On a typical Monday in the Aravind Eye Care System in India, spanning seven tertiary eye hospitals and several secondary centers, over 3,000 patients will undergo surgery for free or at steeply subsidized rates.
Around 80% of these patients will be implanted with intraocular lenses (IOLs) from Aravind’s own manufacturer, Aurolab.
Since its launch in 1992, Aurolab has driven down the price of cataract surgery. About 60% of the IOLs Aurolab manufactures today are distributed to nongovernmental organizations working in India and other developing countries.
In fact, through Aurolab’s products, India today is able to offer “efficient, high-quality cataract surgery to millions of people,” according to a 2016 Health Affairs article.
It’s a major change since the early 1990s, when relatively few patients could get IOLs because of the cost. During that time, India had a growing population of people blinded by cataracts, a shortage of well-trained ophthalmologists and lacked the latest technological marvel in eye care: intraocular lenses at a reasonable cost for the masses.
Back then, existing treatment for cataracts (leaving patients aphakic with high power biconvex glasses to compensate) was inefficient, with some studies demonstrating a compliance of only 50% at the end of one year. Everyone knew there was a great need to bring IOLs to India.
But how could you bring in a product that in the 1990s cost half of what the average Indian made in an entire year? How could you treat millions of people blinded by cataracts?
This was the question constantly running in the heads of Aravind’s founders. So in 1992, they made the daring leap, a decision considered ridiculous by many at the time: Aravind decided to manufacture intraocular lenses, an advanced technology, in the temple town of Madurai in South India.
With the help of the Seva Foundation and Aravind’s investment, Aurolab was founded in 1992 with the goal of producing high-quality IOLs at an affordable price. Under the leadership of P. Balakrishnan, BE, PhD, who left his teaching position in the University of Wisconsin to come home to India, Aurolab was launched.
Since then, Aurolab has expanded its work in ophthalmology beyond IOLs to other surgical tools, blades, sutures, pharmaceuticals and novel devices. Aurolab’s mission was to bring high-quality, advanced technology to developing and underdeveloped countries at an affordable cost.
Aurolab’s first product, the polymethyl methacrylate (PMMA) IOL, was groundbreaking. It immediately brought the cost down from over $100 for the imported lens to under $10. Today it is sold for just $3 to the end user. All this while maintaining precision and quality.
Moreover, Aurolab was the first Indian manufacturer to obtain the CE mark for its IOL, which means it conforms with European health, safety and environmental protection standards. This forced other manufacturers to increase their quality and get the certification.
Aurolab improved upon this product by changing the design to incorporate a 360-degree square edge optic that shows a remarkable reduction in posterior capsule opacification (PCO) rates even on a nine-year follow-up, in comparison to the standard round edge design. Aurolab has now expanded to include multifocal and extended depth-of-focus IOLs at an affordable price.
Glaucoma is a challenging pathology to treat and many patients with uncontrolled intraocular pressure need drainage devices or shunts. For many years, the only option for intractable glaucoma was the imported valve that cost around $350. George Baerveldt, MD, who created his version of a glaucoma drainage tube, was kind and gracious in supporting Aurolab with the view of creating an implant that was both affordable and effective. That was how AADI-Aurolab aqueous drainage implant was born. It sells at just under $75, one-fifth the cost of other devices and has made advanced glaucoma care affordable to most.
The Boston keratoprosthesis (or KPro) is often the last resort of treatment in patients with limbal stem cell deficiency and corneal ulcers not responding to keratoplasty. In a country like India with high prevalence of corneal blindness there is considerable need for the keratoprosthesis. Aurolab was able to collaborate with Boston keratoprosthesis and bring it to the Indian market manufactured in Madurai at a cost of $80, a minor fraction of what it costs in the West. Multiple studies have demonstrated results similar to its western counterpart.
Aurolab has produced more than 20 million IOLs and distributes to 140 countries around the world. But it did not stop at IOLs. Aurolab’s next foray was into pharmaceuticals. We’ll discuss how it has changed eye care in India in our next article.
|About the author: Prabhu Krishna Sriram, MBBS, is a resident in ophthalmology at Aravind Eye Hospital-Pondicherry. He completed his MBBS from the Amrita Institute of Medical Sciences, Kochi. He has a keen interest in community ophthalmology and improving eye care equity. He can be reached at firstname.lastname@example.org.
Disclaimer: The views expressed below are solely those of the author and do not necessarily express the view of the American Academy of Ophthalmology. The Academy does not endorse individual companies or products.