Role of laser refractive surgery in cross-subsidization of nonprofit humanitarian eyecare and the burden of uncorrected refractive error in Nepal: Pilot project

J Cataract Refract Surg. 2018 Aug;44(8):1012-1017. doi: 10.1016/j.jcrs.2018.05.023. Epub 2018 Jul 20.


Purpose: To establish a refractive surgery unit at Tilganga Institute of Ophthalmology through support from international donations and provide knowledge transfer for doctors and management to make the unit self-sustaining, nonprofit laser refractive surgery, and financial support for other eyecare projects at Tilganga.

Setting: Tilganga Institute of Ophthalmology, Kathmandu, Nepal.

Design: Retrospective study.

Methods: A foundation was created to establish a refractive surgery unit using a cost-recovery model; that is, patients are charged according to their financial status to cover running costs, patients without funds to pay for surgery, and other eyecare projects for the underprivileged population of Kathmandu, Nepal. Donations were obtained to fund refurbishment within Tilganga Hospital and purchase equipment and technology. A Nepalese surgeon was selected from Tilganga and completed an 8-month fellowship and proctorship of the first series of surgeries. The refractive surgery unit was opened in January 2012, and the cost-recovery model was evaluated up to December 2016.

Results: During the period evaluated, 74.8% of patients were treated at full cost, 17.2% at subsidized cost, and 8.6% free of charge. The refractive surgery unit generated a profit representing 28% of the running cost in this period, which was used to reduce the deficit of the main hospital. Surgical outcomes achieved were comparable to those reported by groups in the developed world.

Conclusion: A self-sustaining nonprofit laser refractive surgery clinic, operating with high quality, was successfully implemented supported by international donations for initial setup costs and a cost-recovery model thereafter.

MeSH terms

  • Adult
  • Aged
  • Cost of Illness
  • Cost-Benefit Analysis
  • Female
  • Health Planning Support / economics
  • Humans
  • Male
  • Middle Aged
  • Myopia / surgery
  • Nepal
  • Organizations, Nonprofit / economics*
  • Pilot Projects
  • Program Evaluation
  • Refractive Surgical Procedures / economics
  • Refractive Surgical Procedures / methods*
  • Relief Work / economics
  • Relief Work / organization & administration*
  • Retrospective Studies