Dear Editor,The incidence of post-cataract endophthalmitis at Arvind Eye Hospital has attracted unusual attention.[1] While Thomas and Khanna are rightly critical of the study methodology, the study still merits relevance.[2] The Arvind Eye Care System has propounded the high quality, high volume cataract surgery concept to tackle the backlog of cataract blindness.[3] The model standardized intraocular lens implant surgery and made it extremely economical. The system has treated millions of cataract blindpatients and trained a generation of eye care professionals.[3] But the “cost effectiveness” has come through use of affordable human resource (abundant in India) and reuse of consumables. The reuse of consumable is a trade off of safety, for the sake of economy, and may not be acceptable as standards of living improve. As someone who has worked in high volume system and authored publications on costing of surgical services, I believe this cost cutting corners is no more necessary, as most consumables are now produced in the country.[4] It is ethically repugnant and legally risky.As Indian ophthalmology gains in bench-strength, high volume may not be needed as there could be enough surgeons to effectively tackle the cataract blind. The pyramidal model proposed by the L.V.Prasad Eye Institute with emphasis on vision centers and primary eye care practitioners would offer an alternative.[5] The community members would demand a personalized eye care service rather than an impersonal assembly line system.However, this should not make us forget the yeoman work that the Arvind Eye Hospitals have done and continue to do in eye care service delivery. But the future of Indian ophthalmic surgery is a move in “high quality” and not “high volume” cataract surgery.