Anterior segment expert works to make innovative contributions

Issue: April 2009

For Rasik B. Vajpayee, MD, FRCS(Ed), FRANZCO, a career in ophthalmology was not a consideration when he finished medical school and completed his internship. However, after his first choice of a residency program became unavailable at the last minute, he had to make a quick and tough decision — one which ultimately led him to ophthalmology and a career he loves.

Rasik B. Vajpayee, MD, FRCS(Ed), FRANZCO is the head of corneal and cataract surgery and professor of ophthalmology at the Centre for Eye Research Australia and University of Melbourne in Australia.

Image: Vajpayee RB

“I always enjoy my work, and I live ophthalmology 24 hours a day. But to be frank, I would have equally enjoyed any other profession and helping people,” Prof. Vajpayee told Ocular Surgery News in an e-mail interview.

He is now the head of corneal and cataract surgery and professor of ophthalmology at the Centre for Eye Research Australia and University of Melbourne in Australia. He received his medical degree from Gandhi Medical College in Bhopal, India, in 1981, where he also did his training in ophthalmology. He has completed clinical fellowships in cornea and refractive surgery at the Royal Victorian Eye and Ear Hospital, Melbourne, and the Massachusetts Eye and Ear Infirmary in the United States.

Researcher, author and innovator

Before joining the Centre for Eye Research Australia in May 2005, Prof. Vajpayee served on the faculty of the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, since 1987. Anterior segment, including cornea, cataract and refractive surgery, is his chosen field of medical research specialization.

He has published five books, more than 30 book chapters and more than 250 scientific articles. He is the recipient of several awards, including the R.P. Dhanda Award for outstanding contributions to the All India Ophthalmological Society and the S.N. Mitter Oration by the Delhi Ophthalmological Society.

Prof. Vajpayee’s innovations in the field of corneal transplantation surgery have won “Best in Show” at the annual meetings of the American Academy of Ophthalmology in 2003, 2004, 2005 and 2008. The AAO also honored him in 2005 with an achievement award at its annual meeting. In recognition of his clinical and academic contributions, he was honored with the fellowship ad hominem by the Royal College of Surgeons of Edinburgh.

Choosing medicine

As a child, Prof. Vajpayee watched his mother, who had narrow angle glaucoma, have frequent acute attacks accompanied with severe headaches and vomiting.

“I was very attached to her and used to have panic attacks because of her illness,” he said. “During each of her attacks, I would always tell her that I would become an eye doctor when I grow up and would cure her eye ailment.”

During his high school years in the 1960s, boys from his town were aspiring to become either engineers or doctors. Prof. Vajpayee said he realized that he did not have the aptitude for the complexities of mathematics, so he took biology as a major subject and, subsequently, entered the field of medicine.

Otolaryngology or ophthalmology

At the Gandhi Medical College, the selections for residency programs were made according to a merit list prepared on the basis of marks achieved in three professional examinations. In a class of 150 students, Prof. Vajpayee was ranked in the top 20. There were two seats in orthopedics, and he was sure he would get one seat in the program. At that time, the candidates before him were mostly opting for seats in high-ranking subjects, such as pediatrics, internal medicine, and obstetrics and gynecology.

“I always wanted to be an orthopedist, and I was sure that I would be selected for its residency program in orthopedics,” he said.

However, on the day of the counseling, a candidate before him who was supposed to choose internal medicine opted for orthopedics instead. On being informed by the dean during his counseling session that both seats in the orthopedics residency program had been filled already, Prof. Vajpayee said he felt shaken and did not know what to do.

“I was so sure of getting residency in orthopedics that I had not thought about any other subject,” he said.

Prof. Vajpayee did not want to do general medicine and general surgery, and during those 10 minutes of counseling, he concentrated on two subjects — otolaryngology and ophthalmology. He said he was so tense about making the decision that he could have used a coin to decide between the two programs.

“During that moment of desperation, I applied the simple logic that almost everything in an eye can be seen externally, while in otolaryngology, everything — including ear and throat — are hidden, and one has to use special instruments to poke and look at the structures,” he said.

Another factor that weighed in favor of ophthalmology for Prof. Vajpayee was that the subject offered a practice of both medicine and surgery.

“I think the words I used to speak to my mother had already decided my fate, and as they say, the rest is history,” he said.

Role of mentors

Prof. Vajpayee said having good mentors is key to advancing one’s career, and he has been fortunate to have good teachers and trainers at all stages of his career in ophthalmology. Notable among his mentors are Prof. Santokh Singh, then head of the department of Gandhi Medical College in Bhopal, and Prof. Madan Mohan, who was then chief of R.P. Centre for Ophthalmic Sciences in New Delhi.

“However, two people who have been my true mentors and have made enormous contributions in shaping up my career as an academic ophthalmologist are Dr. Salil Kumar and Prof. Hugh R. Taylor,” he said.

When Prof. Vajpayee was training in ophthalmology, Dr. Kumar was a consultant at Gandhi Medical College Bhopal, and he already had been exposed to his teaching skills during his undergraduate course in medicine.

“He is an amazing teacher, and it was he who taught me how to question everything without fear and bias, and learn to analyze every issue dispassionately. He would go to great lengths to teach us every evening and conduct special clinical rounds — sometimes at 9 p.m.,” he said.

Prof. Taylor was the other person whose mentoring has made a significant impact in Prof. Vajpayee’s career. They met in February 1995 in Melbourne, during Prof. Vajpayee’s fellowship in cornea and external diseases.

Since then, Prof. Taylor has encouraged him to give his best and is still always available by e-mail to answer colleagues’ queries. Prof. Vajpayee said he admires how Prof. Taylor always tries his best to find the best solutions.

“His contributions to ophthalmology in Australia and internationally are colossal, and I have been fortunate to be able to sustain his mentorship during all these years,” he said. “Everybody knows that he is a great teacher, clinician par excellence and an outstanding researcher. But few people know that he has a unique quality of allowing connectivity to his students. It is this connectivity that has enabled people like me to aspire to excel in the field of ophthalmology.”

Research in corneal transplantation

Prof. Vajpayee specializes in cornea and external diseases. His principal area of research interest is corneal transplantation surgery, in which he works to develop newer, safer and more effective techniques. A majority of the techniques have a component of lamellar corneal transplantation surgery. Currently, he is trying to develop newer techniques, as well as to standardize the existing techniques, such as deep anterior lamellar keratoplasty and Descemet’s stripping automated endothelial keratoplasty.

Among Prof. Vajpayee’s other research projects is developing a treatment algorithm for conditions such as keratoconus and keratoglobus.

“We are trying to develop a treatment algorithm for the management of keratoconus cases about the choice of surgical technique in relation to progress and the morphological features of the disease,” he said.

Balance needed

Indian ophthalmologists are talented and equal to their peers from other parts of the world, Prof. Vajpayee said. However, a balance is needed between ophthalmic research pursuits and entrepreneurship.

“We have to learn to enjoy not only using second-hand know-how to improve our skills, but also to strive hard to make path-breaking contributions to the existing knowledge of ophthalmology,” he said. “Indian ophthalmology is a kind of powerhouse now. But power brings a great amount of responsibility, and it remains to be seen how we are able to use this power of knowledge to shape the future course, where equal attention is paid to teaching, research and patient care in ophthalmology.”

Indian ophthalmology has grown quickly in the past 2 decades, Prof. Vajpayee said, and the latest treatment modalities are being offered by a new crop of young and aggressive Indian ophthalmologist.

“We have moved from the era of intracapsular cataract surgery, during my training time, to the state-of-the-art microincision cataract surgery of today,” he said.

Research institutes

Prof. Vajpayee said the establishment of research institutes in the private sector such as the LV Prasad Eye Institute, Sankara Nethralaya and Aravind Eye Hospitals has made a significant positive impact on ophthalmic teaching and training in India.

In the future, he said, a private-public partnership and establishment of small and comprehensive eye care modules in rural and disadvantaged areas of India would be a major step to advancing ophthalmic care in India.

Prof. Vajpayee’s current outreach project is working with the R.P. Centre for Ophthalmic Sciences, in which patients from remote villages in India who need ophthalmic services can go to the hospital for treatment. The community ophthalmology section of the R.P. Centre provides preventive, diagnostic and therapeutic eye care services to those in the developing areas of the country. — by Kristine Houck

Rasik B. Vajpayee, MD, FRCS(Ed), FRANZCO, can be reached at the Centre for Eye Research Australia, L1, 32 Gisborne St., East Melbourne, Victoria 3002, Australia; +61-3-9929-8652; fax: +61-3-9662-3859; e-mail: rasikv@unimelb.edu.au; Web site: www.cera.org.au.