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Expert in uveitis looks to advance the field in India
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One of the earliest experts in uveitis in India attributes his knowledge of the disease not to specific professors or courses he took during medical training, but to the introduction of angiography in India in the early 1970s.
 Amod Gupta |
“I didn’t have any formal training, so you could call me a self-trained uveitis expert, if there is anything like that,” Amod Gupta, MBBS, MS, said in a telephone interview with Ocular Surgery News.
The angiogram provided constant opportunities to learn about new diseases and new disease expressions.
“I used to do my own angiograms, and I must have done several thousand angiograms in the last 25 years,” he said. “That kind of opened my eyes.”
According to Dr. Gupta, he and colleagues would make clinical observations and then go to the local library to search the journals for precedents and to compare their findings with others.
Using this process, Dr. Gupta said he created a database of cases that has helped educate ophthalmology students at the Postgraduate Institute of Medical Education and Research (PGI) in Chandigarh, where he has been the head of the department for the past 18 years.
“We have a huge database formed as a kind of learning resource. You could go back to the record and see and learn for yourself,” he said. “That is how, at this institute, we grew up learning something new every day and building up on that experience over a period of time. So that is how I got to become a kind of uveitis expert.”
When retinal surgeons were scarce
After Dr. Gupta completed his basic medical training in 1973, he went on to ophthalmology training, which he completed in 1976.
“I happened to join ophthalmology because of my uncle, who was a famous ophthalmologist in this area,” Dr. Gupta said. “He had done extremely well for himself, so [my family] thought that I should try to match him in life.”
But it was a lack of retina specialists in India that persuaded Dr. Gupta to specialize in back-of-the-eye diseases.
“In the ’70s, somebody doing retinal surgery in India was a great phenomenon, and that is how I got interested,” he said.
Not only were retinal specialists scarce, but record-keeping was not a common practice, according to Dr. Gupta. So when angiography emerged, conditions were favorable to begin building the comprehensive database that would lead to his career-defining work.
“We started seeing lots of posterior uveitis, and they were different. They were not like what is described in the Western literature,” he said.
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Images: Gupta A |
Recognizing choroidal tuberculosis
It was about 10 years ago when Dr. Gupta began taking his observations of posterior uveitis further by using polymerase chain reaction to detect Mycobacterium tuberculosis in aqueous samples.
Initial work that Dr. Gupta and colleagues had published in the journals Acta Ophthalmologica Scandinavica and Tubercle and Lung Disease demonstrated that uveitis and intraocular tuberculosis were linked.
“The major contribution is recognizing tuberculosis as a major part of uveitis in this part of the world,” he said.
This work allowed Dr. Gupta to describe the clinical characteristics of retinal vasculitis in patients who tested positive for tuberculosis, leading to a membership in the International Uveitis Study Group.
Subsequent work led to the recognition and description of serpiginous-like choroiditis as a manifestation of choroidal tuberculosis.
“Now this has been seen in people of Indian and Asian origin, wherever they are,” Dr. Gupta said.
The next step will be to create guidelines for diagnosing latent tuberculosis and treating it in patients with uveitis, he said.
“Some of us feel that it’s a major challenge, and latent tuberculosis needs to be treated in patients with uveitis,” Dr. Gupta said. “We have submitted an abstract for the American Academy [of Ophthalmology Meeting], and hopefully it should get accepted because we are putting together the experience of treating several hundred patients of latent tuberculosis who had uveitis.”
The Uveitis Society of India
To build interest in a field that was still in need of Indian specialists, Dr. Gupta helped create the Uveitis Society of India 6 years ago.
“There are no [Indian] ophthalmologists seriously looking into uveitis. This is one area that is absolutely open. We still have some 200 retinal surgeons in this country now, but there are fewer than 20 uveitis experts,” he said.
According to Dr. Gupta, the Uveitis Society of India has helped to build an interest in other groups such as the All India Ophthalmological Society.
“There would be hardly any uveitis sessions or uveitis lectures or symposia or instruction courses, and since then, now if you ask me, there is so much enthusiasm, and every hall, every course, the hall is jam-packed. There is no standing space because suddenly people want to know more about uveitis, so I think we got the ball rolling in that field,” he said.
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Images: Gupta A |
Working to control diabetic retinopathy
In addition to his work in uveitis, Dr. Gupta has focused on diabetic retinopathy, which he says is a major problem for India.
“The number of diabetics in India is almost two and a half times than that in the U.S., and by 2030, this number is going to become 80 million,” he said. “We will never have the infrastructure to manage the complications of diabetes, so we need to focus on the control of diabetes.”
According to Dr. Gupta, he found that when treating diabetic patients in India, oftentimes the patients did not realize they were ill until they were symptomatic and had lost vision. With this lack of initial treatment, he realized the importance of waiting before treating with laser.
“When the patient comes to your clinic, please don’t start shooting laser unless it is urgently warranted,” he said. “If it is a diabetic macular edema only, wait for a few days, get the profiles done, get them under the supervision of a physician and wait for laser for 6 weeks.”
Dr. Gupta calls these preliminary precautions “multifactorial interventions.” By doing this, he and colleagues found that 30% of patients gained two lines of improvement.
“There was a study done almost 25 years ago where they said that when you treat diabetic macular edema, you reduce the risk of losing further vision by almost 50%. They never talked of improving the vision,” he said.
Based on his work showing improvement, Dr. Gupta was made the first native Indian member of the Macula Society.
Creating a research center
With 12 faculty and 16 residents, the department of ophthalmology at PGI is a small one, according to Dr. Gupta. Despite the size, he said he hopes to transform the department into an independent research facility on par with centers in Hyderabad and Chennai.
“Earlier, we were trying to collaborate with research institutes, and now we want to be on our own feet, so that will be my focus in the next 5 years,” he said. “We should be able to lead research for our own diseases and not depend on others.”
He has spent the past 18 years developing the Advanced Eye Center, which recently opened within the PGI campus. Now that there are facilities for doing research, Dr. Gupta said he hopes to begin producing more research work.
“I am trying to encourage my faculty to get some funded research protocols,” he said.
The other factor, he added, is producing top-quality ophthalmologists who are ready and willing to ask the important questions.
“Meetings are well-attended. Not only are [ophthalmologists] listening, they are asking questions. That is where I see hope,” he said.
For more information:
- Amod Gupta, MBBS, MS, can be reached at the Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India; +91-172-2747837; fax: +91-172-2747837; e-mail: eyepgi@sify.com.
References:
- Arora SK, Gupta V, et al. Diagnostic efficacy of polymerase chain reaction in granulomatous uveitis. Tuber Lung Dis. 1999;79:229-233.
- Gupta V, Gupta A, et al. Presumed tubercular serpiginouslike choroiditis: clinical presentations and management. Ophthalmology. 2003;110:1744-1749.
- Singh R, Abhiramamurthy V, et al. Effect of multifactorial intervention on diabetic macular edema. Diabetes Care. 2006;29:463-464.