Thursday, December 29, 2005

The State of Eyecare in the Soviet Union

This column was published in Vision Monday in August 1990.

Irving J. Arons
Arthur D. Little

I have just returned from a two week tour of four cities within the Soviet Union. I had anticipated telling you about the state of eyecare within the USSR, but unfortunately, our visit to the premier Moscow Research Institute of Eye Microsurgery was canceled at the last minute, as we were informed by Dr. Fyodorov that the "Institute will be closed in July for preventative maintenance," and that "your visit at the term (sic) you have stated is inexpedient." We had originally been invited following my February letter requesting to have our delegation visit the clinic. In fact, in late June we were told that we were welcome to visit the clinic, which was scheduled to shut down in August for holiday.

Apparently, the hotel we stayed at in Moscow, the Kosmos, is part of the Intourist program to provide visitors with eye care at Fyodorov's Moscow clinic. We found a brochure advertising "Beautiful Eyes for Everybody," and describing how the Moscow Research Institute of Eye Microsurgery "treats 22,000 people annually, restoring or improving vision and removing the need to wear eyeglasses for many." In addition to RK, the clinic claims to do laser treatment of secondary cataract, laser treatment of glaucoma, and laser treatment of "complicated myopia of high degree." (It must be one of the only facilities with surgical lasers in the USSR, as we visited a laser research institute and three hospitals and saw very few surgical lasers -- mostly therapeutic HeNe and GaAs biostimulation type devices.)

The brochure goes on to state that your pre-operative stay is arranged at the Kosmos, and following the outpatient surgery, your post-operative treatment is done at the hotel by a team of qualified doctors and nurses. Foreign patients are offered a program of excursions, including theater tickets (the ballet only costs 4 rubles -- the equivalent of 30 cents at the black market exchange rate) and other services offered by Intourist. Fyodorov hopes to treat 20,000 foreigners a year by 1992.

A recent profile of Fyodorov in Fortune (May 1989) talked about the Fyodorov entrepreneurship, with his clinic being a $75 million a year business, and growing at 30% a year annually. The clinics have over 5000 employers located at nine treatment centers across the Soviet Union, and include two factories producing eyeglasses and surgical instruments. (In addition, Dr. Fyodorov recently spent some $12 million outfitting an 11,000 ton "floating eye hospital" called the Floks, which travels from port to port in the Persian Gulf offering RK and other eye surgeries.)

Having missed out on the opportunity to visit with Dr. Fyodorov, I would like to offer some personal observations about eye care in the Soviet Union. As previously mentioned, our People-to-People delegation of medical laser specialists visited Moscow (Soviet Russia), Tblisi (Soviet Georgia), Kharkov (Soviet Ukraine), and Leningrad (back in Russia). We saw very few optical shops (none that were open) and only a small number of Soviet citizens wearing eyeglasses! One ophthalmologist at a central hospital in Kharkov told me that 50% of the people need corrective lenses -- similar to the percentages in the rest of the world -- but we saw very few people wearing lenses. If 5% of the people in the streets had glasses, that's a lot. This says that Western technology and entrepreneurship could provide a needed service in the Soviet Union if a way could be found to open (and stock) optical retail shops in the major cities. However, you must remember that the average citizen only earns about 200 rubles per month (the equivalent of about $350/month at the "official" business exchange rate or about $10-15/month at the black market exchange rate of 10-15 rubles to the dollar). Therefore, the price of eyewear would have to be low for the average person to be able to afford it -- unless the health care system can be convinced to reimburse or pay for the glasses. (The government health care system pays Fyodorov's clinic the equivalent of $300 for each RK procedure carried out.)

If a Moscow McDonalds can generate hours long lines for a $5 "Big Mac", why not $20-40 eyeglasses at a Moscow Lenscrafters or a Leningrad Pearle Vision Center?


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