GIFT OF SIGHT APPLICATION FORM

Restoring Vision Through Cataract and Refractive Surgery

The Urgent Need for Action

Cataracts and uncorrected refractive errors remain the leading causes of preventable blindness worldwide. Every day, millions of people struggle with poor vision – not because treatment doesn’t exist, but because they cannot access or afford it.

That’s exactly why the Gift of Sight Trust exists. Since 2015, we’ve helped restore vision to South Africans by offering subsidised cataract and laser eye surgeries. We focus on those facing long delays in the public system or those who lack access to private care.

What Is a Cataract?

A cataract develops when the eye’s natural lens becomes cloudy and stiff. As it progresses, vision becomes blurry, light sensitivity increases, and daily tasks become more difficult.

Fortunately, cataract surgery is highly effective. The surgeon removes the cloudy lens and replaces it with a clear artificial lens. In most cases, vision returns within minutes – greatly improving quality of life.

What Is Refractive Surgery?

Refractive errors affect how your eyes focus light. Common examples include:

• Myopia (short-sightedness)

• Hyperopia (far-sightedness)

• Astigmatism (irregular corneal curvature)

To correct these issues, we use advanced laser procedures such as TransPRK or LASIK. These reshape the cornea, allowing light to focus correctly. As a result, many patients no longer need glasses or contact lenses.

How We Help

Thanks to our donors and partners, the Gift of Sight Trust provides partial financial assistance for qualifying cataract and laser surgeries. Our goal is to make vision-restoring procedures more accessible to those who need them most.

Apply for Support

Do you – or someone you care about – need help accessing eye surgery?

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Please specify what procedure you are applying for *Cataract SurgeryLaser Refractive SurgeryRetina SurgeryUnsure

Write your story (Please share your story and why you are in need of a cataract or refractive eye surgery): *

Name *

First

Last

Age *

Date of birth (YY/MM/DD) *

Address *

Contact number *

Email *

Gender *MaleFemalePrefer not to say

Race *Black AfricanColouredIndian/AsianWhiteOther

Marital Status *

• Married
• Unmarried
• Single

Next of kin *

Contact Number (Next of kin / Emergency) *

Are you currently employed? *

• Yes
• No

If yes, please specify your current salary per annum

Job title *

Contact details of employer *

Is your eye sight or dependence on spectacles negatively affecting your work? *

• Yes
• No

Do you have any dependents? *

• Yes
• No

Are you a South African citizen? *

• Yes
• No

If no, what is your Nationality?

How did you hear about the GOS programme? *

• KFM Radio
• Cape Talk Radio
• Social Media
• Friends/Family
• Internet / Google
• Doctor
• Optometrist
• Government Clinic
• V&A Waterfront
• Other

Have you been diagnosed with cataracts? *

• Yes
• No

If yes, please specify date of diagnosis?

Are you completely blind due to cataracts? *

• Yes
• No

Are you partially blind due to cataracts? *

• Yes
• No

Have you had any previous eye surgery? *

• Yes
• No

If yes, when and what type of surgery? *

Is your vision affected In both eyes? *

• Yes
• No

Are you on a waiting list at a Government Hospital for cataract surgery? *

• Yes
• No

If yes, since when and at which Government Hospital?

Do you wear glasses? *

• Yes
• No

Do you wear contact lenses? *

• Yes
• No

If yes, please specify refraction (You can ask your Optometrist for a note if you are unsure)

Do you have Medical Aid? *

• Yes
• No

If yes, please specify

Do you have any other health/chronic conditions? *

• Yes
• No

If yes, please specify

Do you use any medication? *

• Yes
• No

If yes, please specify

Can you, your family or your employer make a financial contribution towards the surgery? *

• Yes
• No

If yes, how much are you able to contribute

Can you pay for the Doctor's appointment? R1500 including tests and final diagnosis (reduced fee) *

• Yes
• No

Will you be able to attend post operation follow up THE DAY AFTER THE SURGERY surgery (at no cost) *

• Yes
• No

Will you be able to attend post operation follow up A WEEK AFTER THE SURGERY (at no cost) *

• Yes
• No

Will you be able to attend post operation follow up SIX WEEKS AFTER THE SURGERY (at no cost) *

• Yes
• No

Will you be able to buy prescribed medication to use after the surgery? (approx R 700) *

• Yes
• No

Submit