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Globally, cataracts have robbed tens of millions of some, if not all, of their eyesight. George Coles, a medical-device researcher at the Johns Hopkins Applied Physics Laboratory (APL) in Laurel, Maryland, is part of a team that has developed a handheld device that allows surgeons to quickly and inexpensively perform sight-saving cataract surgery, opening the door for millions of low-income patients who until now could not afford the procedure or the aftercare.

The team was recently awarded a $250,000 Impact Grant from the Johns Hopkins Alliance for a Healthier World to hone their design, conduct a clinical study with surgeons and partner with a distributor to enable broad distribution of their device. Impact Grants are awarded to enable teams of faculty, staff and students from Johns Hopkins schools or divisions to produce findings and innovations that help communities in low- and middle-income countries.

Cataract surgery is a 15-minute procedure that almost immediately restores an individual’s vision and has been shown to improve a patient’s physical and mental health, income and assets, productivity and quality of life. Nonetheless, cataracts remain the leading cause of blindness, disproportionately affecting older adults in poor, rural areas.

Phacoemulsification — the more expensive surgical option — involves breaking up the cataract and then aspirating the pieces through a small incision of about 3 millimeters. But this procedure is not suitable for the advanced cataracts found in many low- and middle-income areas, Coles explained.

“Patients in poor areas and those with mature cataracts are relegated to manual small incision cataract surgery [MSICS], which involves removing the whole, intact cataract through a large incision,” he said. “Because of the large incision, MSICS results in significant surgically induced astigmatism and increased recovery time before the patient’s vision improves.”

The degree of astigmatism — blurry vision — induced in MSICS requires expensive cylindrical eyeglasses that poor and older patients are not likely to wear. Moreover, MSICS requires 30 days of recovery (compared to the three-day recovery period for phacoemulsification). This extended period increases the financial burden of treatment for patients, discouraging them from seeking treatment or surgery when it can still make a difference.

Coles, along with physicians and engineers at the Johns Hopkins Wilmer Eye Institute and Center for Bioengineering Innovation and Design, partnered with the world’s largest eye care system, Aravind Eye Hospital in Tamil Nadu, India, to create a device that allows surgeons to perform MSICS through a small, phacoemulsification-sized incision while maintaining the time- and cost-efficiency.

“By shrinking the incision required to perform MSICS, our device has the potential to eliminate the need for expensive glasses and for an extended recovery period, enabling equity in outcomes for the most marginalized patients,” Coles said.

The Impact Grant will allow the team to test the device with surgeons at Aravind and then partner with Aurolab, which manufactures a wide range of ophthalmic products.

Benjamin Link, executive manager of Alliance for a Healthier World, said the project is an excellent example of letting the data guide the work. “This team identified a huge health equity problem, then brought together their different areas of expertise to create an elegant solution,” Link said. “We are thrilled to support such an important and potentially life-changing project.”