Address on the Occasion of Silver Jubilee Celebrations of Sankara Nethralaya

THE MISSION TO GIVE VISION

I am delighted to participate in the commemoration of Silver Jubilee Celebrations of the Sankara Nethralaya and dedicate the tele-ophthalmology facility and brachy-therapy project for ocular tumours, to the nation. During the past 25 years, Sankara Nethralaya has created experienced doctors, nurses and other paramedical staff and has given the light to the life and removed the pain of the community, particularly the people below poverty line. I greet the Sankara Nethralaya family, including Dr. S.S. Badrinath, who has done pioneering work in the field of ophthalmology.

Eye Care Mission

When I am in the midst of doctors and other distinguished members, I was thinking what thoughts I can share with all of you. You may be aware, a Healthcare Technology vision document was evolved as part of Technology Vision 2020, a few years back. Prof M. S. Valiathan led the team in evolving the Healthcare vision document. A number of experts in the area of ophthalmology were involved in the task teams. Many important issues were brought in the document. It is said that in India, minimum 20 million people in a billion population are blind, while 25 million people are visually handicapped. The population growth coupled with increase in life expectancy will only lead to increase in the number of blind and visually handicapped. 80% of the cause of blindness is due to cataract. The other causes have been identified as cornea, glaucoma, diabetes and other vitreo retinal disorders and vitamin-A deficiency etc. The expert team had identified preventive technologies, diagnostic technologies and curative corrective technologies. One of the major recommendations is to develop eye lasers with slit lamps for post glaucoma and cataract patients treatment and large-scale production of cost effective vitamin-A tablets. Laser treatment for diabetic retinopathy to arrest eye bleeding has also been added. Above all, education and management system for eye care and also creating a human feeling to increase large number of eligible eye donors has been recommended.

A national mission for fast track treatment method has to be evolved involving number of missions and mission-oriented doctors throughout the country. In doing so, integration of minds is possible and governmental support can be made easier. India already has a national programme for control of blindness and also Vision 2020: The Right to Sight initiative (Global). Throughout the country and also around the world, each and everyone are sympathetic to the visually handicapped who need vision and prevention of blindness. This service oriented attitude towards visually handicapped can bring together a number of partners in the national mission.

Mobile Clinics

I have seen mobile clinics equipped with modern equipments and onboard facilities like X-Ray, Ultra-Sound, ECG and supported by a team of doctors including a Lady Medical Officer, a Radiologist and Paramedical staff. In addition the vehicle is equipped to impart healthcare education through audio-visual facilities. I have also seen a indigenous CATHLAB facility, and Minimally Invasive Surgery(MIS) (Robotic Surgery) facility which can be made mobile.

I witnessed an experiment that I would like to share with you when I was at Hyderabad. I was in a hall at a Hospital. The hall was full of medical doctors, communication engineers, computer scientists, software experts and industry chiefs. The whole place has been geared for a telemedicine experiment. A patient was tested, in a far off place from Hyderabad, for ECG, liver functioning in real-time. The hall almost turned into an electronic hospital. We could see the doctors and the patients interaction. Telemedicine is one area which will take advanced medical technology to the rural villages and give a connectivity between primary health centres, area hospitals, district hospitals and specialty hospitals at capital cities. Mobile tele-ophthalmology is indeed a very important step in eye care taken by Sankara Nethralaya.

Mobile Rural Tele-ophthalmology project

70% of India's population lives in villages. The doctor - patient ratio in the rural sector is unfavourable and medical facilities are not fully equipped. Under these circumstances we have to harness the ICT revolution in India to deliver quality eye-care to rural patients in their villages. Tele-ophthalmology can play an important role in this area in curing preventable blindness. Tele-ophthalmology represents a combination of expertise and technology that delivers ophthalmic services and information over distances. I am happy to know that the Sankara Nethralaya is making available diagnostic facilities in remote areas, sharing resources and screening patients for ophthalmic ailments. These facilities I understand will minimize delay in diagnosis of ocular diseases and will be economical for the patients since they do not have to travel to far off towns at a prohibitive cost foregoing their meagre daily earnings.

I appreciate the Sankara Nethralaya's significant contributions in establishing the first tele-ophthalmology satellite link between Bangalore and Chennai and the mobile rural tele-ophthalmology project in partnership with agencies like ISRO. This project envisages use of a mobile van equipped with all instruments for a complete eye examination and instrumentation for transmitting the images by satellite to the central hub at Sankara Nethralaya. In addition to the diagnostics, this facility will provide instant custom made spectacles for rural patients with the help of a van with required spectacle making equipment.

Brachy-therapy for ocular tumours

Choroidal Melanoma is a primary cancer of the eye. It arises from the blood vessel layer beneath the retina called "choroids". About one in a lakh people get choroidal melanoma each year. This cancer usually spread to other parts of the body, particularly the brain. For over a century, the usual treatment for choroidal melanoma has been removal of the eye. Radiation treatment has been used for this disease for many decades. During the last two decades this method of treatment has been refined. Radiation at the appropriate dose rates and in the proper physical forms has been successful to stop the growth of tumour cells and shrink the tumour saving the eye from removal. Ophthalmic plaque brachy-therapy delivers a highly concentrated radiation dose to the tumour without harming the surrounding healthy tissues. The radioactive plaque is also called a radiation implant. The radiation sources used for brachy-therapy come in the form of small rice sized radioactive seeds Iodine 125 or Palladium 103. They emit low energy of photons. These seeds are attached within a gold bowl. The bowl size is selected to cover the tumour completely. The gold is used to contain the radiation within the enclosed space. With the plaque in place, radiation is continuously delivered over 5 to 7 days and then removed. India has the technical potential to develop the brachy-therapy ophthalmic plaque. The Bhabha Atomic Research Centre, Defence Metallurgical Research Laboratory and Sankara Nethralaya can work together and evolve to productionize the plaque indigenously.

Stem Cell : For Restoration of Vision

The recent identification and characterization of progenitors with stem cell properties has opened new avenues that may be useful for treating functional impairments caused by the death of specific cell population. Stromal and neuronal degeneration are the causes of debilitating visual impairment associated with many ocular diseases, such as degenerative diseases of cornea, retinitis pigmentosa (RP), age- related macular degeneration (AMD) and glaucoma. The stem cells may help restore vision in patient who have these diseases, by repopulating or rescuing the damaged ocular surface cells or retinal cells from further degeneration. The stem cells can be used for two different but complimentary ways to treat the degenerative diseases of the eye.

1. Cell Replacement Therapy: Cell replacement therapy exploits the plasticity of stem cells progenitors to replace cells and repair tissue damage by diseases or injury.

2. Ex vivo gene therapy: Ex-vivo gene therapy could be used effectively as a neuro protective strategy to prevent retinal cell loss in retinitis pigmentosa (RP), age-related muscular degeneration (AMD) and terminal stages of glaucoma.

I would like to know from the medical community whether brachy-therapy for treating ocular tumours can be combined with stem cell treatment for restoring full vision for the affected patient.

What can I do for you?

Every one of us has gone through the various phases of education from childhood to profession. A scene appears in front of me. A child, a teenager, an adult and a leader. How does each one react to a particular situation? The situation is human need. The child asks, "What can you do for me"? The teenager says, "I want to do it alone". The young person proclaims, "let us do it together". The leader offers, "What can I do for you". So, the principals have got a tremendous responsibility to transform a child into a leader - the transformation of 'what can you do for me' to 'what can I do for you'. That will demand a principal to be a visionary with an inspiring capability. Also the principal has to ensure that teachers impart learning to the children in such a way as to bring out the best in them and for this, he has to be a good teacher himself. I am sure, the best of creativity among the students will emerge by integrated influence of principals, teachers, and parents on students.

Now, I would like to administer an oath for attaining enlightened citizenship. Would you repeat with me?

Conclusion

'Defect free vision for all' should be our national mission. For realizing this mission, I suggest you to focus your attention on the eye care for children. The eye problems of the children can be corrected, if diagnosed early. Such programmes should aim at screening all the children. A team of paramedical personnel visits nearby schools and villages and examine children for possible vision defects. Any one having defective vision or any obvious complaints should be sent to the Institute for further investigation and treatment.

We have the best of doctors and technologists in India. We have core competence in design and software engineering. Emerging technologies in virtual reality and micro machines will transform the healthcare scenario. This transformation should lead to helping the people who cannot afford the modern medical care. Removal of the pain of suffering humanity will be the Service to Almighty. Friends, I am happy to commemorate the Silver Jubilee Celebrations of Sankara Nethralaya and dedicate the tele-ophthalmology and brachy-therapy facilities, to the nation.

I wish you all success in your mission.