- November 1997-March 1998
- Sankara Nethralaya Number 17 & 18
CHANGE AND CONTINUITY
Dr. T.S. Surendran, Assistant Medical Director will soon become Medical Director, Medical Research Foundation, Dr. S. S. Badrinath who has been the Medical Director of the institution since its inception in 1978 will become the Chief Executive of the organization.
After 19 years of single minded service to the organization, Dr.S.S.Badrinath, Founder and Medical Director of Medical Research Foundation will be retiring from his present post on 24 February, 1998. Dr.T.S,Surendran, his successor, has been with the institution since 1979 and has served as Assistant Medical Director since 1990. He has qualified with a graduate degree in hospital administration from BITS, Pilani (in association with CMC, Vellore and Tulane University, USA).
Dr. S.S.Badrinath as Chief Executive will continue to be associated with all the activities of Sankara Nethralaya.
Free from the chores of the day to day running of the hospital, he will be more involved in teaching and research areas besides continuing to take a deep interest in patient care and planning the future direction of the institution. Dr.S.S.Badrinath will be handing over the post of Medical Director to make way for the younger Dr.T.S.Surendran, Being actively involved in the administration of the hospital for the past 7 years,
Dr.Surendran will bring to his new post a wealth of experience in hospital management. Change amidst continuity will foster the further growth and development of the institution into the 21st century.
ISO 9002 for Sankara Nethralaya
Finally we have it. For implementation and management of quality systems with management of quality systems with respect to ophthalmic care and sevices, Sankara Nethralaya has been recommended for the prestigious ISO 9002 certification on December 19, 1997 by KPMG Quality Registrar USA, an accredited third party registrar of international repute. The Centre of Business Transformaton(CBT), the consultancy division of Aptech Ltd. Chennai was employed as our consultant for documenting and implementing the systems and procedure to meet ISO standards.
The ISO 9000 series standards define the formal system necessary to assure technical, administrative and human excellence according to internation standards. The comprehensive eye care services coming under the certification not only include administrative activities of the hospital but more importantly, professional ophthalmic practice, laboratory facilities, nursing, operation theatres, medical record keeping etc. all of which directly involve the patient. This cerftification formalizes our commitment to provide excellence in eye care.
Sankara Nethralaya will achieve a record of sorts by becoming the first eye hospital in Asia to have the ISO 9002 certification.
The One-Stop Shop
Patients visiting their ophthalmologists commonly have glasses prescribed and many of them would like to have their new spectacles made at the same place cutting short an additional visit to the optician’s shop. Keeping in mind this one-stop shop concept to providing total eye care , Sankara Nethralaya launched its optical dispensing service on August 15, 1997. The optical dispensing center is managed by GKB Rx Lens Pvt. Ltd. Which has over three decades of expertise in this field. The center is exclusively meant for patients of Sankara Nethralaya. The other purpose of starting this unit was to provide high quality lenses in both glass and plastic at affordable costs. Patients undergoing free surgeries at the hospital are also provided glasses free of cost. Mr. Jyoti Balaji of the Optical Services facility at Sankara Nethralaya is managing the shop.
NEWS BRIEFS
Meetings attended
The macula Meeting 1997 was conducted by Singapore National Eye Centre. Sankara Nethralaya took an active part in this meet, with Dr.S.S.Badrinath, Dr.lingam Gopal and Dr.Tarun Sharma forming part of the distinguished foreign faculty.
Dr. Jyotirmay Biswas was invited to deliver a keynote lecture on “Aetiopathogenesis of Eales’ disease – Research at Sankara Nethralaya” at the Fourth International Symposium of Uveitis (ISU) held in Japan in October 1997. Dr.Biswas is the only Indian to have been nominated as a member of the prestigious International Uveitis Study Group comprising 40 experts from all over the world
Dr.T.S.Surendran, Dr.Mahesh Shanmugam, Dr.G.Sitalakshmi and Dr.B.Shantha attended the 1997 American Academy of Ophthalmology Meeting in San Francisco and presented papers and Posters.
Community Service
Sankara Nethralaya introduced a new dimension to the community service programme by offering free treatment to all freedom fighters. This formed part of the 50 resolutions taken by the institution on the occasion the Golden Jubilee of Indian Independence.
Pammal Annexe Update
Sankara Nethralaya’s new extension at Pammal in the outskirts of the city has performed more than 2500 cataract surgery free of cost to the deserving poor since its inception in June 1997.
Pammal Annexe, as it is referred to, has 60 beds, and 2 Operation Theatres. 60% of the beds of this hospital are reserved for poor patients who are provided with completely free services.
The remaining beds have been earmarked for paying patients who will be charged at concessional rates only.
Take moment to Read
Medical Research Foundation, Sankara Nethralaya has completed 19 years of service to the ophthalmic patients of our country.
We are in the process of expansion. We are planning to construct a Community Hospital at St.Thomas Mount, Chennai at cost of Rs.23 crores. We need funds and we request you to extend your helping hands and contribute generously, Donations to the above project are 100% exempted under 35AC of the Income Tax Act 1961.
Mission for Vision – Support our cause (for question and contributions)
In India please contact: Dr.S.S.Badrinath, Medical Director, Sankara Nethralaya (Unit of Medical Research Foundation) 18, College Road, Chennai – 600 006. Tamil Nadu, INDIA Tel : (91-044) 826 1260, 8261265,
827 1036, 827 1616, 8279435
Fax: (91-044) 825 4180
Email : [email protected]
Web Site: http://www.dynacs.com/-sankaranethralaya/
In USA please contact: Mr.S.V. Acharya, Secretary and Treasurer, Ophthalmic Misson Trust inc. (OM Trust) 14613, Pommel Drive, Rockville, MD 20850, USA Tel: (301) 251 0378 Fax: (202) 293 0448
Available
Back issues of certain volumes of Insight Journal.
Insight is the scientific journal of Medical Research Foundation and carries articles on Ophthalmology and related Basic Sciences. Those interested in these back issues may kindly contact The Editor, Insight, Sankara Nethralaya.
Dr. H.N.Madhavan Honoured
Dr.H.N.Madhavan, Director – Research (Basic Sciences) and Vice-President, Vision Research Foundation has been elected as a Fellow of the National Academy of Medical Science(India).This award is an honour bestowed on him as an acknowledgement of his achievements in medical education and research in field of Microbiology.
Dr. Madhavan played a major role in the development of Department of Microbiology particularly virology at Jawaharlal Institute for Post Graduate Medical Education and Research (JIPMER), Pondicherry.
He is known intemationally for his research work in microbiology and has several research publications to his credit. Among the earlist contributors in the investigation of enterovirus infections of the central nervous system in India, his report on the outbreak of Coxsackie virus B6 infection being the first in the literature. He was awarded a Phd. By the University of Madras for his thesis on the role of viruses in myocarditis with particular reference to cellmediated immunity in experimental Coxsackie virus B3 myocarditis.
As Director of Research at Sankara Nethralaya, he has organized excellent research facilities and continues his research work in ophthalmic infections and immunological diseases. He demonstrated the presence of high incidence of chlamydial ocular infections in patients attending Sankara Nethralaya, the first such report in our country. He discovered the existence of Mitomycin (MMC) “sensitive “ and “resistant” strains of Tenon’s capsule fibroblasts in human eye and showed their role in the outcome of the use of MMC in trabeculectomy in glaucoma. His work on virological investigations in retinal inflammation was the first of its kind in our country. He has pioneered rapid diagnostic methods in chlamydial and viral diseases of eye. Under his guidance the Microbiology Research Centre at Vision Research Foundation has developed the polymerase chain reaction, a new molecular biological method, as a tool in detection of several infective agents from clinical specimens. On the occasion of 50 th Anniversary of India’s Independence, Life insurance Corporation donated Rs.13 lakhs to Sankara Nethralaya on 3rd July ’97. They also adopted 13 beds in the general ward. The Chief Invitees were Mr. P. Chidambaram Hon’ble Union Finance Minister, Shri G. Krishnamurthy, Chairman, L.I.C., Shri R.N. Tripathi, Managing Director, Shri B.R. Gupta, Executive Director (Investment). Shri P.V. Subramanian, Zonal Manager, South Zone, Shri H.Faruqi, Chief (PR & Publicity) and Shri R. Subramaniam, Chartered Accountant.
Ocular Tumour Meet
Medical and Vision Research Foundation organized a symposium on What’s New in Ocular Tumours on 7th & 8th February 1998. For the first time the important subspecialty of ocular tumours was dealt with in a separate symposium. For the first time ophthalmologists as well as experts from other oncologists, radiotherapists delivered lectures and took part in interactive discussions of
- disciplines
- like
- pathologists,
- radiologists
- and
challenging cases. The internationally renowned foreign faculty included Prof. Narsing A. Rao and Prof. Ronald L.Green
From Doheny Eye Institute, LA, California, Prof. Edward Howes from University of California, San Francisco and Prof. Jacob Pe’er from Hadassah University, Jerusalem, Israel. Reputed national faculty from various parts of the country also participated. The symposium was attended by 182 ophthalmologists from India, Sri Lanka, Bangladesh, Bhutan and Australia. For the first time, delegates received important duplicated slides of the various presentations made in the conference in addition to a detailed 170 page course book.
LASIK comes to Sankara Nethralaya
EXCIMER PRK & LASIK
- NORMAL EYE
- MYOPIC EYE
Light rays focus(F) on the retina in the back of the eye.
Light rays come to focus(F) in the front of the retina.
.
- HYPEROPIC EYE
- ASTIGMATIC EYE
Light rays come to focus (F) behind the retina.
Light rays do not reach a common focus(F1 and F2 ).
The cornea is clear glass-like structure in the front of the eye. The excimer laser precisely removes corneal tissue alterning the corneal contour. Now light rays can focus on the retina. This procedure is called PPK (Photorefractive Keratectomv)
- MYOPIC PRK
- HYPEROPIC PRK
- ASTIGMATIC PARK
Central corneal tissue removed (Shown in dark blue). To correct myopia tissue is removed in a circular fashion Astigmatism is corrected by removing tissue in an elliptical manner. Hyperopia is corrected by removing a ring of tissue in the mid-periphery of the cornea.
PRK’s predictability is reduced with very high refractive errors. Moreover, increasing removal of corneal tissue required to correct high refractive errors produces haziness of the central cornea with poorer results.
Corneal haze
LASIK
The keratome creates a flap of superficial corneal tissue.
The flap of corneal tissue is lifted exposing the deeper stroma.
The storma is then exposed to the excimer laser beam.
After the laser delivery is completed the corneal flap is repositioned without stitches.
In December 1993, Sankara Nethralaya became the first hospital in India to introduce excimer laser PRK treatment for the correction of refractive errors. LASIK, its new refinement was also recently introduced. With these two procedures. Sankara Nethralaya now offers state-of the – art – treatment for a permanent cure for myopia, hyperopia and astigmatism. Freedom from glasses at last.
Eyelights reviews these two revolutionary treatment and also interviews the man who co- discovered excimer laser PRK – Dr. Rangaswamy Srinivasan.
Refractive Errors
Normally, rays of light entering the eye are brought to a precise focuse on the retina – the light sensitive layer lining the back of the eye. When such a focus is not achieved, refractive error results and vision in not clear. a
When light rays are focused in front of the retina, the resulting condition is termed myopia (short – sightedness). In hyperopia (long – sightedness) , the light rays come to a focus behind the retina. Astigmatism (cylindrical error) occurs when incoming light rays are unable to reach a common focus within the eye.
How are Refractive Errors Corrected?
Non-surgical opitions for the correction of refractive errors include Spectacles and Contact Lenses. Spectacles contain lenses that suitably alter the incoming rays of light and enable them to focus on the retina. Contact lenses perform the same function but are placed on the cornea – the clear front portion of the eye. Hence, they provide better cosmesis and improved quality of vision in the higher refractive errors.
Surgical procedures attempt to eliminate the dependence on external aids like glasses and contact lenses. In Radial Keratotomy, 4 to 8 corneal incisions are made in the peripheral cornea involving 90 to 95% of the corneal thickness. The weakened peripheral cornea is pushed outwards by the pressure within the eye. This results in a flattening of the central cornea which corrects a myopic refractive error.
Similar operations like Hexagonal Keratotomy and Astigmatic Keratotomy can correct Hyperopia and Astigmatism respectively. However all these incisional procedures weaken the structural integrity of the cornea. This theoretically result in an increased tendency for corneal rupture following trauma.
Removal of cornea tissue alters the corneal contour. By specifically removing tissue from different portions of the cornea the surgeon is able to correct the different refractive errors. Removal of central corneal tissue in a circular fashion results in the central flattening and corrects myopia.
When central corneal tissue is removed in an elliptical fashion, astigmatic refractive errors can be corrected.
To Correct hyperopia, a ring of corneal tissue is selectively removed from the mid-periphery resulting in central corneal steepening. Excimer photorefractive keratectomy (PRK) has been in use all over the world since 1987 and has proven to be safe and effective, particularly in the treatment of myopia and astigmatism. However, when very high refractive errors are treated by excimer PRK, the predictability of the procedure is reduced with increased occurrence of undersirable side-effects.
A recent advance in the treatment of such high refractive errors is a procedure termed Laser In-situ Keratomileusis (LASIK). In this surgery, a flap of superficial corneal tissue is cut using a motorized blade.
The flap is lifted exposing the underlying corneal stroma. The excimer laser is then used to perform the appropriate tissue removal in the corneal bed. At the conclusion of laser delivery, the corneal flap is repositioned in its original position. The flap adheres to the underlying corneal stroma without the need for sutures.
Since the corneal epithelium is retained and corneal healing occurs within the corneal layers, the safety and predictability of the procedure is improved, in eyes with high refractive errors.
Both PRK and LASIK are performed as out-patient procedures using topical anaesthetic drops only.
Exquisite Precision
he use of the EXCIMER LASER in corneal refractive surgery has greatly increased the safety of the procedure as the refractive correction is achieved by the removal of as little
Tas 10 to 20 % of the total corneal thickness.
The word “excimer” is contraction of “excited” and “dimmer”. Dimer refers to the combination of atoms of argon and florine gases, to form an unstable molecule. When this unstable molecule breaks down, it emits photons of ultraviolet light which are used in the laser.
The excimer laser is a “cool” laser, and does not generate heat in the cornea. The laser energy destroys intermoleculas bonds in the corneal tissue resulting in tissue removal by a process termed “photoablative decomposition”. The exquisite precision with which tissue can be removed and the absence of thermal damage render this laser particularly suitable for surgery on the delicate cornea.
Who is a suitable candidate for Corneal Refractive Surgery?
You must be at least 18 years of age, with stables refraction for the past 6 months. You should not have any serious eye diseases eg., rtheumatoid arthritis
If you fulfil the above criteria and are interested in undergoing refractive surgery, please contact the following department and demand expeditious service.
EXCIMER LASIK CELL – SANKARA NETHRALAYA 18 College Road, Chennai – 600 006 Phone : 8271036, 8271616 Fax: 91-044-825-4180
E-mail : [email protected]
With Clarity of Vision – Dr. Rangaswamy Srinivasan
SankaraNethralaya was honoured with the presence of Dr. Rangaswamy Srinivasan, the man who co-discovered excomer laser corneal refractive surgery which has allowed thousand of people around the world to see clearly without glasses or contact lenses. Eyelights spoke to this remarkable Indian about his landmark discovery.
This is his fascinating story. here are two breedsof scientists, generally speaking. One can’t help but notice the first species. The media happy and savy types who easily impress us with thir commanding
Tpresence and just that hint of scholarly air. The other kind of genius is publicity shy and
awkward in general company. These backroom boy are happiest holed up in their labs comfortable in the company of impersonal microscopes and the test tubes.
So, which one of these would Dr.Srinivasan be, I wondered as I went to interview him. As it turned out,neither. Or a bit of both maybe?
Appearances are deceptive and this could not be more true than in the case of Dr. Srinivasan. He could very easily have been R.K.Laxman’s Common Man. Dr. Srinivasan was modest and matter of fact when talking about his work. His answers were not only laced with humour but revealed a clear ordered mind, the hallmark of a man of science.
This was the Man who discovered the photoablative effect of ultraviolet light. The man whom millions of people in over fifty countries around the world had to thank for helping them get rid of their spectacles forever. Freedom at last from short sightedness. This was Dr.Rangaswamy Srinivasan, the father of excimer laser PRK (photorefractive keratectomy).
Dr.Srinivasan started his academic life in Madras in the Sri Pennathur Subramaniam High School and later Loyola College where he graduated with B.Sc Honours degree from the University of Madras in Chemistry in 1949. Leaving for western shores he arrived in USA and set about earning a Ph.D degree in protein chemistry at the University of Southern California. He then specialized in organic photochemistry at University of Rochester, New York. Aftr a short stint at the institute now known to us as the Bhaba Atomic Research Centre, Dr.Srinivasan returned to USA to join the IBM Thomas J Watson Research Centre for Physical Sciences in Yorktown Heights, New York, where he worked till his retirement, in 1990. This research institute was well known not only for its favourable scientific environment but also for producing five Nobel laureates.
Because of his interest in photochemistry Dr.Srinivasan was working on ultraviolet light and its photochemical effects. Ultraviolet light had the power to after organic compounds by a process called photodecomposition. This well know effect was utilized by the computer industry for creating for silicon chips by a technique called photolithography.
SRINIVASAN’S LAW
“People discover only what they are looking for”
“You don’t lie awake at night waiting for the Nobel Prize. You might lose a lot of sleep”
Among the many sources of ultraviolet light used in experiments at IBM was the excimer laser. A veritable ugly duckling of its time, the first excimer was a big monster of a machine made in Germany. “It was acquired by one of my colleagues who discovered later that he did not know what to do with it,” recalls Dr.Srinivasan, “so he gladly handed it over to me.” While working on higher wavelengths of ultraviolet light such as that produced by the excimer laser, Dr.Srinvasan found to his astonishment that not only was there a photodecomposition effect but a photoablative effect as well. The material exposed to the ultraviolet light emitted by the excimer laser was slowly being vaporized, vanishing into thin air, all this occurring at a microscopic level. Magnified hundreds of times the photoablative effect of the excimer laser looked not unlike an atomic explosion complete with a mushroom cloud, in miniature of course. “I first tried the excimer laser on biological tissue on Thanksgiving Day and the most handy biological tissue available on that day was the Thanksgiving turkey, a dish I was not particularly fond of. “Dr.Srinivasan later tried the excimer laser on other tissues – a dragonfly’s wing and even his own hair. The effect was visually electrifying. The laser could make precise cuts on a single hair without damaging adjacent cells. The precision was at the level of microns. He spoke about his findings to his fellow scientists at IBM. Initially skeptical, their doubts were laid to rest after further studies proved Dr.Srinivasan right. “My loss of hair is partly due to the number of times I have had to repeat my experiment, “ admitted Dr.Srinivasan, a trifle ruefully.
