As a rule, the latest and greatest new technology first becomes available to the haves in this world, and only much later, if at all, to the have-nots. One exception to this rule may be health care within the developed world, where government programs, such as Medicare, provide for people from all walks of life; but even in our American democracy, studies have shown differences in access to care based on gender, race, and socioeconomic status.
Outside of the developed world, access to any care is extremely limited among the poor, and access to the latest technological breakthroughs remains a dream. Nevertheless, in rare instances, a happy coincidence may arise and make a dream come true.
No one who keeps abreast of developments in ophthalmology can be unaware of the development of femtosecond lasers for cataract surgery. Over the past couple of years, I and others have presented papers at multiple international meetings reporting data that show enhanced outcomes with laser surgery.
Perhaps surprisingly, most of these data come from investigational sites outside the United States. In fact, submissions to the FDA increasingly incorporate data gathered at "OUS" (Outside United States) sites. This trend reflects the relative cost of doing clinical research here versus doing it in other countries.
A couple of years ago I was visiting the Florida headquarters of one of the companies pioneering femtosecond laser technology, LensAR. At the time they were looking for a new site outside the United States for clinical research, and I had an idea. A friend of mine, a cataract surgeon in Pennsylvania, Frank Bucci, MD, had established a charity clinic in Lima, Peru, called Instituto de Ojos Sacre Cuore (Sacred Heart Eye Institute). Frank had shown me pictures of the clinic taken during a visit from former President Bill Clinton, whose foundation provides support for Frank's work. The modern state-of-the-art equipment and beautiful facility impressed me. I suggested that LensAR contact Frank.
Things worked out. In March, my idea came to fruition, as I and a handful of leading surgeons from around the world traveled to Lima to treat patients with cataracts with the LensAR laser for the first time. The patients were truly destitute, poor people from the outskirts of Lima, which is a vast desert city along the coast of Peru. The patients were transported by the clinic's minibus from their ramshackle hillside dwellings into the city to receive the gift of sight, and their cataracts were among the most severe and debilitating I have ever seen. In a moment of divine justice, these most vulnerable patients received the most technologically advanced surgery available in the world today.
By the end of the day, LensAR had achieved its goal of providing experience to key international opinion leaders in cataract surgery, the patients had regained the ability to function independently and enjoy their lives, and I had experienced an epiphany of knowledge, skill, and love. LensAR expects final approval from the FDA this year, and I am looking forward to making this revolutionary technology available here.
[For more information on Instituto de Ojos Sacre Cuore, visit http://www.clintonfoundation.org/what-we-do/clinton-giustra-sustainable-growth-initiative/i/shared-vision-a-partnership-to-provide-cataract-surgeries-in-peru. For more information on LensAR, visit http://www.lensar.com/. To view photos of the event in Lima, visit