Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. In India, cataracts are the most common cause of preventable blindness, and one company in particular — Appasamy Associates Group — makes the equipment that the country’s ophthalmologists rely on to treat the afflicted.
For the past few decades, the Indian government’s National Programme for the Control of Blindness has been working to reach those afflicted with cataracts, all over the country. Mr RV Ravichandran, general operations manager at Appasamy, says: “Thanks to the government programme, once someone with cataracts is in the system — even someone in a very remote location — they may only have to wait a week or two for an operation to restore their sight. In the UK, by comparison, I gather that it can take several weeks.
“Cataracts are common in India for many reasons, although ultra-violet radiation is a major cause. Many Indian people spend a lot of their lives outside in very bright sunshine, so by the time they are elderly, many of them need surgery. Poor diet is also a factor, and this affects all age groups. Iodine deficiency is common, particularly in inland areas, where fish — a principal source of iodine — is scarce. As a result, even the very young can develop the milky, opaque clouds that reduce their view of the world to nothing.”
Appasamy makes 80% of the replacement intra-ocular lenses used in India to treat cataracts. These lenses are flexible, plastic inserts with positioning and holding struts. The patient’s own lens is removed (usually after it has been cryogenically frozen), and the replacement lens is implanted inside the capsular bag of the eye. Often, especially where the patient is elderly, the new lens gives better vision than the natural lens did before it became diseased.
The Indian company produces 300,000 lenses a month, as well as the disposable syringes used to inject them into the eye; it also makes an enormous range of other instruments and equipment used in eye clinics and hospitals. The company has an office and manufacturing facility in New York (Ellis Opthalmics, near JFK airport): almost all of its output goes to India. “Indian doctors want US-made lenses, even though they cost more,” says Mr Ravichandran.
Formed 33 years ago, the company is still chaired by its founder, PSN Appasamy. In the 1970s, he worked in the USA for a contact lens manufacturer, and he soon started his own company making a low-cost machine that freezes the patient’s natural lens, ready for removal. At that time, a European company made the only other machine capable of doing the same job, but it was too expensive for doctors in India. Mr Appasamy simplified the design and was able to sell his machine for a lower price. It became very popular in India and made cataract removal a much more viable procedure, particularly for doctors taking their services to patients in rural and remote areas.
Appasamy employ’s more than 2,500 people: 1,380 at its Puducherry factory, most of the others at plants in Calcutta, Chennai and Dehli. The company’s annual sales are currently more than US$2 billion, and many of its mainstay products are made on a line of 20 Haas CNC machine tools (www.haascnc.com) at Puducherry.
Comprehensive product range
A single Haas Mini Mill, 11 VF-1 vertical machining centres and eight SL-10 turning centres make the parts for 1,800 different surgical instruments and pieces of equipment in the Appasamy catalogue — products such as microscopes and slit-lamps used in clinics and operating theatres, and tonometers for testing the pressure of an eyeball. Mr P Prakash, deputy manager CNC, says: “The tonometer is one of our best-selling products and is our own design. All of its 45 different parts are made on the Haas Mini Mill, and we make 150 units a month.”
Another successful ‘home-grown’ Appasamy product is a YAG laser. After a cataract is removed and replaced by an intra-ocular lens, it sometimes happens thatthe capsular bag becomes thicker and ‘frosted’ behind the lens, causing light to scatter before it reaches the retina. To alleviate this problem, a laser is used to perforate the opaque area of the capsule, allowing light to penetrate more readily. In the eight years since it launched its YAG laser, Appasamy has sold around 1,000 units.
The company’s less-invasive system for replacing intra-ocular lenses eliminates the need for surgical stitches, since the hole made to insert the lens is smaller than 5mm. The replacement lens is furled and then injected into the eye, where it unfurls. Eliminating the need for stitches makes the procedure quicker and easier, so there is less chance that the eye will deform. As mentioned earlier, Appasamy also makes the single-use syringes; the moulds are machined on a Haas VF-2 Super Speed.
The Appasamy Slit Lamp alone has 60 components made from aluminium, stainless steel and brass — some turned, some milled. The company currently makes around 350 assemblies a month; it aims to increase production to 500 a month. The optical assembly for the ‘operating’ microscope is made on the Haas VF-1s. There are two models of the finished product, one with continuous magnification, the other with step magnification; the drum of the latter is machined in aluminium to a tolerance of 5µm on the Haas VF-1s. The Appasamy Keratometer, for measuring the curvature of the cornea, used to be made by a Japanese supplier and imported into India, but it is now also made by Appasamy.
Quick-change fixtures
With so many parts and products, the company spends a great deal of time and effort designing quick-change fixtures and fittings. Batches are often just five components, and some of the machines are set aside for development work, proving programs (generated by EdgeCAM software), andreducing cycle times. With a seemingly inexhaustible demand for clinical equipment and instruments, and with such an enormous customer base of indigenous ophthalmologists, it is no surprise that Appasamy has enjoyed uninterrupted growth for the past two decades.
Business is brisk, in no small part due to the company’s relentless development of innovative lower-cost products. Doctors in India are free to undertake their own private practice, so it is essential that equipment is affordable, which is also why Appasamy runs a scheme to help doctors buy the equipment they need to undertake cataract surgery.The company also exports its products, and it regularly attends trade shows in the USA and Europe. By doing so, it qualifies for lower taxes on imported machine tools under a government-run incentive scheme.
Mr. Ravichandran says: “Because we export a large part of our production, import duties on the Haas machines are less. Our company has also been recognised for its exports. We received the Engineering Export Promotion Council of India award for the best performance under the category ‘small-scale industries’.”
While a lot has been written about the surge of technology that has swept across India (call centres there have transformed the customer interface of every cost-cutting insurance company and ticketing agency in the UK and the USA), less well documented is how engineering companies in India — like Appasamy — are taking advantage of the best-available manufacturing technology, and in so doing are not only addressing the country’s pressing social and health issues but also quietly establishing innovative Indian products in Western markets.