In a remote Tibetan village, a cheap and speedy surgical procedure transforms the lives of people who have suffered for decades.

By TIM BLAIR

ore than 100 km beyond the tiny tibetan village of Gucho stands Mount Everest. On a clear day, the sharp profile of Everest's northwest face is visible from the village's rocky paths. But not to the dozens of men and women gathered outside Gucho's medical center. They can barely see their own hands, much less the imposing form of the world's highest mountain.

These people are blind, most made so by the high levels of ultraviolet radiation present at the towering altitudes of their homeland. Seared by UV rays, the lenses of their eyes have formed the cloudy patches known as cataracts. In their early stages cataracts merely dim the sight but eventually, as they become whiter and denser, they block it entirely. In Tibet, about 30,000 people are believed to be blind as a result of cataracts; each year about 1,000 receive operations--and another 1,500 to 2,000 go blind. Among those over 50, the problem is endemic. Most of the patients waiting at the Gucho hospital are elderly and have been brought in by relatives and friends. Some have been blind for decades.

The duration of their misery is staggering, considering the swiftness of the procedure that will restore their vision. Dr. Sanduk Ruit--a Sherpa from Nepal, where he is medical director of Katmandu's Tilganga Eye Centre--has come to Gucho at the invitation of the Tibet Development Fund on what he calls a "commando mission" to remove cataracts and to train local doctors in his methods. There are plenty of patients available for study; today 72 cataract sufferers are waiting here for treatment.

Just 50 years ago, that treatment would have been a crude form of surgery known as couching, which is believed to have been practiced in Tibet for 2,000 years. Couching removed the clouded part of the lens but provided no replacement, meaning that although vision was improved, it remained blurred. Ruit, who has performed 20,000 cataract operations in the past 15 years, replaces the ruined natural lens with a plastic intraocular lens--a method popularized in the 1980s by the late Australian eye surgeon Fred Hollows, who trained Ruit.

The operation is one of the simplest surgical procedures; even a medical trainee can perform an intraocular transplant in less than 30 minutes. In the deft hands of Ruit--who with the support of the T.D.F. has trained dozens of doctors in Tibet since 1993--the procedure is often completed within five minutes. For most Tibetans or Nepalese who have intraocular transplants, it is the first surgery they have ever undergone. Beyond light tugs and scratches felt through the anesthetized eyeball, the experience is completely painless, the optical equivalent of minor dental surgery. The effect, however, is dramatic. Within a day, bandages covering the eye can be removed. (In cases where both eyes are cataract-blind, operations are usually scheduled one day apart.)

At first, only vague outlines of nearby objects can be seen. After a day or two, patients are able to focus on objects further away, and to make out the faces of children and grandchildren sometimes never seen before. Within weeks, their fully healed eyes can once more take in Tibet's icy, sun-reflecting landscapes.

And, on a clear day, Mt. Everest.

THE SIMPLEST MIRACLE

Intraocular surgery can be performed in minutes. First the eye is washed to reduce the risk of infection. A local anesthetic is injected below the lower eyelid, blocking sensation in the eyeball. After the clouded interior of the lens is removed through a tiny incision on the side of the eyeball, the intraocular lens is inserted into the empty lens capsule. Says Ruit: "It is the best thing a human can do in five minutes."