New innovations tend to first manifest as expensive indulgences. We’re seeing it now in healthcare with treatments like CAR T-cell therapy proving too expensive to scale to everyone despite its incredible efficacy in curing cancer. Invariably these innovations eventually become ‘democratised’ and accessible to all, but the question is, how quickly? When looking at projects to end corneal blindness in poor communities, I have to balance the immediate scientific and clinical merits of a project with the likelihood that it can be ‘democratised’ to serve poor communities.