Reasons for superior outcomes obtained by local surgeons operating under prevailing conditions in local facilities in the current study, as pointed out in early studies by Ruit et al,24 may include the use of modern equipment and materials, including IOLs biometrically selected on the basis of axial length and keratometry, and a high-quality operating microscope (Leica 841; Leica Microsystems GmbH, Wetzlar, Germany). Of equal importance was the successful skill transfer to nonophthalmologists, the result of an intensive training program involving practice surgery on 100 animal eyes, assisting a senior surgeon on 100 cases, and direct supervision by senior surgeons on 100 additional cases. The entire operative team, including physicians and nurses, received a combination of on-site instruction and regular visits to an international facility, the JSIEC in nearby Shantou, for practical training in areas such as sterilization technique. Though the initial inputs required were substantial, the program is currently self-sustaining through funds obtained from low-cost surgery, in part through the use of the SLIMCE technique, which does not generate the recurring costs of phacoemulsification surgery. Social marketing resulting from these excellent results clearly played an important role in the uptake of surgery; as reported elsewhere (N.G.C., S.K.R., K.C., W.W., Shaofang Lin, MD, Shaomian Chen, MD, L. J. Chen, MD, K. Liu, MD, I. C. Hu, MD, and D.S.C.L., unpublished data, August 8, 2005-October 21, 2006), 85% of subjects operated on at Sanrao had a close friend or relative operated on at the same facility.