Life Through a Lens

It’s estimated that humans receive 90% of their sensory information visually. If you’ve ever wondered what your life would be like without this information, imagine never seeing the faces of your loved ones, never seeing the sun set or rise, never seeing what you eat or what you’re wearing, never seeing a movie, a work of art, your favourite beach or mountain or the view from an aeroplane window. If deprivation of these privileges isn’t bad enough, think of the sheer, disabling inconvenience, impracticality and frustration of trying to make your way in a world designed by and for sighted people.

For the blind living in the developed world, this is the hard, no-frills reality of everyday life – a life that no seeing person can easily comprehend. But for blind people in developing countries, the reality presents a more fundamental and immediate challenge: survival. In fact, aid agencies dedicated to helping the blind in such countries estimate that in some regions survival expectancy of a newly blind person is just three years. Blindness in these hostile environments is, effectively, nothing short of a death sentence.

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According to the World Health Organization, on average, every 10 seconds someone somewhere in the world goes blind. That’s two to three newly blind people in the time it has taken you to read this paragraph.

In Nepal there are already 400,000 people living in darkness. In India there are some 9 million. Africa: another 7 million. In fact, conservative estimates suggest that approximately 40 million people around the world are needlessly blind, and of these, 17 million could be cured with a simple 20-minute operation. That’s more than the population of London and Los Angeles combined.

Just in case you’re having trouble comprehending the humanitarian cost of this blindness, consider the economic cost. The U.S.-based One World Sight Project estimates that in the U.S. alone, blindness costs some $16 billion a year. And the U.S. has one of the lowest per-capita rates of blindness of all nations.

So what are the causes of preventable blindness?

CATARACT: Opacity, cloudiness and, ultimately, loss of sight caused by water droplets forming in the eye’s lens. In developed countries, cataracts are normally associated with old age. In developing countries, especially where environmental conditions are harsh, they mostly affect people over 40 years of age.

TRACHOMA: Corneal clouding caused by a severe and particularly nasty, contagious conjunctival viral infection.

GLAUCOMA: An easily preventable progressive condition that results in irreversible damage to the optic nerve and the retina.

XEROPHTHALMIA: Blindness caused by a lack of vitamin A in a person’s diet. It affects mostly children, and is preventable with nothing more technologically advanced than vitamin supplements.

ONCHOCERCIASIS: Severe ocular inflammation caused by infestation by a parasitic worm. In Africa and Latin America, 20 million people are infected with the parasite, some 350,000 of whom are blind.

LEPROSY: Communicable disease most people in the developed world have only heard about in the Bible. Can cause severe corneal and intraocular inflammation, with sadly predictable results.

The list of causes of preventable blindness makes for miserable reading. But for one small, privately owned Australian organisation, the list reads as a call to action.

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Scan Optics

Adelaide-based Scan Optics was founded in 1987 to manufacture portable microscopes for use in ophthalmic surgery in the world’s poorest and most remote regions.

The inspiration behind the company is Rod Watkins, optical scientist, graduate of Imperial College London, businessman and an individual with a mission: to help reduce preventable suffering throughout the world. But let’s not rush to canonize. What Rod Watkins also saw when he started the company was a niche, a business opportunity in an already huge and growing market. It’s a combination of his compassionate pragmatism and business acumen that forms the foundation of this successful and profitable company.

“Most forms of blindness can be treated and cured,” says Watkins. “The issue with developing countries is that 80% of the population lives in rural locations without easy access to doctors, medical facilities, power supplies, etc.”

It figures that if such a high percentage of the population of these countries lives in rural areas, it’s also where most of those needing medical help are likely to live. To reach them means having robust, portable medical equipment.

“Scan Optics builds ophthalmic microscopes that are designed to be easily portable, are protected against corrosion and mold, can be operated from a range of main or battery power supplies, are robust and are reliable in extreme environmental conditions,” says Watkins.

“We make four models of microscope, from a very simple device through to a foot-operated system that is designed to leave the surgeon’s hands completely free during an operation. Using the same expertise and applying the same principals, we also make microscopes for ear, nose and throat surgery, as well as the optical inspection instruments used during eye examinations.”

It took Scan Optics two and a half years to make the first prototype portable microscope and get it into production, a period funded in part by investors and in part by government grants.

The time and financial investment paid off. The company is now a major supplier throughout the world to prevention-of-blindness programmes such as Christoffel Blindenmission, the Fred Hollows Foundation, Sight Savers International, Surgical Eye Expeditions, the Lions SightFirst Project and the International Eye Foundation.

The Australian government is evidently pleased with the faith it placed in the fledgling organisation, recently presenting Scan Optics with a certificate of achievement for technical innovation.

“Since we built and sold our first finished product in 1990 we’ve shipped equipment to 104 countries,” states Watkins with typical, quiet modesty. “In fact,” he continues, “more cataract surgery, in particular, is carried out using our equipment than any other make, anywhere in the world. That’s very gratifying.”

The challenge for the world’s aid agencies fighting blindness is the sheer volume of those needing treatment. Because Scan Optics’ products are portable, medical teams are able to move quickly from region to region, offering much needed help to the vast numbers of those affected.

“The most common cause of preventable blindness is cataracts,” says Watkins. “Overall, more than half of the world’s curable blind suffer with them, but in some developing countries, the condition accounts for 90% of those needing help.”

In 1997 alone, more than 600,000 cataract operations were carried out using Scan Optics ophthalmic microscopes. From a total of some 10 million operations performed worldwide that same year, it’s clear that Scan Optics is making equipment that makes a difference.

Manufacturing Vision

Ever since the company was set up, the research and development process has driven it to produce better products. This philosophy is still strong, explains Brian Staples, Scan Optics’ general manager:

“R&D has always accounted for a large percentage of the company’s resources, and continues to be today. We currently have 21 employees and, at any one time, at least four or five of them are working on developing new products.”

Staples is from a technical background in consumer ophthalmology: spectacle manufacturing. He’s largely responsible for Scan Optics’ investment in the latest manufacturing technology.

“This year was a watershed for Scan Optics,” says Staples. “We’ve made a pretty big investment in manufacturing and design technology. To reduce product development times, we wanted to move to using CAD/CAM and CNC. The objective was to dramatically change and improve the way we have been developing our products. We’ve pretty much achieved what we set out to do.”

“Our new-product development has certainly changed,” interjects Watkins. “Ten years ago, in fact even five years ago, we had a normal prototype procedure where we built and tested a model, then we built an improved version, and so on. It was very time and resource intensive. Now, we have a small team of mechanical and industrial designers using Mechanical Desktop to draw components and design finished products.

“In fact,” he adds, “we have a mixture of people in our R&D department: industrial designer, computer programmer, mechanical engineer and an electronics engineer.” Such is the nature of the Scan Optics product.

“The latest and most complex Scan Optics development is a microscope we designed entirely in the virtual space,” says Staples. “The very first example we made was a fully functioning product that we took to a show in China to demonstrate.”

Using the same new technology, Scan Optics is also currently developing a Fundus imaging system that digitally photographs the back of the eye. Yet another new product has also been developed “virtually” over a period of almost 3 years – the first metal being cut just recently.

“To improve the development process, streamlining the design of the product was the first step,” says Staples. “Once this was taken care of, we needed to make the parts in the kind of batch numbers we wanted. We decided that we needed to make the investment in CNC.

“We’d been using manual milling machines and lathes for some time, outsourcing some of the more complex work to subcontractors. Part of the problem with outsourcing machining is that the batch sizes often had to be bigger than what we wanted. Consequently, if we made any updates or improvements to our microscopes, we’d have to exhaust current stocks before redesigning and remachining the part.”

“We’d also had one small CNC lathe for about a year – a very simple one that we were using continuously. So, we already had some in-house expertise of CNC, although not much of CAD/CAM,” adds Watkins.

“We were looking at a variety of suitable CNC lathes and vertical machining centres when we decided to take a look at what the local Haas distributor could offer,” continues Staples. “Not just the machines, but also the support, the training, the response, etc. I’ll be honest. We were very impressed with the package that they put together. Also, Brian Harding, the local Haas sales and applications engineer, was able to offer very valuable advice and support for the machines, as well as the entire design-to-manufacture process.

“As an example, Patrick Walsh, our CNC specialist, had some useful knowledge and adapted very quickly to the machines. However, there’s always a learning period, and if he ever needs help with running the machines, or if he has a manufacturing problem, he can call Brian on his mobile phone and, nine times out of 10, Brian can resolve the problem over the phone.”

Once Scan Optics has designed its parts in Mechanical Desktop, it sends them to its Surfcam installation, where it generates the NC code for the Haas machine.

“Some of the parts we make are quite complex, so the programs are drip-fed to the machine,” says Staples. “Generally, we’re machining non-ferrous materials such as brass, stainless, aluminium and plastic, so our microscopes remain corrosion resistant.

“Our run sizes are small, typically 100 to 200 parts,” he adds. “So the setup time for the machines is important in the costings. We store some 300 to 400 programs for different parts on the Haas controls. When it comes to changing parts, we just swap fixtures or chuck jaws and open the correct program. The simplicity and speed of changing from one part to the next has made such a difference that the setup times are no longer such a significant factor.”

Watkins adds: “The Haas SL-20 lathe went in in March 2001. The VF-0E was installed in May. Each machine took just three days from installation to training to cutting metal. We were very impressed.”

“The machines have performed very well and the support has been excellent,” says Staples. “We make approximately 25 to 30 microscopes a month, so we’re currently only running one shift, but we will need more capacity if we are to meet our very conservative demand estimates. And, we never have any downtime, which is great.”

Worldwide Support

With such a huge and growing number of blind people needing urgent assistance – in the words of One World Sight, the world is slowly going blind – it would seem that Scan Optics needs all the help it can get.

The company’s almost surgically clean and tidy facility is based on land owned by the University of Adelaide. This gives it very good access to the university’s various faculties, including the teaching hospital. Doctors are frequently invited to the Scan Optics office to help with product development, and university undergraduates occasionally join as interns.

The company also works with a local outpost of British Aerospace – a protagonist in Adelaide’s thriving defence industry – to help develop the optical systems used in its products.

But the main problem for Scan Optics is not one of finding the local talent to develop the products, it’s supporting a growing user base in such out-of-reach and remote countries.

“In the last fiscal year we shipped equipment to 54 countries,” says Watkins. “The main market was China. But all of Asia, Africa and India have huge populations with many people awaiting surgery. Virtually none of our business came from Australia.

“To be able to support these countries, and the Scan Optics products already in the field, we have to travel a lot. We currently have an office in Shanghai, and we’re slowly developing a support network. Thankfully, Scan Optics microscopes are built to last in tough environments, so we don’t often hear of equipment failures. We frequently solve problems with technical support provided by e-mail, shipping new parts whenever necessary.”

“There’s an enormous variation in the conditions where our products are used,” says Staples. “In developed nations, the surgical operating rooms are sterile and have good air-conditioning systems. In other countries, surgical operating rooms may not even have glass in the windows. Some microscopes travel around, some of them stay in one place all of their serviceable lives.

“We have several large microscopes with aid agencies based in the U.S., and these units travel around the world some four to six times a year. They’re constantly on the move.

“On the other hand, one of our latest products, weighing 120 kg, is designed to be installed permanently in an operating room. So you can see, the level of support a user requires varies considerably. We have to be flexible.”

Where Prevention Fails . . .

For admirers of socially aware business organisations, Scan Optics is certainly an interesting study – not just a good example of 21st-century social entrepreneurism, but a company growing and thriving on the cusp of the profit/not-for-profit motive. That’s not to say that the Scan Optics profit motive is in any way compromised. It isn’t. It co-exists with the management’s genuine empathy with the not-for-profit aid agencies that its products serve, and for the ills that they are helping to eradicate. It wears two hats.

In the company’s meeting room, where this interview with Rod Watkins and Brian Staples took place, the bookshelves house manuals on optical physics and medical ophthalmology, as well as some of the classics of business best practice and management theory. But the motivation and success of companies such as Scan Optics can’t be found and copied from the pages of academic tomes. It comes from passion and intellect and, just as importantly, from taking entrepreneurial risk to help overcome some of the world’s most daunting and pressing problems. Scan Optics shows that free enterprise can make a difference and still make a profit.

“There are an additional two million people who become blind every year,” says Watkins. “Ideally, prevention is better than cure, so the more we can understand about the causes of blindness, the more we do to help prevent it. In the meantime, we will continue to ship Scan Optics’ products around the world.”