Female pioneer in cornea continues to develop innovations

Issue: April 2008

Today, lamellar procedures are an integral part of the cornea subspecialty, but in India in the 1970s, many doubted their ability to help patients. One woman did not let that stop her from seeing the potential of the techniques.

Anita Panda

Anita Panda, MD, had a gold medal in ophthalmology during her MBBS studies but tried her best to pursue a career in pediatrics, she told Ocular Surgery News in a telephone interview.

“My teacher said, ‘You have too much potential in ophthalmology. Why do you want to go for pediatrics?’” she said, laughing.

Dr. Panda said when she was admitted to the All India Institute for Medical Sciences (AIIMS), where she continues to work today, her mentor pushed her to make the move into ophthalmology. She eventually conceded and has since left her mark on the cornea subspecialty.

“Whenever the candidates join or postgraduates join ophthalmology, they are given a thesis topic. This is my good luck or bad luck, whatever it may be, my thesis topic was in cornea,” Dr. Panda said. “It was from day 1 that I was introduced to cornea, and somehow I developed an affinity for the subject.”

Lamellar procedures

When Dr. Panda began clinical work in cornea, in about 1977, she saw lamellar procedures as an area that needed development.

“At that time, very few people were doing lamellar procedures, so I tried my best to develop that in India,” she said. “Abroad, also people were not doing that many lamellar procedures as it is being done today.”

Other physicians did not see that this type of procedure had potential to help many patients, and they disparaged her attempts to further it within ophthalmology.

“When I took present lamellar keratoplasty, they used to criticize: ‘How is lamellar keratoplasty going to work because it is lamellar, so it only interfaces with a part. It will not work.’ No help,” she said.

Still Dr. Panda persevered, beginning with anterior lamellar keratoplasty, which she performed manually until the mid-1980s, when she obtained her first microkeratome.

“Then I used to use a microkeratome only for anterior lamellar keratoplasty,” she said.

In the early 1990s, Dr. Panda said she started doing deep lamellar keratoplasty and eventually, once she succeeded, began performing posterior lamellar keratoplasty.

“My first posterior lamellar keratoplasty was in 1999. That I did manually. I didn’t have any instruments,” she said. “Nowadays, the flap technique is obsolete, so I left that. Now we have shifted to the recent one, which is DSEK (Descemet’s stripping endothelial keratoplasty).”

In 2000, Dr. Panda received the M.N. Sen Oration Award (Indian Council of Medical Research), R.P. Dhanda Cornea Award (All India Ophthalmological Society) and in 2007, PK Jain Oration (Delhi Ophthalmological Society) for her work in lamellar keratoplasty.

Eye banking

While working closely with corneal research and procedures, Dr. Panda also adopted eye banking as one of her causes.

“Our country was severely lacking in eye banking,” she said. “We were not really getting even a handful of eyes. So my intention was how to develop this eye banking.”

Dr. Panda’s biggest contribution to India’s eye banking endeavors was to introduce corneal preservation media, such as McCarey-Kaufman medium (5% dextran, streptomycin, penicillin) in 1981.

Working at the Dr. R.P. Centre for Ophthalmic Sciences within AIIMS, Dr. Panda also helped develop an improved form of corneal preservation media, now called RPC media.

“I thought, ‘How are we sure that this is really working nicely or effectively or not?’ Then I started doing my research, all sorts of research,” Dr. Panda said.

The first area she wanted to look at was the endothelium loss that occurs in the donation procedures, including when the eye is stored in different media.

“How much endothelium was lost?” she asked. “I compared [RPC media] with [McCarey-Kaufman medium] that is available abroad from the U.S.A. Then I have seen our prepared [McCarey-Kaufman] media is on par with that media, and RPC media was even better. So I was very happy.”

In 1988, Dr. Panda and five other eye banking specialists began to discuss the idea of forming a national body to further their goals within eye banking.

“Eye banking was really intensive,” she said. “We had six members, so we just sat and started discussing it. … After 6 months, in 1989, we had constituted the Eye Bank Association of India.”

These six members began to recruit others who were already working in eye banking, she said.

“Gradually, we got a large number of members,” Dr. Panda said. “Now we have a large number of members in the Eye Bank Association of India.”

Today, according to its Web site (www.ebai.org), the executive committee consists of 15 people. The organization is open to any person or group who is committed to the mission of eye banking.

The main goals of the Eye Bank Association of India are to increase donations of corneas and to continue the education of the general population regarding cornea donation.

“Definitely there is increase [in cornea donations], but still we are lacking,” Dr. Panda said. “Previously there was religious taboo. Nowadays I think something else is there. … They are quite ignorant about eye banking.”

This lack of knowledge among the living greatly affects the donation of corneas of the deceased, she said.

“We have to have consent [of the next of kin] after the death. That is the reason, because by this process we’ve lost so many eyes,” Dr. Panda said. “The major drawback in our area isn’t the donor eyes; it’s a problem of our law. Our law does not permit to get the eyes [without consent from relatives]. That is the major setback.”

Even if a person has agreed, before his or her death, to donate the corneas, physicians must still receive consent from the relatives for donation, she said.

“We are trying to change the law, but still we are not successful,” she said. “In our country, everything has to go through parliament. So we are trying … to motivate.”

Current work, future predictions

As Dr. Panda looks to the future, she continues her commitment to corneal research and eye banking efforts. She currently has a large ongoing study on corneal dystrophy, and she sees the promise of artificial corneas on the horizon.

Her corneal dystrophy study is a genetic study looking at as many generations as possible in one family. The study has been under way for a year now, she said.

“If the patient is coming to the clinic and I diagnose it as a case of corneal dystrophy, primarily I’m taking Fuchs’ dystrophy, then I ask them to bring [into the clinic], as far as possible, at least three generations,” Dr. Panda said. “I’m keeping notes on them with history, clinical findings and genetic study.”

In the future, she said she has hopes that an artificial cornea will be developed to further alleviate eye banking concerns.

“I think the future of Indian ophthalmology is to start something with artificial cornea. Once we get an artificial cornea, if we can succeed in that, I think … we won’t depend much on the eye banking,” Dr. Panda said.

For more information:

Anita Panda, MD, can be reached at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India; +91-11-26588162; e-mail: anitap2001@yahoo.com.