Sitting Down With…

Aier Eye Hospital Group is the world’s largest ophthalmology hospital chain. Headquartered in Changsha, Hunan, China, it operates more than 970 eye hospitals and clinics across China and abroad, with business footprints in Hong Kong, China, Europe, Southeast Asia, and North America. Aier’s clinical services span refractive surgery, optometry, cataract, glaucoma, corneal diseases, retina care, pediatric ophthalmology, and more. In 2024 alone, Aier recorded over 20 million outpatient visits and performed over 1.5 million surgical procedures.

Since joining Aier in 2014, Elaine Zhang has been the driving force behind its overseas acquisitions and a steadfast leader and implementer of Aier’s internationalization strategy. As Vice President, Head of International Business, Innovation and Translation Research, she has led efforts to build its global presence, including expansions into Hong Kong, China, Europe, North America, and Southeast Asia, leading an overseas team of 2,300 employees. She helps forge academic and clinical partnerships while oversees multiple investment and incubation projects, managing a fund of approximately USD 300 million that supports over 30 ophthalmology start-ups.

The Ophthalmologist sat down with Elaine Zhang at this year’s ESCRS Congress in Copenhagen to discuss Aier’s current and upcoming plans.

Aier began planning for international expansion soon after its IPO, and after in-depth research and analysis, took its first step abroad in 2015. I joined Aier in 2014, at a time when the company was starting to move forward with its international strategy. It was a steep learning curve. We began by looking at two things: technology and demographics. From a technology standpoint, we looked to Western countries – Europe and the US – for advanced solutions. From a demographic standpoint, we considered population size, economic conditions, and healthcare structures.

Our first step was Hong Kong, serving as a bridge between mainland China and the international medical community, giving us exposure to international healthcare policies and doctors with diverse backgrounds. From there we moved into Europe, acquired Clinica Baviera. That platform appealed because it was mainly out-of-pocket healthcare, which made it easier to understand. They had a stable, high-performing team and strong financial results – which is key for us as a listed company.

Broadly, our criteria have been macroeconomic strength, population demographics, and healthcare policy, alongside financial performance, brand awareness, and medical quality. But most crucially, we look for strong teams. Integration success depends on people. We evaluate potential partners against what they’ve already achieved and assess their willingness to work with us. With our growing track record of experience and success, more organizations are choosing to collaborate with us, drawn by our systematic management, empowering approach, and focus on creating win-win outcomes.

Aier’s Southeast Asia presence is anchored by the International Specialist Eye Centre, providing a foundation to reach the region’s vast population and unmet eye care needs.

In the US, things are different. We currently have one eye care center there, Wang Vision Institute. However, given the scale is enormous and the system is complex, we are still exploring opportunities carefully there.

In mergers and acquisitions, statistics show that around 80% of deals fail, mostly due to poor integration. For us, the key to success has been trust and cultural integration. However, trust doesn’t mean letting partners operate entirely independently without alignment. Our advantage lies in coming from the same industry – we understand ophthalmology and its culture, which build genuine heart-to-heart connections.

Doctors, whether in the East or West, share the same fundamental motivation: the desire to help patients and perform surgeries well. As managers, our job is to build platforms that satisfy both doctors and patients. Before taking over Clinica Baviera, we spent months visiting more than 50 of its 75 centers. That helped us deeply understand their management style, brand value, and patient relationships. This process not only built mutual respect and trust between us, but also helped us recognize that successful integration is about cultural blending and uniting as one family.

Once on board, we set up regular management meetings. Importantly, we did not interfere in day-to-day operations. Instead, we encourage exchange: inviting their top experts to China, sending our teams to their events, and participating in medical and management meetings. This sharing of ideas – discussing future models and best practices – has been essential to making integration work.

Innovation is essential – though we’ve not seen many real breakthroughs in ophthalmology recently, mostly are gradual improvements. Still, it’s critical to stay updated with latest developments, bring doctors into conversations, and adopt new tools that benefit patients.

Investment is a long-term game. In medical devices and pharmaceuticals, timelines stretch into decades. According to venture capital models, it takes an average of 14 years for a start-up to go from an idea to a successful product. Therefore, our strategy is to learn continuously, invest steadily, and remain patient.

This is one of our most important university partnerships. Historically, our group engaged more with industry than academia, and PolyU is world-renowned in optometry. Especially in China, we are implementing myopia control policies, and PolyU’s expertise is very valuable.

Our collaboration has three pillars. The first is education: every year we host 40-50 PolyU students in our hospitals across mainland China for clinical placement. This benefits both sides – the students gain real-world clinical experience, while our doctors learn new approaches to training and international practice.

The second is innovation. PolyU runs the Centre for Eye and Vision Research (CEVR), a joint program with University of Waterloo, Canada, which produces more than a dozen research projects annually in optometry and vision care. We collaborate closely with them, inviting their professors into our hospitals, visiting their labs, and conducting joint research. This “bench-to-bedside” model helps scientific findings be rapidly translated into clinical applications.

The third is training systems. We have 10,000 doctors in China, and we want to build more sophisticated training frameworks, not only for us but for the whole ophthalmology field. Together with PolyU, we aim to bridge world-class academic knowledge with large-scale clinical practice.

AI has been essential to our strategy for over five years. We even have our own AI research institute. We’re working together to apply cutting-edge technology directly to ophthalmology. Our starting point is retinal imaging. With over 20 million outpatient visits each year, efficiency is crucial. AI can help read images more quickly and accurately, allowing doctors to focus more on patient care while improving satisfaction and outcomes. We’ve mapped out scenarios for AI development, with goals to increase efficiency, improve patient satisfaction, and enhance clinical results. Just last week we announced our AI strategy for the next decade.

Yes, this is very important to us. Women make up a significant part of the healthcare workforce. At Aier, the overall gender balance is healthy, with women accounting for 76.2% of employees. Even at senior levels, over one third of our vice presidents are female, which is a relatively high proportion even compared with many Western organizations.

We value the unique qualities women bring – such as attention to detail, patience, empathy. Among surgeons too, we have seen many female doctors, reflecting the high proportion of women in medical schools.

For patients, we are attentive to their needs. Women often carry heavy family responsibilities, so illness affects them in more complex ways. We ensure private areas for female patients, provide supportive recovery processes, and focus on health education. In remote regions, many women prioritize their families while neglecting their own health. To address this, we run community education programs and build eye health centers to raise awareness of conditions like cataracts. These efforts have had positive impact. For example, cataract surgery rates in China have tripled in recent years. Much of that is due to improved awareness, and we are proud of what we have achieved.