This article is more than 5 years old. Information may no longer be current.
Ophthalmic innovator balances love of surgery, research and teaching
Click Here to Manage Email Alerts
When asked why she enjoys being an ophthalmologist, Soosan Jacob, MS, FRCS(Glasgow), DNB, MNAMS, said because she can do surgery, research and teach in a field that she loves. As a self-described hands-on person, she would not like to sit in an office and do mental mathematics.
“What brought me to ophthalmic surgery is that it is technology-driven, precise and elegant. You get fantastic, immediate results,” Dr. Jacob said.
With teaching, she has found her way to give back to the profession. She said she enjoys talking on topics of interest and is part of the invited faculty in numerous national and international conferences, as well as a course co-instructor at American Society of Cataract and Refractive Surgery courses. She is involved in multiple publications, is a contributing author to numerous chapters in ophthalmic textbooks and has co-edited five textbooks in ophthalmology.
Research offers her the opportunity to drive innovations and be at the cutting edge of the technological and surgical revolutions in ophthalmology.
“Each person’s work should be like a ripple in a pond spreading exponentially. When you do and learn so much, there is no point in keeping it all inside of you. It doesn’t make sense to just sit in your own cocoon and be in a pseudo comfort zone,” she told Ocular Surgery News in a telephone interview.
 Soosan Jacob, MS, FRCS(Glasgow), DNB, MNAMS is a senior consultant ophthalmologist at Dr. Agarwal’s Eye Hospital in Chennai. Image: Jacob S
|
Dr. Jacob is a senior consultant ophthalmologist at Dr. Agarwal’s Eye Hospital in Chennai. This is the main center of the Dr. Agarwal’s Group of Eye Hospitals, which currently has 27 branches, 140 ophthalmologists and more than 1,000 employees. She is part of the international training program that the hospital runs for phaco, LASIK and oculoplasty and is on the faculty for the teaching program for post-graduate students of the National Board of Examinations in the field of ophthalmology.
Choosing a career path
Dr. Jacob said she initially thought of medicine as a career because it seemed a safe bet for a stable and fulfilling life.
“It would be an inexact truth to say I wanted to be an ophthalmologist from my early days,” she said. “But having a crusty, old relation with progressive blindness, which I later learnt to be due to cataract, and stoutly refusing surgery might have made a subliminal impression on my mind.”
Another influence was that as a child, she listened to beautiful Western classical music sung by blind vocalists. Dr. Jacob said she thought that their voices sounded heavenly but often wondered what was wrong with their eyes.
Then, during her third year at Medical College Kottayam in Kerala, she made a discovery. A professor, who was often without a stethoscope and rarely used one, told her that she could use her hands and brains while performing surgery. Dr. Jacob said that was probably her “eureka” moment into ophthalmology.
“Here was surgery without bloodshed and with instant gratification. Once the interest was born, the rest of the pieces fell in place,” she said.
It was then that Dr. Jacob realized that her journey in ophthalmology had only just begun.
“What amazed me, then and even now, is the feeling I get — can I call it a high — when a patient after cataract surgery holds my hand and says, ‘You are the first and most beautiful thing I have seen in 5 years,’” she said.
Mentors and role models
“A mentor is one who shows you the path and encourages you to travel the path, even though he himself might or might not have conquered it,” Dr. Jacob said.
Prof. S. Viswanathan, her post-graduate teacher at the Regional Institute of Ophthalmology, Madras Medical College in Madras, was her earliest mentor.
“In a world of myriad subspecialties, he encouraged me to find my own interest,” she said.
From there, she joined Dr. Agarwal’s Eye Hospital, Chennai and worked with Prof. Amar Agarwal and Dr. Athiya Agarwal. Both of them ignited her interest in ophthalmology into passion and always encouraged independent and lateral thinking, Dr. Jacob said.
In describing Prof. Agarwal, she said, “A thinker out-of-the-box beyond par. He has introduced numerous innovative concepts such as the no anesthesia cataract surgery, phakonit, microphakonit, aberropia, etc., the latest among the long list being glued IOL, which has made possible [posterior chamber] IOL implantation in eyes with no capsule using fibrin glue. By constantly raising the bar, I was made to see different vistas as a doctor-scientist. Innovating in surgeries, publishing articles, making surgical videos, giving lectures were all made possible.”
Ophthalmology in India
Ophthalmology has undergone a number of changes over the years, Dr. Jacob said. It evolved from torch-light intracapsular cataract extraction, performed sometimes under a banyan tree, to coaxial and bimanual microincision cataract surgery in corporate hospitals with multimillion dollar equipment.
“It has become much more technology-driven and challenging. The evolution of India is the right metaphor for this furious pace of change, sometimes scorching everything in its path,” she said.
Issues in ophthalmology in India are different from that in other countries.
“The great controversies, I think, are not regarding which phaco machine, ultrasound mode, tip shape or size to use, but rather which is the safest, quickest and most economical technique to eradicate mass blindness due to cataract. The acclaimed mass-based Aravind model and the hub-and-spoke practice pattern of corporate ophthalmic hospitals both have merit, and one should strive for a balance,” Dr. Jacob said.
The demographics of the world and ophthalmic patients are changing. Increasing aging and diabetic populations have caused a shift, with greater emphasis to age-related macular degeneration and diabetic retinopathy, especially the preventive and rehabilitative aspects.
“Extensive normative databases for individual demographic groups are now crucial, as the world has metamorphosed into a global village,” she said.
Sling surgery
One of Dr. Jacob’s research projects was the development of the Jacob-Agarwal single pentagon guided sling surgery. She said the frontalis muscle suspension procedure is the most common surgical technique performed for the treatment of congenital ptosis with poor levator function. There have been various modifications to performing the sling procedures in the recent past, and different sling materials have been tried.
“Our technique differs from the conventional procedures by the use of a single stab incision in making the pentagon and guiding the silicone sling in the surgical plane with one external incision while suspending the upper eyelid,” she said.
In this surgery, the needle of a silicone suspension set is passed in the epitarsal tissue horizontally. Both the needles on either side are then guided upward on either side following the path of the pentagon. On reaching the brow, using a combination of inspection and palpation, the needles are turned and guided along the final limbs of the pentagon toward the central mark without exteriorizing anywhere along the path. The two ends of the rod brought out through the single central stab incision are then passed through a silicone sleeve, and the lid margin and contour are adjusted. This is then buried subperiosteally.
Ptosis, poor levator function
The technique can be performed in all eyes with ptosis and poor levator function that necessitates frontalis sling, Dr. Jacob said. The stab incision is about 3 mm and is advantageous over the conventional procedure, which involves five stab incisions in a visible location and creates more bleeding, edema, ecchymosis and pain in the immediate postoperative period and more suture-related complications and scarring in the late postoperative period. Only needle puncture wounds are present on the lid margin, and these need not be sutured. There have been reports in the past on minimum incision and incision-less sling procedures.
“Our technique differs from these procedures because the ends of the sling material are united in the central forehead incision rather than in the eyelid incision. This gives a more physiological upward direction of traction. Thus, good lid height and contour was possible,” she said.
The technique provides better aesthetic and equal functional results in lids with poor levator function and congenital ptosis. It is also optimal for patients with myopathies, myasthenia gravis and third cranial nerve palsy in which silicone suspension is conventionally preferred over other sling materials because of its inherent elasticity.
“Simple learning curve, reduced surgical time, minimal skin incisions, good cosmesis and less number of sutures while retaining the clinical outcome of conventional frontalis sling procedure are the unique features of our technique,” Dr. Jacob said.
Another active basic research project going on at the institute is the use of anterior segment optical coherence tomography in various situations such as to detect inflammatory cells in eyes in which it is clinically not possible because of media opacities. Looking at future surgical research, she and Prof. Agarwal are jointly looking beyond normal corneal transplantation and into newer surgical techniques for patients with extensive anterior segment problems.
“This looks very exciting and promising in a lot of situations that are otherwise considered hopeless,” Dr. Jacob said.
Award-winning videos
In addition to her research and teaching efforts, Dr. Jacob is involved in making a number of surgical videos.
 Dr. Jacob received the award in “Symposium on Challenging Cases in Cataract Surgery” at the American Society of Cataract and Refractive Surgery 2008 meeting. Image: Jacob S
|
“I believe videos are an important and wonderful medium for expressing ideas and for conveying our work so that it is retained in the memory of the audience, especially in situations such as conferences, where a lot of information is bombarded into the brain. It is also the best form of teaching a person,” she said.
Dr. Jacob has produced/co-produced 13 award-winning videos at ASCRS, European Society of Cataract and Refractive Surgeons and American Academy of Ophthalmology meetings in the past 3 years.
In 2008, she received the ASCRS award in “Symposium on Challenging Cases in Cataract Surgery.” She also received a Certificate of Appreciation in the John Henahan Award for Young Ophthalmologists at the 2008 ESCRS meeting in Berlin.
At the 2007 ASCRS film festival in Chicago, the video Paradise Regained, which she co-produced, won an award. The video details the technique of glued IOL, described by Prof. Agarwal, which involves making two partial thickness scleral flaps, exteriorizing the haptics of an IOL under the flaps and then tucking the haptic tips into scleral tunnels, followed by gluing the flaps down. In the same film festival, the video The Untouchables, on her surgeries on ocular surface squamous neoplasia, also won first prize. At the 2006 ASCRS annual meeting in San Francisco, she won the award in the Cornea and Refractive Complications category for her film Battle of the Bulge, a film on post-LASIK ectasia.
Outreach programs
Preventable blindness is still a cause of great concern and frustration. Dr. Agarwal’s Group of Eye Hospitals is currently involved in vision screening, treatment and rehabilitation of the blind due to cataract and other eye diseases in 30 villages in the state of Tamil Nadu. They also collaborate with the Rotary Club, Lions Club and other non-governmental organizations in their efforts. Dr. Jacob said it is her desire to establish a network of volunteers, educators, communication systems and awareness programs that can make sight possible for all.
Where does Dr. Jacob see her future as an ophthalmologist?
“I have not reached anywhere near my ideal,” she said. “Still, I dream on — not the dreams seen sleeping, but the dreams that do not allow sleep. The road is long. But as Winston Churchill said, ‘Every day you may make progress. Every step may be fruitful. Yet there will stretch out before you
an ever-lengthening, ever-ascending, ever-improving path. You know you will never get to the end of the journey. But this, far from discouraging, only adds to the joy and glory of the climb.’” — by Kristine Houck
- Soosan Jacob, MS, FRCS(Glasgow), DNB, MNAMS, can be reached at Dr. Agarwal’s Group of Eye Hospitals, 19 Cathedral Road, Chennai 600 086, India; +91-44-281-16233; fax +91-44-281-15871; e-mail: dr_soosanj@hotmail.com; Web site: www.dragarwal.com.