N E W S E R V I C E A T S A N K A R A N E T H R A L A Y A

Madras South Round Table 39 OCULAR PROSTHETIC SERVICE

The Ocular prosthetic Service, a new addition to the department of Ophthalmic Plastic Surgery was recently commissioned and inaugurated at Sankara Nethralaya on 23rd August 2001. In fact, it will be the first time in India, that an ocularist and a dedicated ocular prosthetic service is attached to an Oculoplastic Department in a Major Institution. patients who have had the misfortune of damage to one or both eyes through trauma, infections, tumors or other reasons, undergo surgery to remove the eye with the placement of orbital implants. These patients are subsequently fitted with an artificial eye (prosthesis) which has traditionally been done from a selection of readymade 'stock eyes'.

With the development of the Ocular Prosthetic Service, we hope to 'customize' the fitting of an artifical eye to fit the socket comfortably. This will improve cosmesis, with better movement of the artifical eye thereby offering an overall improvement in appearance and psychologtical rehabilitation.

Other specialized treatment modalities like customized pressure conformers/socket expanders, designing spectacle mounted prosthesis and even fcilities to couple the artificial eyes to underlying implants will be made available.

The ocular Prosthetic Service has been made possible by generous contributions from Madras South Round Table 39 and 'Beach City Friends', Chennai. The service was inaugurated by Mr Jagannathan CMD of United India Insurance Ltd. Dr. Nirmala Subramaniam, the Head of the Orbit and oculoplastic Services received the keys to the department. Ms. Vijayalakshmi, a Senior Optometrist has been trained specially for this service by Dr. Chandrasekhar Chawan, a renowned ocularist based in Mumbai and Miami. She will be offiering the service under the division of Ophthalmic Plastic and Reconstructive Surgery at Sankara Nethralaya, Chennai. Çxà{ÜtÄtçt Çxãá

Histopathology Department in Sankara Nethralaya got a new microwabve oven. It is obviously not for cooking. In recent years, microwave has been found to be useful for various histopathologic procedures particularly in processing and staining. In addition, immunostaining can be done in faster way through the microwave. Antigen retrieval, a specialized procedure in immunostaining can be done better with the microwave. A small pooja was held on 2nd August 2001 between 11.30 to 12.00 Noon which was attended by Basic Science Department staffs. Ms. Vanitha, senior histopathology technician inaugurated the function.

i N N O V A T I O N

Amino Acids like tyrosine, phenylalanine, cysteine, homocystine are associated with inborn errors of metabolism. Identification and estimation of amino acids in children with a specific error could save their life. Our institute has the facility to perform this analysis. This investigation requires a chemical named Ortho pthalaldehyde (OPA) supplied by Hewlett Packard, Germany which is very expensive and short lived.

S.Lakshmi, scientist in the Department of Biochemistry standardized the preparation of this reqgent indigenously. Hence it is now available for lesser cost, with the same quality. Our organization has greatly benefited both financially and also by eliminating the hurdles in procuring the chemical from Germany.

FRCS REVISION COURSE

The third Revision Course in Ophthalmology for FRCS was successfully conducted from 27th June to 3rd July 2001. Forty eight people participated in the revision course from India and abroad.

The invited guest faculty included Dr. Adrian Koh, Singapore; Dr. Viswanath padmanaban, Singapore; Dr. T.K. Ramesh, Bangalore and Dr. G.Sathish, Chennai.

New Integrated Computerised Hospital Management System

Medical Research Foundation and Larsen & Toubro Infotech Limited have worked together in the implentation of the New Integrated Computerised Hospital Management System for the first time in an ophthalmic institution in India. The System comprises of the modules for the Outpatient system, In-patient system, Medical records, Eye Bank and Inventory management. S N ALUMNI MEET

The 7th Sankara Nethralaya Alumni Scientific Meeting was organized on 28th August 2001 from 6.00 pm to 9.00 pm.

It was a well organized annual scientific get together of previous fellows and consultants held in the evening of 28th August 2001. The evening commerced with a guest lecture by the invited speaker Dr. Eva Kohner of the United Kingdom.

As many as 15 papers were presented in the scientific forum by alumni. Dr. Manoj Saswade, who is now a consultant at Sri Ganapathy Nethralaya, jalna, Maharashtra was awarded the "Late Dr. S. Nataraja Pillai Best Paper Award". The award was received from the Cheif Guest, Professor Selvasundari, Director of Regional Institution of Ophthalmology, Chennai.

ESO-13TH Graduation Ceremony

The 13th graduation ceremony of the Elite School of Optomery was held in the premises of ESO, St. Thomas Mount, Chennai on 18th August 2001. Dr.S.Srinivasan, Principal, ESO delivered the welcome address. The chief guest of this ceremony Prof. A. Rajasekaran, senior urosurgeon and past president of the the National Borad of Examinations, New Delhi delivered the convocation address. 31 graduates received their degrees and prize on graduation day.

8th Sri V Venugopal Memorial Endowment Lecture

The eighth Sri V.Venugopal Memorial Endowment lecture, organized by the Sankara Nethralaya. Medical Research Foundation and Vision Research Foundation instituted in the year 1994, was delivered by Dr. Pratap C Reedy, Chairman, Appllo Hospitals, Chennai, on 8.9.2001.

The Government must take steps to make health insurance a viable proposition and declare healthcare a socially relevant infrasture industry. Dr. Reddy said.

Suggesting that the state move away from tertiary healthcare delivery, Dr. Reddy, however, mapped a greater role for the Government in making health insurance 'compulsory'. He foresaw a greater role for the private sector in secondary and tertiary quality care, but said the Government must be a catalyst and accelerate the transformation. preventive and primary care must be made available freely, with a highly integreated approachencompassing food, nutrition, sanitation, drinking water and education. In this context, the new role definition for the health ministry would involve drafting a common strategy and orchestrating implementation by all departments. Talking about the impact technological and scientific advancements would have on health care delivery, Dr. Reddy said the mappingof the human genome would bring different dimensions to preventive health care. Solution would get personalized and customized. Diagnostic services were going to be more accurate, cheaper, safer, faster and accessible.

Another significant issue was consumer activism, a movement which would become active in the healthcare sector,. With the net opening up opportunities for the consumer to access information, he would insist on participating in the decision making process.

Dr. T.S. Surendran, Medical Director, Sankara Nethralaya, Dr. S. Bhaskaran, Head, Department of Internal medicine and Mr. V Govind, family member of Sri V Venugopal, spoke in the meeting.

Dr. C. Balasubramanian Best Outgoing Fellow 2000-01

Dr. Iyer Geetha Krishnan Best Outgoing PG of the Year 2000-01

Dr. Anand Pamparkar Best Outgoing DNB PG 2000-01

Dr. G.Kumaramanickavel Best Research Worker of 2000-01

Dr. A R Anand Best Research Fellowship Training Student of Year 2000-01

Dr. Parveen kharbanda The Indian Society for Prevention of Blindness Prize for 2000-01

Dr. M. Baskaran Best Junior Consultant / Associate Consultant 2000-01

Dr. Lingam Gopal Asst.Medical Director

Dr. Lingam Gopal was awarded the best Researcher Award from the Andhra Pradesh Academy of Science on 12.09.2001. The selection for this award was made by the padmabhushan Sri P. Siva Reddy Endowment Award Committee.

FOUNDATION DAY CELEBRATIONS

Foundation Day was celebrated in a grand manner on 09.09.01 wherein Cultutral programmes by employees were organised.

As a part of Foundation Day celebrations, a Blood Donation Camp was organized on 08.09.2001, wherein 93 of our employees donated blood. The camp was conducted by Dr J. Balasubramaniam (VHS, Adyar) and his team & Madras Vouluntary Blood Donors Association.

ISLSM WORLD CONGRESS 2001

Recent advances in laser application relating to disease and treatment in various specialities were discussed at a 4 day conference - 14th World Congress of the International Society for Laser Surgery and Medicine (ISLSM) held at Chennai from 27th to 30th August 2001. This is the first time that this meeting has been held in India.

The conference was organized by Dr.B.Krishna Rau, who was elected President of the ISLSM. The applications of laser in various specialities such as ENT, denistry, ophthalmology, cosmetology and gastro enterology were highlighted.

The ophthalmologhy symposium lasting 3 days was organized by Dr.S.S.Badrinath and Dr. Mahesh P Shanmugam of Sankara Nethralaya. Financial suppport by Cart Zeiss, Bausch & Lomb, Novartis, FDC and Blue Cross contributed to the success of the programme. This sub-speciality module featured symsposia on the uses of laser in oculoplasty, cornea, cataract, galucoma and retinal diseases.

" I have never been honoured in my own country like this before".

Among the invited international speakers at the 14th World Congress of the International Society for Laser Surgery and Medicine was Dr. R.Srinivasan who was honoured with a citation. Dr SRinivasan discovered the use of the Excimer Laser in reshaping the corneal contour which revolutionized the field of refractive surgery, enabling millions of people to get rid of glasses forever.

Taking Glaucoma Awareness to the Villages

Dr.G.Kumaramanickavel reports

It is four months since Sankara Nethralaya has commenced the epidemiological project on glaucoma in Jagadguru Kanchi Sri Chandrasekarendra Saraswathi nethra Nilayam. Here the rural people were examined and those who needed spectacle correction were given free glasses or underwent free cataract surgery. This programme was sponsored by the Chennai Wellingdon Foundation and the Tulsi Trust.

Dr. L.Vijaya, Dr.G.Kumaramanickavel and their team members along with Mr.N.J. Samuel, General Manager of Chennai Willingdon Corporate Foundation and Mr. C.S. Durai of Tulsi Trust reached Thirupanthiyur viallage. The villagers gave a traditional welcome with Nadhaswaram Guest for the function was Dr.(Mrs.) D.Rajakumari, Medical Officer of the local Primary Health Care Center, People from Thirupanthiyur, Agaram, Thirumanikuppam and vasanampattu villages belonging to the panchayat of Thiruvallur district gathered in the village schoolyard for the function.

The programme started with a welcome address by Mr.N.Kumar, Advisor of the village V.O.C Youth Association. The traditional kuthuvillaku was lit by Dr.L.Vijaya. The villagers honored the team members with a shawl as a token of respect. It was followed by the project report by Mr. Madhanraj, social worker, Dr.G.Kumaramanickavel gave a general speech to the villagers about our project. He thanked the 73% of the villagers who have responded to the project and requested the remaining 27% to come. The village school children performed cultural programme to entertain the gathering. Twenty- five villagers voluntarily pledged their eyes for eye donation and the forms were handed over to Dr.L.Vijaya during the meeting. Spectacles were distributeed to the patients. Vote of thanks was given by Mr. K.Elumalai, President of V.O.C. Youth Association. The villagers then provided snacks to the project team.

A total of eight hundred people attended the function and the villagers told that this was one of largest response of the villagers and our resolve to strive harder for their benefit strengthened.

Glaucoma Awarness for You

The eye has its own internal "plumbing" system that circulates a fluid called aqueous fumour. Aqueous is constantly produced in the eye and drains out of the eye through microscopic channels.

When something goes wrong with this plumbing system the pressure of the aqueous humour (intraocular pressure) builds up. This can damage the delicate optic nerve which transmits visual information to the brain. This condition is called glaucoma.

Damage to the optic nerve results in blindness that initially affect side vision only. Because central vision is still clear, people seldom notice this loss until considerable optic nerve damage has already occurred. Hence glaucoma is also called 'the silent thief of sight'. If unrecognised or untreated, eye sight can be lost forever.

1. Measuring intraocular pressure by applanation tonometry.

2. The Humphrey Field Analyzer evaluates visual fields.

3. The Optic Nerve: Normal (Left) & affected by glaucoma (Right).

4.The GDx Nerve Fibre Analyzer for early diagnosis of glaucoma. for further information cotact: Glaucoma Clinic at Sankara Nethralaya e-mail: [email protected]

Argon Laser Treatment at Sankara Nethralaya

LASER TRATMENT FOR THE EYE

Reshaping the Future of Vision

Novelties have appealed to human beings ever since mankind existed. So it is not unusual for patients and doctors to share fascination for the latest procedure or the newest equipment. Lasers are at the focal point of these converging interests. The era of lasers began in the 1950s. The word laser is an acronym, standing for Light Amplification by Stimulated Emission of Radiation. It is a device that produces a powerful beam of highly "Coherent" electromagnetic radiation.. The uses of lasers in today's world are too numerous to list - be it the CD player at home, or the bar-code reading device at the supermarket. Laser light is endowed with the ability to carry an enormous amount of energy. It is this energy that is harnessed by doctors to burn, disrupt or ablate abnormal or unwanted tissues in the eye in a very controlled manner without any damage to adjacent tissue. The eye, with its optical accessibility to light, is especially receptive to laser treatment. This article describes how the awesome destructive poser of the laser is harnessed as a sight saving device. Also highlighted is the fact that India does not lag began First World countries - neither in availability of instruments and equipment nor in knowledge and expertise. Laser in Retinal Diseases The retina is the light sensitive layer of the eye. Its central and most sensitive area is the macula, which helps one see fine detail such as these words. Retinal Vascular Disease Diabetes mellitus (high blood sugar) and hypertension (high blood pressure) can affect the retina. Small retinal blood vessels are damaged and leak, resulting in swelling of the macula. The ability to read and appreciate fine detail is impaired.

Tiny laser burns, a few hundred microns in size , are applied on the retina closing the tiny leaking vessels in the macular region thus restoring retinal function.. In advanced diabetic eye disease, fragile new blood vessels bleed in the the cavity of the eye. The laser is used to destroy the stimulus for abnormal new vessel used to destroy the stimulus for abnormal new vessel formation and lower the risk of bleeding. Argon Laser treatment was introduced for the first time in India by Sankara Nethralaya at Chennai in 1979.

Ocular Tumours

An ocular tumour before (L) and after (R) treatment

Laser is particularly useful in treating young childrn who develop a cancer called retinoblastoma. A child with this tumor can have a white reflex at the pupil, much like that of a cat's eye caught in the other vasular tumors and malignant melanoma, Transpupillary Thermotherapy, initiated for first time in India at Sankara Nethralaya, is a new technique using the diode laser that has been found to be effective in many eye caners.

Transpupillary Thermotherapy

Retinal Detachment

Laser are also widely used to treat retinal detachment - a condition where holes in the retina cause it to separate from its underlying layers causing loss of vision. As a preventive measure, laser is used to seal the hole. Laser are also used extensively in advanced stages of retinal detachment along with the vitrectomy surgery.

Age Related Macular Degeneration

Age related macular degeneration (ARMD) is another disease that affects the macula of the retina in the elderly. Reading vision is affected and gainful employment impossible. In one form of ARMD, early laser treatment arrests progression of ARMD, Transpupillary Thermotherapy, is a newer laser treatment effective in a subset of ARMD patients and has been in use at Sankara Nethralaya for treating patients since 1999.

Photodynamic Therapy (PDT) is the new weapon in the battle against ARMD in situations where simple laser can do more harm than good. This laser-assisted technique introduced at Sankara Nethralaya has raised the hopes of many ARMD patients for whom no treatment was available until recently.

Laser in Cataract Surgery - What They Can and Can't Do!

Cataract is a condition where the normally clear lens loses transparency with age. Phacoemulsification is currently the most advanced technique of cataract surgery. It involves breaking the hard catacactous lens within the eye using ultrasonic energy.

Laser cataract surgery has received much attention. Although the use of Erbium: YAG laser energy does have some theoretical advantages over ultrasonic energy it is still to gain widespread acceptance. The laser is unable to remove the harder varieties of cataracts, which is common in India.

In contrast, experienced surgeons can remove 95-99% of cataracts using the ultrasonic phacoemulsifier. The few published reports of clinical trials using laser- based cataract systems indicate that phacoemulsification is at present the better technique.

Treating After-Cataract

A common postoperative change after Intraocular lens implantation is opacification of its supporting capsule - a condition termed after cataract. This results in blurring of vision. The least invasive and safest method of treatment an after-cataract requires the use of a neodymium yttrium-aluminum-garnet(Nd:YAG) laser. This laser is an accepted modality of treatment. Sankara Nethralaya was the first institution in India to install the Nd:Yag laser.

Laser Corneal Refractive Surgery - Vision Correction for the Millennium

Light entering the eye passes through the cornea (the front surface of the eye), which bends the light rays to initiate focussing on the retina. Refractive errors like myopia (short sight) and hyperopia (long sight) are conditions where light does not focus accurately on the retina. Clear vision is not possible without the aid of correcting spectacles or contact lenses. Refractive errors are a significant cause of visual impairment in India.

Excimer Laser

In the 1980's Dr.Rangaswamy Srinivasan, a New york-based scientist of India origin, introduced the excimer laser to ophthalmology to reshape the corneal contour to correct refractive errors. It delivers high-energy ulttraviolet rays to the corneal surface resulting in sub-micron precision in the corneal sculpting. The introduction of Laser-Assisted In Situ Keratomileusis(Lasik) increases the predictability of the procedure freeing patients from their dependence of glasses and contact lenses.

Excimer Laser Lasik

Pionnering Steps

In 1993, Sankara Nethralaya commissi9oned the first modern excimer laser in India. The institution is engaged in research to increase our understanding of the procedure and was one of the first to publish results of this procedure in Indian patients. Nethralaya specialists aslo conducted instruction courses on LASIK at the recently concluded meeting of the American Society of Cataract and Refractive Surgery at San Diego, California which is considered the premier meeting for refractive surgeons in the world.

"Supper" Vision

The most exciting and recent development is customized corneal ablation which takes into account the ocular characteristics of individual patients. Aberrometry is a procedure that allows an instrument to map the optical imperfections of the eye's optical system. The ability to correct these aberrations allows the patient to achieve visual acuity better than what he or she had before the procedure - a phenomenon called super-vision or hyper-vision, Sankara Nethralaya is all set to acquire this exciting new technology shortly.

Laser in Glaucoma - A light in the darkness

Glaucoma is the second most common cause of blindness in the world. Aptly named a 'silent thief of sight', this disease is largely underdiagnosed because of its silent nature. Early diagnosis and management is the key for which Sankara Nethralaya is equipped with instruments like the GDx Nerve Fiber Analyzer and Ultrasound Biomicroscopy, Lasers are used in various stages of glaucoma in a preventive, supportive or active role. New lasers are under evaluation to be used instead of surgery. In a decade, glaucoma will be treatment with simple laser techniques safely and effectively. Laser have generated equal excitement in the scientist as well as the common man, it has applications in modern warfare. Doctors create new methods of treatment, and ultimately preserve vision by using the inherent destructive nature of lasers. The medical uses of the laser, a result of many decades of research by medical scientists, give us hope that mankind will not apply it to self-destruction.

for further information contact:

Sankara Nethralaya 18 College Road, Chennai 600 006 Phone: 826 1265, 827 1616 Fax: (044) 825 4180, 821 0117 e-mail: [email protected]

2000 - 01 STATISTICS Community Service at Sankara Nethralaya

Growth-Outpatients Growth-Surgeries "Let the word Sankara of Sankara Nethralaya ever remind me and my associates His Holiness' command that there be a missionary spirit in the project."

Revenue Foregone

Tuamasama Jyatirgamaya (from Darkness to Light)

They did not just lose their vision. They lost their jobs, could not move about, and more importantly lost their status as important members in their families and finanlly their self-confidence. Their stories tell us how vision loss degrades the quality of life and how restoration of vision is like a rebirth.

A team from Tulsi Trust (who greatly assist Sankara Nethralaya in its community service work), visited small towns and villages where poor patients operated by Sankara Nethralaya live. All they were armed with was simple camera. They captured on film our patients at home and work. The pictures, some of which are reproduced here, speak for themselves. They powerfully drive home the point that vision is the most important of the five senses that God has given us.

For poor patients with cataract blindness, the Jaslok Community Ophthalmic Centre at Sankara Nethralaya stands as a beacon of light. They come to us with their vision profoundly impaired, sometimes practically blind. With the blessings of the Paramacharya, we return them their sight... at no cost to the patient.

Sankara Nethralaya is proud to be the instrument of change.

With your help we can continue to return vision. With your help we can continue to restore hope. With your help we can continue to change lives. With your help.

Name E.pattu Name Annamma Age 85 years old Age 61 years Residence Tandalam village, Residence Pudu Colony, Aranvoyal, Kanchipuram district, Tamil Tiruvallur District, Tamil Nadu Nadu Occupation Fruit Vendor Occupation Agricultural labourer Before Surgery She was unable to continue Before Surgery Could not see enough towork her job. Not able to walk on and stopped accepting the road. Unable to identify assignments. currency notes. After Surgery She is able to look after After Surgery She is receiving assignments herself. reqularly and contributing to Resumed her fruit vending the family kitty. business as a hawker. Respected in her family.

Name Gothandam Name Kesavan Age 59 years Age 67 years Residence Nambi Nagar, Residence Pattabiram, Poonamallee, Tiruvallur District, Tiruvallur District Tamil Nadu Tamil Nadu Occupation Auto-rickshaw driver Occupation Mobil tea stall vendor. Before Surgery Not able to drive in Before Surgery Found it difficult to the night. Found it take care of his difficult to support business. his family. After Surgery Is able to drive both After Surgery Restarted his during night and business Able to daytime. Feels support his family. useful to his family.

Name Rajammal Name Nirmala Age 62 years Age 24 years Residence Pattabiram, Residence Sathy Nagar, Tiruvallur District, Pandeswaram, Tamil Nadu Tiruvallur district, Tamil Nadu Occupation Housewife Occupation Labourer Before Surgery She had to employ Before Surgery She was not able to outsiders to look get married due to after the cattle. poor vision. After Surgery She is able to After Surgery Happily married and maintain cows very blessed with a child. well. Family status She is also able to has significantly get short improved. assignments and earn for her family.

A N A P P E A L

Dear Friends, Time files. Yes! Sankara nethralaya is almost 25 years old. Sankara Nethralaya is a bold experiment in the health care delivery system in India. We are the first eye institute to be ISO 9002 certified for quality consciouness. Whether it is for the 38% of poor or 62% of paying cadre of patients we offer a single standard of service - the best. Sankara Nethralaya is probably the only charitable non-profit organization which has full time salaried professional core. Our consultants don't practice outside or hop from one hospital to another. They concentrate their energies in only one institution so the ultimate service is for the patient, and only for the patient. It is cost effective for consumers as the organization is non-profit and charitable. None other than Mr. Nani A palkhivala has described Sankara Nethralaya as the best run charitable organization in India. We meet our recurring expenditure from the hospital collections, However, expansions require public support - donations. The recent Willingdon expansion has cost Rs. 27 crores (2.7 millions). to mitigate the loan early we need your support. We shall continue on with our avowed objectives of quality service, training, teaching and research. Won't you support an organization with accountability, creditability and transparency in its functioning.? Your donations are Income tax exempt and are eligible for 100% or 125% tax deductions. Send your cheque either to : Medical Research Foundation (35 AC tax excemption affords 100% deduction), or Vision Research Foundation (35 (i) (ii) exemption affords 125% deduction). You may also consider OM Trust recognition if you are living in USA which has 100% IRS tax exemption in USA. Get maximum income tax benefit with the deductions while supporting our cause. with best wishes and regards,

Dr.S S Badrinath V I S I O N

f o r t h e m i l l e n n i u m SANKARA NETHRALAYA a household name in eye care in India

YES, I WANT TO HELP

Your donations are income tax exempt and are eligible for 100% or 125% tax deductions. Get maximum income tax benefit with the deductions while supporting our cause: Medical Research Foundation 35AC tax exemption affords 100% deduction Vision Research Foundation 35 (i) (ii) exemption affords 125% deduction OM Trust in USA 100% IRS tax exemption For questions about tax exempt status and contributions, Please contact:

Dr. S.S.BADRINATH, Chariman, Sankara Nethralaya (UNIT OF MEDICAL RESEARCH FOUNDATION) 18 College Road, Chennai 600 006 Phone: 826 1265, 827 1616 Fax: (044)825 4180, 821 0117 INTERNET e-mail:[email protected] WEB SITE: http://www.sankaranethralaya.org

Mr. S.V.ACHARYA, Treasurer Ophthalmic Mission Trust Inc. (OM Trust) 14613, Pommel Drive, Rockville, MD 20850, U.S.A. Phone: (301) 251 0378. INTERNET e-mail: [email protected]

The Issue of Eyelights is sponsored by : M/s. Rampion Eyetech Pv.Ltd. Kalash, New Sharda Mandir Road, Paldi, Ahmedabad - 380 007. M/s. Apex Laboratories Pvt.Ltd., 44, Gandhi Mandapam Road, Kotturpuram, Chennai-600 085.

Edited & Designed by Dr.Navin Jaykumar & Dr.M.Baskaran. Typeset by A&S Dizyn. Printed at Gnanodaya Press, Chennai -600 034.