Tilganga Institute made its own lenses to cut cataract surgery cost

By the mid-1980s, ophthalmologist Sanduk Ruit and Australian eye surgeon Fred Hollows had already attacked the surgical side of the problem: their manual small-incision cataract technique, developed from 1986, let a trained surgeon complete an operation in minutes without the expensive imported phacoemulsification machines Western clinics relied on.

Ruit and Hollows instead asked where the surgery's real cost was concentrated, and the answer wasn't the surgeon's time or skill — the technique had already made that fast and low-tech — it was this one imported physical object. In 1995 they commissioned a small lens-manufacturing laboratory inside the Tilganga Institute in Kathmandu, built with Fred Hollows Foundation funding and engineers from New Zealand, Australia and Nepal, to make the same functional lens domestically instead of buying it from abroad.

Built a Kathmandu lab to make the identical lens locally, replacing the imported markup with Nepal's own cost and collapsing the operation's price.

The imported lens price bundled Western margins, shipping, and brand markup, not just manufacturing cost.

The surgical technique had already made labor cheap, so the lens was the dominant remaining cost.

A local lab could produce an equivalent lens with outside engineering help, avoiding the import markup.

Cheaper lenses made surgery affordable at scale, enabling high volume and proving quality with outcomes data.

When a product is unaffordable, check if the cost is one imported component; making that component locally can collapse total cost without changing the process.

The lens's cost fell from over $200 imported to as little as $7 domestically manufactured, and total surgery cost (lens included) came down to under $20 per case in Ruit's own published series — a roughly 90%+ collapse in the single largest cost driver in the operation. Clinical outcomes did not suffer: Ruit's 1999 peer-reviewed series reported zero major surgical complications at the Tilganga centre and best-corrected vision of 20/60 or better in the large majority of patients at two months, matching results reported for far more expensive Western procedures.