Dr.

T: In terms of major mile stone in eye care I cant say any thing which has been a paradigm shift of
that kind. In one sense it is a kind of more of the same but increasingly we are sort of strategically
thinking and then changing some of the directions which we want to go, it is both in aspiration,
intention and also in terms of aligning our decisions and how we go forward. Let me touch upon a
few broad areas like one prediction that we are working on is that like cataract surgery for instance
as an example which was at one time a domain of a very highly skilled person, there are a few
people doing it well and people would come long distances to seek it, for the skill part. For the trust
and other part they may still travel but over time we feel that people may not travel for this
procedure. Now the procedure is becoming very good in many hands it is very standardized,
outcomes are predictable, the technology is playing a bigger part, so you buy the technology, you
get it, prectdictable out come, so we are predicting that over time less and less people want to travel
long distances for the cataract surgery which means we need to become more locally available. So
this is one deviation in our thinking, of course in the past we tended to by putting up large hospitals
and trying to draw people from quite far distances, so now we are making this deviation to having
more local presence in smaller towns and small formats.places like Udumalpet, Dindugal

Interviewer: These are all ownership model, owned by

Dr.T: Completely ownership No partnership, we did not go the franchisee route at all ever, we are
not looking at that, not looking at that . I mean in the sense we are quite clear we are not after
money so we are not getting pressurized somebody else is expanding making lot of money doing it,
that is not part of our equation.

Interviewer: The smaller hospitals are basically for cataract.

Dr.T: What we call as Secondary care so we are pushing that at any level they should do a
comprehensive eye examination, even if it is an Eye camp, even if it is vision centre, Eye care Centre.
Comprehensive eye care does not mean every body should do every thing, that is not possible, but
then recognizing that most of the time. You may understand this a little better being a doctor, like
often times most eye care providers will go to an out reach, pick up only cataract and tell that
person some detail, they will just give some false information, they will not look for anything else,
that vision is not right, comprehensive means you look at every thing and some you are able to deal
with locally and some you refer, rest you refer to an appropriate place.

we will continue doing cataracts but we recognize that , that is reasonably well addressed in terms of
the full eco system is in place, the training is reasonably good, even at residents Government
hospitals, other private hospitals for cataract, you have affordable supply service, enough awareness
is there on all the public so the demand also is quite matured. That market is reasonably matured,

because I recall the early days when we used to go for camps patients were petrified of surgery, they
would say, please can you give some medicine drops or some thing like that. Two years back I went
to a camp where a patient was not advised surgery because he didnt need it, so he was kind of
going after the local sponsors saying that Aravind is not taking me for surgery. So the market is
matured in terms of awareness and demand, so we may have to create the accessibility and
affordability and then cataract used to account for eighty percent of the blindness, today in Tamil
Nadu it is down to sixty percent and it is reducing and other reasons are coming up, because of the
percentage more other reasons are coming up more and we also recognize it is a kind of a win win,
focusing on the non cataract areas by one making an impact on the areas where it matters and also
areas where others are reluctant to get into, Addressing a new one it requires lot of investment, it
needs lot of skill and it is not straight forward as a cataract surgery, money is very less in that, out
comes are not great, skill is more, so there are multiple reasons why others dont want to get into it,
which means it will be less competitive market as well so we are looking at growing more in that
segment in all spheres. Retina, cornea, glaucoma, pediatric ophthalmology and all those areas, we
try to push into become stronger in that in all aspects, service delivery we are looking to from
primary to secondary, tertiary all levels, also get into training, research, all of it we will start focusing
more on that, then we will try to grow from that, which would as we succeed in that way of growing
we will become much more stronger organization from market competition perspective. Then the
third deviation is to focus more on primary eye care. Till now the market is not matured there was
lot of low hanging fruits which everybody has been enjoying so the whole focus has been on
numerator driven which is true in most health care even otherwise very few people talk market
share as a notion and even market share in the right perspective very few people think of the
scenario, they only think of market share in terms of what is happening, how much I am getting, so
we would like to take a stand to define the denominator as the need rather than the demand
because in most health care areas the market is not matured. Suppose you take cardiac, you take
pacemakers, if hundred people would benefit from pace makers today only five people are
demanding so we compute all the market share based on that five but we would like to do the
market share on the basis of hundred and then decide how do we need to go beyond this reacting to
demand, we need to do whatever it takes to generate the demand, because we dont have the
financial factor as a drive we wont become exploitative in doing it, not over prescribing or over
treating by recognizing some body can benefit by a pair of glasses.