Everyone in eye care is probably aware of the study published in the journal Nature in June of 2015 showing that a naturally-occurring steroid, lanosterol, could clear cloudy cataract proteins. A lanosterol-containing solution worked in human lens cells (in the lab), in rabbits, and in dogs. The big question, of course, is whether it will also clear human cataracts in actual patients. That is a question that lens cells, rabbits, and dogs can’t answer. Human trials are needed.

In March of 2016, Acucela (an eye-care biotechnology company based in Washington state) announced an agreement with the researchers who did the lanosterol work to commercialize it. No clinical trials have begun yet, as far as we know. Even assuming that successful trials take place, it will be years before the lanosterol treatment is approved for human use.

Another candidate for anti-gluacoma eyedrops, N-acetylcarnosine, is being investigated in Russia. This potential therapy is also years away from clinical use.

But let’s do a little thought experiment. What if it turns out that eye drops really can restore good vision for most cataract sufferers? What is the impact on the business of eye care? Here are a few back-of-the-envelope calculations.

There are almost 4 million cataract surgeries every year in the US (and over 20 million world-wide). In the US, the typical cost is $3,500 per eye, for a total of close to $14 billion in industry revenue. It is probable that eye drops would be much less expensive than surgery, so much of that $14 billion would disappear.

Who would be affected if most of those surgeries went away? The first impact would obviously be on cataract surgeons. Looking at just the Medicare patient base (for which data can be downloaded from the Centers for Medicare and Medicaid Services), there are over 5,600 ophthalmologists that each bill Medicare for more than 100 cataract surgeries yearly.

But the impact would go far beyond those surgeons themselves. Many of their staff are involved in supporting the surgical procedures, and many clinics derive a substantial part of their revenue from cataract surgery. Far less staffing would presumably be needed if eye drops replaced surgery. The impact on employment in the eye-care field would be substantial.

Beyond that, there would be a dramatic drop in the need for medical consumables, notably replacement intraocular lenses. Intraocular lenses account for something like $3 billion/year in sales.

And the market for equipment to diagnose cataracts and operate on them would also be hit hard. We’re particularly conscious of the effect on medical equipment here at DGH: our ultrasonic A-scans and associated software are widely used to measure the eye and calculate the correct lens power for replacement lenses. You can be sure we’ll be closely watching the clinical trials of eye drops, and we’ll keep you posted on their progress.


This post was written by George Alexander [email: george at dghtechnology.com]