice will evaluate the patient and schedule the necessary procedure.
Duval notes that if a practice diagnoses a patient with a cataract who cannot afford to pay for the surgery, they can refer their patient to Operation Sight for screening, and, if approved, can perform the procedure in their ASC rather than matching that patient with another local surgeon.
For those who would like to do more, Dr. Levenson and the South Carolina surgeons of Operation Sight share some useful observations. “I’ve been practicing for 35 years, and every week or every other week somebody will come into my office who’s poorly sighted or blind and doesn’t have health insurance,” says Dr. Levenson. “So we started doing these cases around Christmas time and it was a way to remind our staff and me about the miracle of modern cataract surgery. It was a great morale booster, and now we do it throughout the year.”
Creating a 501(c)(3) organization is an important step for those who wish to do more, as it allows surgeons to receive donations and grants to offset the cost of lenses, medication, and surgical materials for their charitable program.
Dr. Levenson works with a local charity called Vision is Priceless to screen patients, and make sure they qualify. The ASCRS Foundation’s Operation Sight has provided Dr. Levenson with grant funding, and he also receives donations from major companies like Alcon, J&J Vision, and Ocular Therapeutix.
Everyone involved in charitable care notes the difference that this work makes in peoples’ lives as highly motivating. “Our doctors and nurses often say that some of their most rewarding days on the jobs are with our Operation Sight patients,” says Mason. “These patients are very resilient people who are looking to better their lives. They’re often caregivers for the rest of their family, so the ripple effect that [vision-saving surgery] has on the community is amazing.”
Mason says that they’re particularly proud of the fact that 97 percent of their patients who had lost their job due to vision loss are reemployed within three to six months of receiving cataract surgery. “We had a truck driver who came through the program last fall,” she recalls. “He was no longer able to drive due to cataracts, so he lost his home and was living in his truck even though he couldn’t drive it. [A few months after his surgery], I called to see how he was doing and he told me he had to call me back because he was on his first drive up to New York. He was very excited that he was back in the workforce and able to drive.
“[Cataract surgery] is an outpatient procedure that changes someone’s life and often takes 10 to 15 minutes,” Mason continues. “If you can squeeze an extra patient into your day once a week, it’ll make a significant impact on their entire world.”
“A lot of what I do every day is not all that gratifying—MIPS and EMR and the bureaucratic requirements of running a business,” agrees Dr. Levenson. “But this is the purest, cleanest distillate of my best self. It’s the thing that I do that keeps me from getting burned out and keeps me excited about this career that I’m privileged enough to enjoy.” OASC
References
1. Lewallen S. Poverty and cataract—a deeper look at a complex issue. PLoS Med. 2008;5(12):e245. doi:10.1371/journal.pmed.0050245
2. Fang Z, Chen XY, Lou LX, Yao K. Socio-economic disparity in visual impairment from cataract. Int J Ophthalmol. 2021;14(9):1310-1314. doi:10.18240/ijo.2021.09.03
3. Centers for Medicare and Medicaid Services. Certification of rates of uninsured. July 3, 2023. Accessed December 14, 2023. https://www.cms.gov/files/document/certification-rates-uninsured-fy-2024-final-rule.pdf
4. U.S. Department of Health and Human Services. 2023 Poverty Guidelines: 48 Contiguous States (all states except Alaska and Hawaii). Accessed December 7, 2023. https://aspe.hhs.gov/sites/default/files/documents/1c92a9207f3ed5915ca020d58fe77696/detailed-guidelines-2023.pdf
