The Eye Surgery Factory That Could Not Expand

In a Moscow operating room in the 1980s, patients didn’t simply enter for surgery and leave when their doctor finished.

They went around in circles.

Eight operating tables turned slowly on a revolving conveyor. A surgeon waited at the head of each station. As a patient arrived, the surgeon performed one step of an eye operation. Then the table moved on to the next surgeon, and another patient took its place.

It was part hospital, part assembly line.

Including anesthesia and cleanup, the entire procedure could take about 10 minutes.

The man behind this unusual system was Svyatoslav Fyodorov, a Soviet eye surgeon who had developed a procedure called radial keratotomy to correct nearsightedness.

The operation involved making tiny, spoke-like cuts in the cornea, changing its shape and improving how the eye focused.

Fyodorov said the idea came from an accident.

A boy came to him after his eyeglasses shattered, leaving glass fragments in his eyes. Fyodorov removed the glass and later noticed something unexpected. As the cuts healed, the boy’s vision had sharpened.

That observation helped lead Fyodorov toward radial keratotomy.

But inventing the procedure was only part of what made his work remarkable. Fyodorov also wanted to change the way surgery was performed.

At the Moscow Research Institute of Eye Microsurgery, he divided the operation into separate steps. Rather than having one surgeon perform the entire procedure, each surgeon became responsible for a particular part.

The patients moved. The surgeons stayed put.

It was the logic of a factory applied to medicine: specialization, repetition and speed.

Fyodorov had found a way to perform eye surgery on a scale that would have been difficult using a traditional operating room. But having built his surgical factory, he ran into another problem.

He wanted to take it around the world.

That proved harder than performing the surgery.

NPR has reported that Soviet bureaucracy blocked Fyodorov’s ambitions to establish clinics internationally. The Soviet system had not stopped him from developing the operation. It had not stopped him from building an institute or organizing surgery on an assembly line.

But expanding beyond the Soviet Union was another matter.

Fyodorov had found a way to scale the medicine. Scaling the business would have to wait.

By the late 1980s, the Soviet economy was loosening, and Fyodorov moved quickly when opportunities appeared.

He built a hotel beside his Moscow clinic to house patients coming for treatment. Then his operation began moving beyond the Soviet Union.

Branches opened in Italy, Poland, Germany, Spain, Yemen and the United Arab Emirates.

But perhaps the most unusual expansion involved no new building at all.

Fyodorov went to sea.

An oceangoing ship called the Peter I was converted into a floating eye clinic and sent into the Persian Gulf and Mediterranean.

There was a practical reason for putting an eye hospital on a ship.

The Soviet ruble could not readily be exchanged for foreign goods. By treating patients abroad, Fyodorov’s operation could bring home hard currency.

The floating clinic carried 18 surgeons and reportedly performed about 1,500 operations a month.

Yet the Peter I was not simply a hospital that happened to float.

It had a sauna.

It had a swimming pool.

It even had a disco.

Patients could board an oceangoing vessel for eye surgery while the Soviet Union earned foreign currency from the operation.

It was an extraordinary final form for an idea that began with a boy, a pair of shattered eyeglasses, and an observation about how an injured eye healed.

Fyodorov had turned that observation into a surgical procedure, the procedure into an assembly line, and the assembly line into an international operation.

For years, the limits placed on him had little to do with medicine.

The eye surgery factory was ready to expand.

The system around it was not.