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Pioneer in retina promotes general ophthalmic education
More than 2 decades have passed since lasers were introduced to India for retina surgery. Today, the surgeon who treated so many early patients still fights for more equipment while he reminds his colleagues that they must concentrate on the basics.
When R.B. Jain, MS, MRCOphth, DO, FRCS, returned to India from postgraduate studies in the United Kingdom, he brought with him the experience of treating retinal detachment surgery and retinal diseases, such as diabetic retinopathy, with lasers.
 R.B. Jain |
“There were not many people doing retina surgeries and laser photocoagulation in India, so I thought it would be worthwhile doing that,” he told Ocular Surgery News in a telephone interview.
Dr. Jain would perform laser treatments for as long as 5 hours a day, treating patients from all over North India, he said. Still, he did not ignore the rest of his practice, and he encourages all ophthalmologists to regularly return to the basics and maintain the skills needed to treat a large variety of ocular complications.
“I do retina, but what I believe strongly is that one should be a complete ophthalmologist. It is important to do a complete ocular examination of each patient seen,” Dr. Jain said.
Surgical retina in India
After receiving his MBBS and MS and completing his residency at Maulana Azad Medical College in his hometown of New Delhi, Dr. Jain went to the U.K. to receive more training.
After about 5 years in the United Kingdom, he faced the decision to stay as a consultant or return to India.
“It was a difficult thing,” Dr. Jain said. “My wife and I were more in favor of settling in the U.K. because life was more comfortable and money was more, but I thought India had the need of people like me.”
He chose to pursue surgical retina, including laser photocoagulation, because although some surgeons had begun the procedures, there was hardly anyone performing them in New Delhi or North India.
“People had been reading about it, and obviously they were looking forward to someone doing it,” he said. When he established himself, Dr. Jain said he was receiving references from physicians up to 500 miles away, including from medical colleges.
“When I started doing laser, I tell my juniors, I was getting references from half of India,” he said. “I used to do laser for retina diseases for almost 5 to 6 hours a day. There were so many references. … I used to just sit on the laser machine and patients would come in and move out and the next would come.”
Thus far, Dr. Jain said his biggest accomplishment in retina has been “treating diabetic retinopathy,” which is a mission he continues today.
Sharing knowledge
In addition to treating diabetic retinopathy, Dr. Jain said he enjoys sharing his knowledge of retina surgery with other ophthalmologists.
“I’ve trained students and some of them are now professors in some colleges. They used to come to me to see how laser is being done,” he said.
For example, a high-ranking army surgeon once approached Dr. Jain and said he still hangs notes in his office from a lecture Dr. Jain gave 18 years ago.
“It was so heartening and satisfying that somebody after 18 years recognizes you and tells you, ‘I’m still following what you told me then,’” Dr. Jain said.
Dr Jain’s contributions in the field of Indian ophthalmology have been recognized by other ophthalmologists as well. He was elected as president of the Delhi Ophthalmological Society in 1997 and last year as president of the All India Ophthalmological Society (AIOS).
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Images: Jain RB |
Back to basics
When Dr. Jain speaks of sharing his knowledge with younger ophthalmologists, as well as his peers, he emphasizes that surgeons should maintain their basic skills, such as refraction and measuring IOP with applanation tonometry.
“You cannot concentrate on just retina because 50% of my work is retina, but 50% I see glaucoma, squints, cataracts and I do refraction, too,” Dr. Jain said. “An ophthalmologist must be a complete ophthalmologist.”
He said this is of particular importance in a private practice, which is the situation for 80% of Indian ophthalmologists. In a larger clinic, he said, a physician can concentrate on one area and rely on colleagues for other areas, but in a private practice, one physician must treat everything.
“Even [in cataract], I say, ‘Look, phaco is a wonderful surgery and rewarding, but if you can’t afford phaco, do an extracapsular.’ It’s a question of providing basic facility,” Dr. Jain said.
His lessons on the basics extend also to the simplicity of Indian children undergoing refractive tests and wearing glasses.
“Parents, at least in India don’t like their children wearing glasses,” Dr. Jain said.
When he became president of the AIOS, his message to the country was for children to wear the appropriate glasses. He said it was featured on television, and he felt he had brought necessary attention to the topic.
“I think there is a gradual improvement. It takes time,” Dr. Jain said.
Ophthalmologists, Dr. Jain said, must continue to educate themselves and refresh their basic knowledge through lectures, symposiums, etc. One should obtain complete postgraduate training rather than concentrating themselves in one area.
“We talk of lasers and everything, but basics and fundamentals are equally important,” Dr. Jain added. “Children must wear glasses. We must take intraocular pressure. Basics are as important as sophisticated work.”
Retina’s future
Today, Dr. Jain is continuing to work toward advancing laser retinal surgery and bringing more awareness about diabetic retinopathy.
When Dr. Jain began using laser photocoagulation in India, there were only six lasers in the country. When he conducted a survey 3 years ago, there were 600. Dr. Jain estimated that 200 to 300 additional lasers have since been put to use in India.
“A rough estimate is that we will be fully better off with 6,000 lasers. We have 600 and we need 6,000. If not 6,000, I do think we need about 3,000,” he said. “If we have 3,000, I think we will have good coverage. Along with procuring lasers we need to train people on how to use them.”
Dr. Jain said at least two Indian manufacturers are in the process of designing and releasing their own lasers.
“Once they come out with lasers manufactured in India, it’s going to be more affordable,” he said. That should encourage others to invest, Dr. Jain said.
“Fortunately, a good ophthalmologist in private practice has a reasonably good income now, and once you have an income, you start investing, and laser is one of the investments for retinal treatment,” he said.
Even a surgeon who performs mainly cataract procedures should invest and maintain a relationship with a junior or colleague who concentrates in retina, he added.
“Many a times, I have seen an excellent cataract surgery but poor visual outcome because retinal evaluation was not done and retinopathy worsened postoperatively in diabetic patients. I am stressing the importance of complete eye examination,” he said.
“As you can see, India is now economically better, so more people can afford to have laser treatment privately now,” Dr. Jain said, “More and more people are becoming aware of the benefits and availability of laser treatments. People are aware now, all over the country, and there are many diabetic retinopathy programs going on.”
Last year, Dr. Jain started a task force for diabetic retinopathy and has designated about 20 people across India to give updates on the backlog of treatments needed. He said the government of India is finally recognizing diabetic retinopathy as a disease in need of treatment.
On a personal level, Dr. Jain said he will continue to teach in the same ways he always has. He is also anticipating his son’s completion of training at Aravind Eye Hospital in Madurai.
“I hope in about 2-years time, he’ll join me and carry on where I’ll stop working at a later date,” Dr. Jain said. “By and large, I think my work is going to be the same as it’s been – just talking to people, meeting them and doing my small contribution in whatever way I can. It’s a question of spreading the knowledge and letting people carry on.”
For more information:
- R.B. Jain, MS, MRCOphth, DO, FRCS, can be reached at RBM Eye Institute, C-2/1, Prashant Vihar, Delhi 110085, India; +91-11-2756-3939; e-mail: drrbjain@bol.net.in.