Child Prodigy

What did you want to be growing up?

I always knew I wanted to be an eye surgeon; both my father and grandfather were ophthalmic surgeons and I was fascinated by what they did. I started helping my dad during the summer school holidays when I was 12, working every day for three or four months of the year. My dad was a good teacher and encouraged me to assist with operations. Though I had no formal training – of course, I was a child – I would practice on tomatoes, which were the closest thing I could get to the real thing. I performed my first cataract surgery (not on a tomato) at 16.

Did you find you had a jumpstart on training?

Absolutely. I had read well about the anatomy and physiology of the eye before I even entered medicine. I certainly knew more than anyone else in my class. My childhood undoubtedly helped me go further and faster.

Why did you choose to specialize in cornea?

After I graduated from medical school, I did my initial Ophthalmology training at Aravind Eye Hospital in a city called Madurai in South India. The area had a large farming community, which meant we saw a lot of people from lower socioeconomic backgrounds with corneal infections from farming injuries. Without treatment, these infections often led to blindness, which hugely impacted the farmers ability to make a living. It was then I became interested in front of the eye, both in terms of infections and complex cataracts.

How has the field changed over the years?

Cataract surgery has been propelled dramatically by technological advances in specialized equipment. When I was training to do cataract surgeries in the mid-90s, we were making cuts as big as 8-9 millimeters in the eye and putting in stitches. Now, we’re making cuts as small as 1.8 millimeters for self-sealing sutureless procedures. As technology has changed for the better, so have our surgical techniques and patient outcomes.

Who are your mentors – and how did they shape you as a surgeon?

Many people have mentored me at various points of my career. My first mentor was obviously my dad, but during my initial training at Aravind Eye Hosiptal, Dr. Srinivasan – no relation to me – really kindled my interest in corneal infections and corneal surgery. I learned a lot from him. When I came to the UK, I did most of my training in Liverpool with Stephen Kaye and Mark Batterbury from St. Pauls Eye Unit at Royal Liverpool Hospital. I then went to Toronto for two years to specialize in corneal transplant surgery with David Rootman and Allan Slomovic. All these surgeons played a huge role in my training. 

You’ve called the 2000s the “golden era of cataract transplant surgery” – why is that? 

I say that because the surgeons who were developing these advances, Gerrit Melles (Rotterdam, Netherlands) and Mark Terry (Portland, Oregon, USA), were bringing about a revolution in corneal transplant surgery. By the time I came to Canada for my fellowship in 2005, everyone was beginning to use these technologies; I was just lucky to ride the wave. Everything I learned, I brought back to the UK in 2007. 

How did the UK compare?

When I arrived in 1996, ophthalmology was a very sought-after specialty – and still is, even today – and extremely competitive. It took a lot of hard work to get into a proper training program here. I really had to believe in myself. And I might add the Britain of the 1990s was very different – and much more inward-looking – than the Britain of today; locals were preferred over foreign graduates, which made it all the more difficult. Today, it’s very pleasing to see doctors of different nationalities doing well.

Why did you choose to settle in the UK?

I initially thought of the UK as a stepping stone to the US but having worked in the national health service and having experienced the work-life balance, I thought the UK was more fun. I like it here: this is home.

What is the next ophthalmic frontier?

In some way, I think we are at the pinnacle of what can be achieved with cataract surgery, although advances are taking place constantly in the field of intraocular lenses. Any subtle changes that may take place are not going to be transformational from a patient care point of view. The really fascinating developments are taking place in the field of corneal transplant surgery; there are at least one or two diseases that we currently only treat with corneal transplant surgery but in future, could potentially be cured or controlled with medicines and eyedrops in the next decade. Work is already taking place in the laboratory and the results are very promising. For example, Japanese researchers are working on drops which could potentially cure Fuchs’ Dystrophy, completely avoiding the need for corneal transplant. Seeing this work become a clinical reality within the next five to seven years is not far fetched – they are going to put us out of jobs!

Outside of work, what makes you happy?

That I have work to go to. I joke. I have a 12-year-old son who wants to make a professional career out of tennis. Watching him play and traveling across the country for tournaments is my second full-time job. If I hadn’t become a doctor, I would have taken up tennis. When I was growing up in India, it was quite expensive and even though my dad was a doctor, I couldn’t afford to play. So, I took up the next best thing: badminton. I played for my university and my county – I still play for a local club now. You could say I’m trying to live my own tennis dreams vicariously! 

Your mentors aside, who else has inspired you?

My mum, who was a professor of economics, and my dad, who was an ophthalmologist. I like to think they gave me good values and showed the effort of hard work, being passionate, and doing whatever you want to do properly.