I'm pretty skeptical of the $50 number. GiveWell thinks it's closer to $1000 (still insanely cheap, but there might be even better opportunities!)

https://www.givewell.org/international/technical/programs/ca...

I remember watching some North Korea documentary where an eye surgeon was visiting to do cataract replacements. He set up in some community center and had dozen of people waiting for surgery. It can take about 10 minutes to perform the replacement and you can leave pretty quickly afterwards. It's an amazingly simple surgery that has a massive increase in quality of life for the patient. The only aftercare is an eye patch and drops to increase tear production to help heal the incision. Once a doctor has all the equipment set up, they could easily do a hundred replacements over a few days. Add to the fact that these doctors and nurses are doing work in third world countries where they may be there as volunteers and the price of the surgery is massively reduced.

>We estimate the proportion of cataract surgery patients who have bilateral blindness or severe visual impairment at 10-47% (more). We estimate success in converting blindness or severe visual impairment to moderate visual impairment of 80%-95% (more). We estimate the cost of surgery at $50-$100 (more). Hence, we estimate the cost per blindness or severe visual impairment reversed at $112-$1,250.124

Givewell agrees with the $50 figure.

You misread the report; it estimates the cost of surgery at $50 to $100, and estimates the "cost per blindness or severe visual impairment reversed" at $112 to $1,250 (with low confidence). That second number is calculated along these lines:

"[W]e suppose that a program costs $5 per person screened, that 20% of those screened receive cataract surgery at a cost of $15 for transportation and $25 for the direct cost of surgery, that 10% of those who receive surgery are blind or severely visually impaired, and that surgery is 100% effective. This program spends $650 per blindness or severe visual impairment reversed. We are highly uncertain about how close these estimated values are to the true costs and uptake of programs."

$30 dollars for an adult cataract surgery:

https://lrbt.org.pk/how-you-can-help/sponsor-a-surgery/

Most cataract surgeries in private hospitals cost around $200 in India including the lens cost. If its done in camps where multiple patients get it done the cost might primarily be lens related.

I'm curious why such a seemingly high value opportunity hasn't attracted massive funding from philanthropy - at that cost a single billionare feeling generous could theoretically eradicate this form of blindness. But more realistically, foundations like Gates or Zuckerberg/Chan with excellent oversight and due diligence could surely jump on something like this and make a huge dent.

Is there something I (we) are missing here?

> E.g. effective altruists credit the B&MGF with basically removing all possible "room for more funding" wrt. vaccinations in low-income countries

This is wrong. idk anyone who believes this

This is my favorite charity. I've been donating to them for at least 5 years now and I even ask extended family to donate to them for Christmas instead of buying me gifts that I don't want/need. They send a lot of annoying snail-mail though, I should call and see if I can at least opt-out of that.

I've long been surprised at how pervasive bad eyesight is, and often at a very young age. It seems like an adaptive trait. Why is it so common to have poor eyesight? What other aspects of human development suffer so much that seem so important for survival?

Insulin resistance is another. It keeps your brain alive when you’re starving, but it destroys millions of pancreases in societies with an over-abundance of food.

Or the overabundance of carbohydrates in the diets....

It may not be related to nature. I remember reading research on how sunlight and focusing on distant objects is really important for developing proper eyesight. The current issues with eyesight could be a side-effect of spending more time in doors and only staring at things within 20 to 30 ft.

https://www.canr.msu.edu/news/the_benefit_of_daylight_for_ou...

30 foot line of sight indoors, more like 1-5 feet for most people working at computers

We're able to kill ourselves by blocking our ability to breathe when eating.

In Australia/New Zealand we have a similar charity started by an Ophthalmologist that began by performing the surgeries himself:

https://www.hollows.org/au/about-fred

I have always been a fan of Watsi (a YC'13 alum) for this as well. Radically transparent and 100% of your donation goes to stated healthcare needs.

Early on they started with a simple GoFundMe-like approach and have since shifted focus to the monthly model that gives them more leeway to prioritize healthcare needs, but overall exceptionally well run:

https://watsi.org/fund-treatments

There are other great charities in this sector -

UK based Sight Savers * -https://www.sightsavers.org/

And in Australia the Fred Hollows Foundation -https://www.hollows.org/au/home

(I am not affiliated to sight savers but am vaguely related to the founders)

As someone relying on glasses my whole life I can relate to charities like this.

There is another interesting one https://www.onedollarglasses.org/ I like their approach of teaching people how to measure eye sights and build glasses. So it becomes a local self sustainable business.

In Pakistan we have LRBT, if you are looking for an eyecare NGO to support.

https://en.wikipedia.org/wiki/Layton_Rahmatullah_Benevolent_...

https://lrbt.org.pk/how-you-can-help/sponsor-a-surgery/

It's crazy how bad eye care can be in lesser-developed nations. My wife was born in one of those countries and had been told her entire life that nothing could be done about her eyesight. I took her to an optometrist, and they fixed her up in less than an hour, for $150. My wife still has the receipt. It helps me get out of trouble sometimes.

Basically "third world issues" (corruption and co).

Both my parents, of old age, have cataracts. My mother can't see a thing with his right eye; my father is almost in the same condition. Without social security the operation would cost millions (COP$) that I can't afford.

Whereas with social security it would be almost for free. But they've hold my mother from the operation _since before the pandemic_ for all sorts of excuses - no turns, the pandemic itself, and now it's that they will put an internal lens in her eye but it hasn't arrived from where they get from (USA?). Literally last year went calling and going to the hospital asking if they would be operating her soon, but the answer is always the same. It's so tiring for me, imagine for them.

There need to be more startups tackling hard medical technology. Most of the high end eye equipment like https://en.m.wikipedia.org/wiki/Optical_coherence_tomography are only supplied by German companies at prices beyond what your typical third world healthcare institution can afford to buy at scale.

If you checked out all others maybe you want to check this one too. Its in Nepal and pioneers of various tech in cataract surgery -- https://tilganga.org/ Their number of treatment is pretty impressive (73,49,257 is their current count of people treated.)

Givewell has an excellent cost benefit analysis of this and similar cataract programs.

https://www.givewell.org/international/technical/programs/ca...

Part of these funds go to Aravind Eye Hospital in India:

> I pay $1 to have an eye test. I can come two more times in the next three months and I will not be charged. I first do a glaucoma test, and then I am tested for vision, and then examined for a detailed uveitis test an eye disease which I suffered in my youth ... The hospital is spanking clean. Everyday it sees 1200 patients and the doctors perform over 200 operations. But then this is only the beginning of an amazing story. It is part of a network of eye hospitals that has seen 32 million patients in 36 years, and performed more than 4 million eye surgeries most of them ultra-subsidized or free.

> Here, the patient has the choice to decide whether to pay or not. In a country where a huge majority of people live on less than $2 a day he ripped of the price tag for access to world class quality eye care ... Today the Aravind Eye Care System is the largest provider of eye surgeries in the world. They see more than three million patients and perform over 300,000 surgeries a year. That is almost 7 percent of the global total. And their record of proficiency is better than that of the UK health care system.

Source: An Infinite Vision: The Story of Aravind Eye Hospital - https://www.huffpost.com/entry/an-infinite-vision-the-st_b_1...

> Using a highly efficient surgical model and variable pricing, this hospital chain has reduced cataract blindness in Tamil Nadu, India, by more than 50 percent and serves all patients regardless of ability to pay.

> Forty years ago, blindness caused primarily by cataracts was widespread in India, rendering almost 13 million people unable to see, even though the condition was relatively easy to correct surgically ... From its modest start with 11 beds, Aravind has grown to perform more than 250,000 cataract surgeries a year. And the rate of cataract blindness in Tamil Nadu has been cut roughly in half.

> Aravind's business model worked because it developed a radically efficient surgical model, with each surgeon performing an average of 2,000 surgeries per year, compared to 300 annually elsewhere in India. Plus it still maintained the dignity of patients while continuing to deliver world-class surgical quality. For example, Aravind's rate of complications is half that of the United Kingdom's National Health Service ... In 1992, it built a manufacturing facility to make its own intraocular lenses, a key element of modern cataract surgery—driving down the cost per lens from about $70 to $2.

Source: https://www.bridgespan.org/aravind-eye-hospital

Aravind Eye Care System is a fantastic and inspiring model.

Here's there latest Activity Report for 2020-21: https://aravind.org/wp-content/uploads/2021/09/Activity-Repo...

327,786 surgeries in 2020-21 breaking down as:

108,619 subsidized (walkins to free hospital)

14,934 free (through screening camps)

204,233 paid

37.7% of their surgeries at 0 or very low costs.

It is an amazing model.