The lens of Tilganga in the eyes of citizens of 40 countries
March 12, 2024: Kathmandu
Dr. Sanduk Ruit had a determined glint in his eyes when they met last Thursday. Though usually cheerful, his face now reflected the weight of serious thought. He envisioned creating a financially sustainable industry around the lens production lab at Tilganga, which currently produces millions of lenses annually, without diverting profits away from the lab itself.
“The lab has been operating successfully underground for some time,” he explained, “but it’s time to expand. We need to increase production.”
Despite its current success, Dr. Ruit saw an opportunity for greater impact. “The lab’s operation is commercial, but the profits are reinvested in the community. It’s sustainable but stagnant. This is a gold mine, and we need to make the most of it for the benefit of society.”
The Fred Hollows Intraocular Lens Laboratory, a critical department of Tilganga Eye Institute’s Nepal Eye Program, is embarking on a major transformation. It’s transitioning from a production unit to a full-fledged, non-profit industry. Dr. Ruit, a key figure in this initiative, explains that they have registered the new entity as a non-profit industry with Nepal’s Ministry of Industry. This signifies a significant shift, allowing them to operate with a broader scope and greater impact. The new industry will be established in Hetaunda, a move that will bring several advantages. It’s expected to significantly increase production capacity, enabling them to address the demand for high-quality intraocular lenses on a larger scale.
This expansion paves the way for them to compete in the international market. By producing a wider range of premium lenses, they can not only serve a larger patient population but also generate revenue to support their mission of providing affordable eye care.This transformation underscores the Nepal Eye Program’s commitment to continuous improvement and its dedication to serving the global community with sight-restoring technologies.
Dr. Ruit urgently requires approximately Rs 30 crore for the production of intraocular lenses in Hetaunda. Currently, he is facing confusion regarding the source of this funding. The registration process at the Ministry of Industry has been successfully completed, and land in Hetaunda has been secured. However, a significant amount of capital is necessary until the production process commences after the establishment of the infrastructure.
Expressing the challenges of managing such a substantial sum all at once as an organization dedicated to community welfare, Dr. Ruit emphasizes the need for government support. He underscores the significance of intraocular lenses as a source of pride for Nepal, likening the planned lens industry in Hetaunda to other nationally celebrated projects. “As leaders of the country highlight the fast track as a prideful project, the envisioned lens industry in Hetaunda is no less deserving of that distinction,” Dr. Ruit states. He believes that the industry will contribute to elevating Nepal’s global recognition. This ambitious plan is indeed a matter of pride and holds the potential to enhance the country’s standing on the world stage.
Dr. Ruit acknowledges that while the current endeavor appears simpler in comparison to the challenges he encountered in the 90s, he is actively seeking support from all quarters to successfully realize this plan. Reflecting on the difficulties faced in the 90s, he emphasizes that the very idea of manufacturing intraocular lenses in Nepal was a formidable challenge at that time. Nevertheless, the lenses produced in Nepal have since become widely accessible to citizens from over 40 countries, making them affordable and contributing to a global impact.
“This accomplishment has instilled confidence in us and personally given me the courage to confront the current challenge. However, to make this endeavor truly meaningful, we require the support of everyone,” he states. Dr. Ruit envisions that the establishment of the lens production industry in Hetaunda could pave the way for the manufacturing of various other types of medical equipment. Drawing parallels between lens production and the technology involved in producing electronic chips, he believes that considering lens production as a standard could lead to the production of diverse materials for medical applications.
Dr. Fred Hallows, reflecting on the journey, remarked, “We uttered the words ‘We make lenses here’ at that time, and I could not have imagined that this path would unfold in such a manner until today,” as shared by Sanduk. He further expressed that while there was a subtle notion in his mind about the possibility of intraocular lenses being manufactured in Nepal one day, he did not anticipate the journey unfolding as it did. Despite the unexpected nature of the journey, he emphasized the lack of room for complaints about the achieved success.
Dedicating himself to the production of intraocular lenses, Dr. Hallows extended gratitude to all employees at every level, acknowledging their pivotal role in the success of the endeavor. He praised the selfless contributions of his colleagues at the Nepal Eye Institute, highlighting their admirable commitment to overcoming every challenge encountered during the journey. Dr. Hallows emphasized that the success attained is not solely his own but rather the result of collective efforts and teamwork.
History of Lens Manufacturing
In the early 1990s, Dr. Ruit found himself at a cataract surgery camp in a village in Nawalparasi. Joining him in this endeavor was his friend, well-wisher, and self-described ‘soul-mate,’ Fred Hallows. Dr. Ruit recalled, “I performed eye surgery on approximately 250 individuals, implanting lenses during the camp. Although Dr. Hallows did not perform surgeries, he closely observed every aspect of the proceedings.” Dr. Ruit, during these surgeries, took it upon himself to personally prepare the necessary instruments, utilizing all his skills to ensure that the surgeries were not only cost-effective but also of high quality. His commitment to making the surgeries accessible and maintaining their quality demonstrated his dedication to providing affordable and effective eye care in the community.
During that period, the conventional practice after cataract surgery involved wearing thick glasses. However, Dr. Ruit opted for a different approach and chose to wear contact lenses sent by friends from abroad instead of glasses. This decision faced criticism from many people who questioned the use of expensive lenses rather than conventional glasses, particularly in Nepal where there was a prevailing belief against using contact lenses post-surgery, especially in rural areas. Despite the criticism, Dr. Ruit remained undeterred. He explained, “I was not discouraged. Keep doing your job.” His emphasis on using contact lenses stemmed from the realization that navigating daily life in rural environments post-surgery with thick glasses was not practical. At that time, the cost of a lens was approximately 200 US dollars. Dr. Ruit acknowledged the shock of many individuals when he placed such expensive lenses in the eyes of people living in remote villages of Nepal. Reflecting on the results of the camp in Nawalparasi, even Fred, who was battling kidney cancer, experienced a boost of energy. Subsequently, a review meeting was held with Nicole Gratchett, Dr. Ruit, and Fred. The overall enthusiasm and positive outcomes from the camp became evident during this reflection session.
As Dr. Ruit narrated the tale of his early life struggles, a subtle sense of satisfaction began to emerge, transforming the seriousness on his face into a radiant energy. Recounting the post-operative review, he noted that Fred displayed great enthusiasm and even teased Nicole, saying, “For less than a quarter of the price of an operation, Ruitt is coming here to a rural area, and the results are excellent.” In response to Fred’s comments, Nicole posed a thought-provoking question, asking, “What do you think about such expensive intraocular lenses? How can you move forward by always asking for help?” The exchange highlighted the importance of self-reliance and sustainability in their mission, challenging the notion of consistently relying on external assistance.
Fred abruptly declared, “We’ll make it here,” a statement that initially left Dr. Ruit in shock. The atmosphere shifted suddenly, becoming more serious. Despite the surprise, Fred remained steadfast in his assertion, comparing it to the possibility of driverless cars 15 years ago—a concept that initially frightened Dr. Ruit. This moment marked the inception of the idea to establish a factory for manufacturing intraocular lenses for cataract surgery in Nepal. Although Fred’s vision articulated in the early ’90s came to fruition in 1995, he did not witness the establishment of the factory. Consequently, the lens manufacturing unit was dedicated to his memory and named ‘The Fred Hollows Intraocular Lens Laboratory,’ as Dr. Ruit explained, “The lenses produced by this laboratory have been applied to more than 6.5 million eyes. That, in itself, is wonderful.” The laboratory stands as a testament to Fred Hollows’ vision and the tremendous impact it has had on eye care.
Dr. Ruit recounted the challenges faced when the initially installed machine did not yield the expected results. He emphasized the universal truth that new ventures often encounter obstacles, stating, “New things do not progress without any obstacles. That is true.” Learning from this setback, they acquired a machine from a company called Lens Tech in Florida, USA, in an effort to address the issues. The years 1994-95 were particularly challenging, marked by a shortage of skilled personnel.
Dr. Ruit shared, “We initially started producing 30,000 lenses. After that, we were able to reduce the price of the lens from $200 to $25.” Over the next three years, production increased to one hundred thousand lenses, resulting in a further reduction in the lens price to less than $6. This strategic approach of increasing production numbers played a crucial role in steadily reducing the cost of lenses, making them more affordable and accessible.
Dr. Ruit shares a bitter experience of facing resistance from established multinational companies worldwide as the lenses produced in Nepal began to sell for less than $6. “When we started to challenge the market dominated by multi-million dollar companies, they began to follow suit,” he remarked. Despite working for the benefit of not only their organization but also global society, Dr. Ruit notes that these companies responded by spreading negative publicity about their efforts. However, he emphasizes their resilience in the face of adversity, stating, “But we are not discouraged.” This determination reflects their commitment to providing affordable and accessible eye care, even in the face of opposition from larger corporations in the industry.
Dr. Ruit explains that the criticism from established lens companies worldwide served as motivation to enhance the quality of the lenses produced in Nepal. “We paid the utmost attention to the production of every lens to nullify their criticism,” he stated. This commitment to quality became a guiding principle for their work, emphasizing the belief that every single lens should meet the highest standards. Dr. Ruit highlighted that maintaining high quality at every stage, from raw materials to the final product, has become a rigorous standard for their team. He also stressed the significance of infrastructure in addition to machinery and manpower for achieving high-quality lens production. Referring to the clean room in their production unit, he noted, “The clean room you see in that production unit is more than one and only.” Keeping it clean is considered essential not just for the facility but also for ensuring the cleanliness and quality of its products. This attention to detail reflects their dedication to producing lenses that meet the highest standards in the industry.
For Dr. Ruit, every step of the journey, until the lenses produced in Nepal reach the global market, feels like a story from a movie. He believes that the challenges faced at each stage have played a crucial role in enhancing the quality of lens production. Describing the lenses as of good quality, he highlighted the importance of verification. Initially, facing a lack of a verification mechanism in Nepal, they pursued ISO certification, followed by CE certification for Europe. Currently, their lenses are also CFDA-certified in China.
Highlighting the global impact of cataracts on eyesight, Dr. Ruit shared alarming statistics: around 13 million people worldwide have lost their eyesight due to cataracts, and an additional 65 million people are partially sighted because of this condition. Moreover, 90 percent of these individuals reside in low-income countries. Dr. Ruit stated, “If they can be operated on, blindness will be removed.” Their ultimate goal is to bring light and vision to those in need, underscoring their commitment to addressing the widespread issue of cataract-related blindness.
Business Success
Sujan Ranjitkar, the Head of the Fred Hollows Intraocular Lens Laboratory, shared that the lenses produced in Nepal are exported to more than 40 countries worldwide. The laboratory, located within the premises of the eye institute in Tilganga, manufactures various types of 9-layer intraocular lenses, along with three types of materials required for cataract surgery.
“We produce 9 types of lenses, each with different characteristics, and there are about 22 variants of the same lens,” Ranjitkar explained. The market price of Nepalese lenses produced in Tilganga ranges from 240 to 4000 rupees. The main export destinations include Pakistan, South Africa, and China, although there was a decrease in exports to China during the Covid period, prompting the expansion of markets elsewhere. Currently, the laboratory exports 60 percent of its lenses, while the remaining 40 percent is consumed in the Nepali market.
Ranjitkar mentioned that The Fred Hollows Intraocular Lens Laboratory currently has an annual turnover of around 22 million rupees. The laboratory is planning to register with the Ministry of Industry to facilitate further growth and establishment in the international market. This move is expected to contribute to the laboratory’s continued success and expansion.
