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Pioneer gives hope to neglected surface disease patients
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 Virender S. Sangwan |
When Virender S. Sangwan, MS, entered the field of ophthalmology, he was hoping to make his own life easier.
It was a “planned strategy” during medical school, he told Ocular Surgery News in a telephone interview. “At that time, the reason I wanted to be an ophthalmologist was that I would like to do clinical practice, and setting up an ophthalmology practice was easier.”
Today, he works at trying to make the lives of patients easier through stem cell transplantation at the L.V. Prasad Eye Institute.
Seeking education
Dr. Sangwan added an extra fellowship to his original strategy to improve his ophthalmic skills.
“The quality of residency in India is not very good across the board, or at least it was not at that time,” Dr. Sangwan said. “I did not learn good microscopic surgery, so I thought that I should learn something better than what I know if I have to live life as an ophthalmologist.”
He was chosen for a competitive residency in cornea at the newly initiated L.V. Prasad Eye Institute after a friend who was already in the program recommended it.
“My whole thinking changed,” Dr. Sangwan said. “I found that this place is the best place I’ve ever been. … Then, from there … it was just one thing after another.”
Flying through
During his fellowship at L.V. Prasad, Dr. Sangwan said Gullapalli N. Rao, MD, founder and chairman of the eye institute, told the group about an opportunity to be a staff ophthalmologist on the flying eye hospital of Orbis International.
“To me, it looked exciting,” Dr. Sangwan said. “I’m young, just starting. Before I start anything serious, let me go around and see if they select me.”
He was selected, and within 6 months, he was asked to serve as acting medical director, an honor that Dr. Sangwan was unsure of at the time.
Despite four other senior ophthalmologists from around the world, Orbis told Dr. Sangwan that he was the first choice for the job.
“If you think I can do it, I’ll do it,” he told them.
In his year and a half of serving in this position, Dr. Sangwan said he faced many challenges.
“The most important [challenge was] managing the staff of 25, consisting of doctors, nurses, technicians, flight mechanics and administrators from different cultural and educational backgrounds, keeping them, as a team, motivated,” he said.
This challenge was on top of constant travel, meeting with representatives of many countries, handling the media and confronting large crowds of people requiring ophthalmic treatment in each country, Dr. Sangwan said.
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Images: Sangwan V |
Uveitis subspecialty
Upon leaving Orbis, Dr. Sangwan again wanted to expand his knowledge, and he pursued a research fellowship under Stephen Foster, MD, at Massachusetts Eye and Ear Infirmary in the United States.
“I always wanted to learn more about particular conditions like ocular inflammatory diseases,” Dr. Sangwan said. “Through my search and contacts, I discovered that if I wanted to do anything with ocular inflammation, [Dr. Foster] is the best and most experienced person in the world.”
Upon Dr. Foster’s recommendation, he completed 2 years in ocular immunology, which included uveitis and ocular inflammatory diseases, before returning to India, where L.V. Prasad offered him a position as the cornea specialist. When the uveitis/retina specialist left, Dr. Sangwan served under both subspecialties.
The lack of ophthalmologists in the uveitis subspecialty led Dr. Sangwan and colleagues to found the Uveitis Society of India in 1999.
“The reason was – even now today – we don’t have a lot of people in formal training fellowship programs, and this is a huge unmet need,” Dr. Sangwan said. “Everybody is looking for quick financial gains or easy methods for making money, so doctors tend to do refractive surgery or cataract.”
He said the idea behind the society was to join the few uveitis specialists in India to create interest and be organized. Then the group could lobby to the larger institutions to implement uveitis fellowships and train groups so they can practice throughout the country.
Thus far, Dr. Sangwan said the group has had “tremendous success” in getting recognition at major national and state meetings and attracting a “maximum crowd” to their sessions.
“That means we have generated enough interest and, again, the demand for the subspecialty,” he said. “There’s not too many [fellowship] programs available, so that’s the next challenge we need to overcome.”
Stem cell pioneer
Dr. Sangwan’s own research and cutting-edge clinical practice is likely helping drive interest to the subspecialty, as he is becoming a pioneer in treating ocular surface disease through corneal regeneration using limbal stem cell transplantation.
“I was seeing patients which nobody else was interested in seeing. It was something called ocular surface disease,” he said. “Most of my other cornea colleagues were not interested in seeing them because we had no solutions.”
Dr. Sangwan began looking for solutions and came upon two academic papers in the opthalmic literature discussing cultivating limbal stem cells, he said.
“I felt that this is an area that no one is interested in. Let me try and see if I can do something better for these people,” he said. “We didn’t ask the hospital for anything extra. We didn’t ask for any grant money, anything.”
After talking to multiple people, Dr. Sangwan found a partner in Geeta K. Vemuganti, DCP, MD, DNB. Together, they worked for 1 year, “sorting out problems,” Dr. Sangwan said.
“Within about a year, we have found that … we can grow [stem cells], and we discovered our own way of doing it, customized,” he said. They then applied for approval to conduct a clinical trial.
Through the clinical trial, Drs. Sangwan and Vemuganti found that they could successfully grow the cells and transplant them to the human eye, where they can repair damaged epithelium and corneas and allow patients to see again.
One year into the trial, Dr. Rao asked Drs. Sangwan and Vemuganti what was needed to continue the research successfully. Dr. Sangwan told Dr. Rao that they needed a lab that would cost about $1 million.
Thanks to the generosity of its namesake, the Sudhakar and Sreekanth Ravi Stem Cell Biology Laboratory was established.
When the benefactor told Dr. Sangwan that money would not be an obstacle, Dr. Sangwan responded in kind: “Work is not a problem. We’ll make sure it’s done, and we’ll get the best out of this.”
After 5 years of work, Dr. Sangwan was awarded the Shanti Swaroop Bhatnagar award, which is the highest award in India for science and technology.
“We have done more than 500 [transplants] now,” Dr. Sangwan said. “I’ve been talking in different meetings, publicizing regularly. … This has created a demand, meaning there is a lot of referral. In my office, I’ll have two, to three, to four patients every day. Many centers have done 10 to 12 cases in a year or 2 years time. I do that in almost a week.”
He said there is a high success rate when the injury or disease is moderately severe, and the center is seeing an increase in the referrals, both from the surrounding area and throughout the country.
Just the beginning
With so many accomplishments already, Dr. Sangwan said he is not slowing down, and that he still has a long road of practice and research ahead of him.
“We’ve created hope, and the idea is to convert this hope into reality in the next 5 to 7 years by refining the surgical procedure, the cultivation, understanding why the procedure fails,” he said. “Can we predict the failure? Can we better understand the cell biology? Can we deliver it better? Can we make the treatment portable? And to address these, we have strategic collaborations.”
Those collaborations have begun, he said, with groups in Australia and Canada.
The Indo-Australian project is finalized and involves 3-year funding to modify the cell-growing structure for easier portability.
“They have some technology which can modify the surfaces on which we grow the cells, and they have developed the technology of delivering the cells for the skin wounds, burns and diabetic foot, so they think that we may be able to do something similar for the eye,” Dr. Sangwan said. “We are going to work and provide a proof of principle, whether the growing cells can be made to grow on a portable medium and [whether] they can grow better if the surface is modified.”
Dr. Sangwan said his group has applied for an Indo-Canadian grant in which they would collaborate with the Canadian group that has done “remarkable work” in growing corneal collagen and synthetic collagen for corneal replacements.
“What we are trying to do is see if these cells can be grown and incorporated on that scaffold and use this as a substitute for corneal tissue so we don’t have to wait for donation,” he said.
For more information:
- Virender S Sangwan, MS, can be reached at L.V. Prasad Eye Institute, Banjara Hills, Hyderabad – 500 034 India; +40-30612632; fax: +40-23548271; e-mail: vsangwan@lvpei.org.