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Subspecialties Retina, Professional Development, Health Economics and Policy

Natural Affinity

What path took you into ophthalmology?

In my fourth year of medical school, I got a distinction in ophthalmology – the top student that year – and realized that I had a particular affinity for the subject.  So, after graduating from medical school at Kerala University in South India,I thought I would try for a post-graduate position in ophthalmology. It was very competitive – if I remember correctly, there were only four ophthalmology seats for the whole state of Kerala – but I actually got one! Since then, I’ve never looked back; I am sure that I’m in the right career. And along the way, I’ve had some wonderful mentors: in India, I was helped enormously by Shailaja Kumari and Dr Kaman, while in the UK I’ve been guided by Philip Hykin, Alan Bird and Declan Flanagan.

What made you leave Kerala for the UK?

I came here to do my fellowship, and then just stayed on – I like it here. Of course, it’s very different from India – back home, public sector ophthalmologists must get through large numbers of diverse patients per clinic, with little time spent per patient. You can’t give everyone a complete assessment; you just have to find and treat the primary diagnosis. In England, by contrast, we can spend more time with the patients and examine each one very thoroughly.

Do you undertake research in addition to clinical work?

Yes. One of my current areas of activity is a UK-India collaborative project in the field of diabetes. Many more people in India get diabetes than in the UK, and few of them are screened for ophthalmological sequelae, so diabetic retinopathy often goes largely untreated. And having seen how in the UK we can prevent or decrease vision loss associated with diabetic retinopathy, I wanted to do something in a lower income country. That’s why I was delighted to receive a Medical Research Council grant – from the UKRI Global Challenge Research Fund – of £6.3 million (~$8.25 million) to start an India-wide diabetes awareness and screening program. It’s not focused on diabetic retinopathy, because in India all the other diabetic complications also need attention, so I felt it would be premature to only pay attention to eyes. Instead, we are taking a more holistic approach by trying to pick up all the complications suffered by diabetics, so that we can direct them to appropriate treatment centers. It’s a massive project – we intend to cover rural and urban populations, as well as particular communities that live in relatively inaccessible locations. Our aim is to recruit 48,000 patients across India; to date, we have reached 10,000 patients, so it is going well.

Might this work have implications for how things are done in the UK?

Absolutely. Our project relies on small, low-cost, compact cameras for retinal screening – the converse of the UK situation, where clinics use large, expensive devices, which is not the most cost-effective approach. If I can demonstrate that the small low-cost devices work in India, there should be no reason why we could not also use them for diabetic retinopathy screening here in the UK. You could say I am trying to learn from India and bring that knowledge back to the UK.

You also wear another hat…

I’m the Editor-in-Chief of Eye, the journal of the Royal College of Ophthalmologists, which in practice means ensuring that the journal comes out in time, every month, with articles of interest to ophthalmologists throughout the world. But it is a team effort – as well as being supported by the Springer Nature publishing group, I work closely with section editors, associate editors and – most importantly – the editorial assistant. I could not do this role alone!

What breakthrough treatments do you anticipate in retinal disease?

I would welcome a longer acting device or treatment for macular degeneration and diabetic macular edema – current therapies are very challenging for patients. Another welcome advance would be a treatment – any treatment – for geographic atrophy or dry macular degeneration. That’s the breakthrough that everyone is waiting for.

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