Aravind Eye Care Hospital is an ophthalmological
hospital with several locations in India.
Currently located at
Madurai, Pondicherry, Coimbatore, Theni,
Tirunelveli, Kolkata & Amethi
Founded by Dr G. Venkataswamy in 1976 at Madurai
Awards (in 2008 -2009)
Bill and Melinda Gates Award for Global Health
Acknowledged by Clinton Global Initiative in Sep
Recognized by C.K.Prahalad in his book „The
fortune at the bottom of pyramid‟
“Elimination of needless blindness”
By the end of 2009 AECS had set up 31 Vision
Centres and 5 Community Eye Clinics (Outreach
Aravind Managed Eye Care Services (AMECS)
Dr V had been succeeded by Dr P. Namperumalsamy
(Dr Nam)in 2006
Its manufacturing arm Aurolab had moved to new
facility at Madurai.
Established by Dr V as a 11 bed hospital at Madurai in 1976.
Dr V served Army Medical Corps from 1944 to 1948
Trained himself to do microsurgery and technique of Intraocular
Lens (IOL) insertion.
To serve paying as well as free patients.
Close control of costs, high productivity of doctors and
achieving high volumes
AECS vital components - Values and spirituality
Thulasiraj (Executive & IT Director at LAICO)
“Our operational model is heavily dependent on work
culture values.The systems are built in our basic
Focused on cataract surgery.
Established 2 bed system of operation to increase
productivity of doctors.
Productivity rate of doctor 25 surgeries/day/doctor in contrast to
general avg of 5-6 surgeries/day/doctor.
High quality surgical and medical equipments used.
Manufactured IOLs in house at Aurolab.
Cost of Imported IOL $80 and Aurolab‟s IOL $5.
60% of surgeries were done free or almost free.
AECS grew quickly –
In 1997 - 1,23,095 Surgeries and 9,75,868 Outpatients per year
In 2003 - 2,02,066 Surgeries and 14,50,000 Outpatients per year
AECS created surplus income despite providing free
In 2002-03 it had surplus of Rs 219 Mn out of total
income of Rs 423 Mn
Exhibit 1 : AECS , no of beds in different Hospitals
Source: Data supplied by
AESC did not consider the number of beds to be an
important parameter as most of the cataract patients
were discharged the same day.
Also, no. of mats had been converted to regular cost,
and the average stay of the patient had reduced.
Hence the no. of surgeries done was a more
meaningful indicator of its impact than the no. of beds
Surgery OP visits
Jan 2006 till 1,140,765
Source: Data supplied by Aravind eye care system
AECS conducted a number of outreach
activities in accordance with its mission.
EYE CAMPS were the most important for they
symbolized the organization‟s determination to
reach out to the people in the villages.
COMPREHENSIVE EYE CAMPS was the
most important type of eye camp, where,
complete examination of eye was done,
spectacles were prescribed and delivered on
the spot in about 70% of the cases
Source: Data supplied by Aravind Eye Care System
AECS also organized diabetic retinopathy
(DR) camps, refractive error camps, eye
screening camps for school children, pediatric
camps, and mobile van DR screening camps.
AECS had also setup its training institute,
Arvind Post-Graduate Institute of
Ophthalmology (APGIM) which offered PG
program, fellowship program for super
specialization and Ophthalmic Assistant‟s
Its manufacturing arm, Aurolab, produced IOLs
and medical consumables for eye care, like
sutures and medications at low cost.
AECS achieved economies of scale by
providing medical consumables to other
hospitals and ophthalmologists outside AECS
since its inception.
This was also in consonance with its mission of
elimination of needless blindness.
This helped many hospitals not only in India but
also abroad to conduct surgeries at a much
Some of the pioneering products from Aurolabs
are: Auroflex-EV, negative aspheric IOLs for
better contrast and visibility in low light
conditions, green laser photo coagulators etc.
Aravind Medical Research Foundation expanded its
research activities dramatically with the commissioning of
Dr. G. Venkataswamy Research Institute on 1st October,
It was engaged in cutting edge research in all the areas
connected to eye diseases.
Some researches going here are:
1. Vision Rehabilitation
2. Glucoma Studies
3. Retina Services and Drug Trials
4. Orbit and Oculoplasty
5. Cornea Clinic
AECS „ training arm, Lions Aravind Institute of Community
Ophthalmology (LAICO) offered training programs to
outside hospitals to improve their practices.
LAICO provided programs both in techniques of surgery
and in management of doctors, hospital managers and
LAICO provides training programs both at its facilities at
Madhurai, at customer sites and also in a number of foreign
It also undertook consultancy for improving the
performance of hospitals, with need assessment, vision
building workshops, follow-up visits and monitoring.
Cataract accounted for 62.6% of blindness.
Increased awareness resulted in early
Cataract Surgery Rate(CSR) ( average per
million of population)
India : 5000
Tamil Nadu : 9000
Bihar : 600
Increase in % of Intraocular Lens(IOL)
High degree of operational efficiency enabled AECS to
provide free surgeries to as much as 60% of its patients.
Source : Aarvind Eye Care System(2009),activity report,2008-2009
Category of surgery
Retina & Vitreous surgery
Trab & combined procedures
Other orbit & Oculoplasty surgeries
LASIK refractive surgery
General improvement in the living conditions.
Expectation of patients going up.
Multiple insurance schemes
Diabetic Retinotherapy (DR) – that included control
of diabetes,refraction correction and prevention
and treatment of glaucoma.
Unlike cataract,DR was preventable
Focus on prevention and early attention then cure,
effective screening for diabetes and monitoring of
Glaucoma if left untreated also lead to blindness.
Refraction correction too had become an important
area of concern.
Doctor‟s salaries were becoming highly
They were looking for opportunities to
establish there name and in particular, looking
for opportunities to do research , publish
papers , to take part in conference and
network among peers .
These would increase doctors competences
and also the hospital‟s visibility .
New hospitals with better looking building and better room and
food facilities were coming up.
New hospital enticed the doctor‟s with better pay but none of
them offered comparative scope for professional advancement.
Most of the doctor‟s in these private chains were ex-AECS
Out of 45 million blind population in the world , 7 million were in
12 million bilaterally blind persons in india with VA less than 6/60
11,000 eye surgeons in India
1 for about 100,000 people
50% qualified eye surgeons are “non operating “ surgeons
Many of the operating surgeons could not perform IOL surgeries .
These factor impacted the overall effectiveness of anti-cataract
Paediatric blindness was also an area to be addressed . About
0.8 per 1000 children were estimated to have serious vision
Absolute number still increased but as a percentage it
Laser surgeries = 20% of AESCS‟s surgeries
Performed in smaller units too- like in Theni & Tirunelveli.
Other areas gained importance
Four types of eye camps:
Traditional comprehensive eye camps
Diabetic retinopathy(DR) screening camps
(Mobile van screening camps)
School Eye Screening Camps
Camps provided a benefit of increased reach and number of patients
Still only 8% of the people requiring screens were being screened
3. ESTABLISHMENT OF A NETWORK OF
VISION CENTRES (VC) AND
COMMUNITY EYE CLINICS(CEC)
VC: small unit staffed with an opthalmic technician and had
telemedicine support from the base hospital and an admin support
person with doctor available on video.
31 VCs (plan to increase to about 50) with each serving a population
of about 50,000 operating from rented buildings. Patients were
CECs: larger than VCs but smaller than hospitals with 1doctor visit
per day and one of each- optician, field organizer, optical shop
person, nurse. Had diagnostics facility, prescribe and delivery
spectacles. 5 CECs with around 60-70 patients/day & served a
population of about 3,00,000
5. OTHER OUTREACH ACTIVITIES
School camps- 210,139 students (base) & 67,237 students (VCs)
Mobile screening vans.
Paediatric screening camps
6. Arvind Managed Eye Care Services
• Trained Doctors in other hospitals to improve their efficiency
• AECS neither provided any facilities nor made any investment
• Selected personnel were sent to supervise the activities
• 5 yr agreement.
7. UPGRADING OF FACILITIES
Private rooms- new block @ AEH, Madurai
Floor mats for free patients
AECS‟ Centre for Patient Empowerment intended to improve
eye care awareness in patients and the community
8. Emphasis On Research
• Focus on research on- DR, transplantation of cells etc.
• Means of providing development opportunities to doctorsoptional 1 day/week off- international conferences etc.- a
• Research- a source of funds: about Rs 15million (2008-09).
• Brand new research facility -in 2008- Dr.G. Venkataswamy
Eye Research Institute, Rs 290 mn.
• 25 research scholars in 2009.
No. of Publications
Source: Data as supplied by AECS
Source: Data as supplied by AECS
“Our emphasis is to be at par with the best eye hospitals in the world
without diluting our vision....We see our activities in four broad areaspaediatric eye care, cataract, retinopathy, glaucoma, and refraction”
- Dr. Nam
They have plenty resources and therefore various options are available.
“We are a highly mission driven set of people. Resources are not the
only consideration in deciding the direction of growth”
- Dr. Kim
• There were a number of directions that AECS could take;
the real problem was one of prioritization.
directions ,as suggested by the key personnel at Aravind
eye care, are as follows:
a) According to Dr. Nam:
Diabetes is a challenge. To reach 46 million diabetics in India ,
innovative methods are needed. E.g. Paramedic
Cataract prevention, refraction correction, glaucoma, etc. Will
Thus, Dr. Nam said, “We need to move in multiple directions.”
b) According to Mr. Thulasiraj:
“ We have a tremendous opportunity in the treatment of refractive
errors.” “We can set up a network of Refraction Centers.”
He also saw big opportunity in training. He saw opportunities in
There will also be a Projects Division to manage research projects.
c) According to Dr. Aravind:
“Resources are not a problem. The challenge today is our aspiration,
not our resources. How do we retain the same hunger and the same
Dr. Thulasiraj also shared similar concern- “ We have to address
mindset issues. We are diffident about moving out of our comfort
There were different views on whether and how to grow
beyond Tamil Nadu. They are as follows:
Concerns about culture:
Dr. Nam felt that expansion to other Indian states is an issue.
He said “ Culture is an important issue for us.” Speaking
about his concerns, he further said “We still have our doubts
and Mr. Thulasiraj shared similar concern about
culture transferability. Dr. Kim said “Business models should
not obscure our hospital‟s growth model.”.
2. AECS executives saw opportunities to expand globally in
According to Dr. Nam: “DR (Diabetes Retinopathy) can be
studied adopting a global approach.”
Dr. Kim – “ We are moving into research , especially in
specialities. We have to give new services that are currently
not available but necessary for eye care to stay ahead of
Mr. Thulasiraj said “ We have a global opportunity. There are
135 countries in the world with a population of less than 20
million each.” “We can thus give our knowledge and offer our
services in many of these countries.”
A major challenge was to develop a large cadre of
doctors, nurses and paramedics, especially because they
had to be imbibed with the right values. The various
Dr. Nam said “We need to train more ophthalmologists
in DR surgical procedures. Knowledge management is
important. We are doing this through our Virtual
Dr. Kim said that MLOP (Middle Level Ophthalmic
Personnel) training is becoming an important activity.
2. Developing next generation:
Dr. Aravind said, “the older generation is
now in the sixties. And except for a few,
the younger generation is in forties. There
could be a situation when the younger
generation would have to take over
responsibilities before they are fully
AECS is preparing itself for the same. For
example, LAICO is developing a cadre of
managers for AECS.
• Change of metrics from no. of beds to
no. of surgeries.
• Standardization is helpful in achieving
• Prepared for problems and Ready for
the risk management.
• For the long run, the organization have
to take necessary steps to succeed.
RESEARCH AND DEVELOPMENT
READY TO TAP OPPORTUNITIES
LEARNING- TIME TO TIME
GIVE BACK TO SOCIETY
LASIK AND OTHER EYE SURGERIES