Prof. Madan Mohan sees changes, promising future for ophthalmology in India

Issue: October 2009

Madan Mohan

Madan Mohan, MS, FACS, FAMS, grew up in ophthalmology. As a schoolboy, he watched his father, Dr. Sewa Ram, perform ophthalmic surgery at the family-owned, 80-bed eye hospital at Mardan in North West Frontier Province, in present-day Pakistan. Dr. Ram Chand, his grandfather, was also a surgeon with a special interest in ophthalmology.

“So ophthalmology was in my genes,” Prof. Mohan said.

Unique opportunity

Prof. Mohan received his MBBS in 1954 from King George’s Medical College, Lucknow University, in Lucknow, India, and soon embarked on his more than 50-year career in ophthalmology.

“Luckily, I got admission in the specialty of my choice,” he said.

In 1960, Prof. Mohan joined the faculty of the department of ophthalmology at All India Institute of Medical Sciences in New Delhi. He said this position provided him with a unique opportunity to practice and perfect newer techniques of the time such as capsule forceps, erysiphake extraction techniques and, later on, extracapsular cataract extraction and microsurgical suturing techniques, as well as conduct research on corneal grafting and eye banking.

In 1963, Prof. Mohan continued his study of corneal surgical techniques during his year-long Rockefeller Foundation Fellowship at various hospitals in the United Kingdom, United States and France.

“Sir Benjamin Rycroft inspired me the most as a mentor and guided me to set up the National Eye Bank at the All India Institute of Medical Sciences on my return to India in 1964. I pursued the subspecialty with passion and trained many corneal surgeons,” he told Ocular Surgery News in an e-mail interview.

In addition to establishing the National Eye Bank, Prof. Mohan started microsurgery and IOL implantation residency training programs and ophthalmic technician training courses during his 29-year tenure at the Dr. R.P. Centre for Ophthalmic

Sciences. He was also the adviser for ophthalmology to the Ministry of Health for the government of India and was instrumental in getting the Eyes’ Act passed by the Indian Parliament in 1984. The act helped promote and popularize eye donation and, therefore, increased corneal transplantation, he said.

Among his other numerous accomplishments are serving as president of the All India Ophthalmological Society in 1988, director of the WHO Collaborating Centre for training manpower in Southeast Asia during the 1980s, and editor of the Indian Journal of Ophthalmology.

Prof. Mohan, now 80 years old, is currently the director of the M.M. Eyetech Institute of Ophthalmology. He has been at this post since he retired as the chief and a professor of ophthalmology of the Dr. R.P. Centre for Ophthalmic Sciences in 1989. His current clinical research includes ocular surface disorders and studying the correlation of optical coherence tomography, Octopus automated perimetry and ocular response analyzer results with clinical parameters in glaucoma.

Changing times

Prof. Mohan said he has closely observed the transformation of ophthalmology in India during the past 50 years. In the 1950s, ophthalmology basically meant a torch examination, cataract and glaucoma surgery, and mass treatment of trachoma and associated conjunctivitis. There were few ophthalmic surgeons, limited ophthalmic beds and operating facilities in the hospitals.

He said the eye departments in the government hospitals were under general surgeons, and eye surgery was largely performed in eye camps organized by non-government social organizations.

“I would perform 40 to 50 cataract operations a day in the eye camps, often with torch light when electricity was not available. Couching was also still being practiced in remote villages. Complication rates of surgery were high and ready stocks of +10 D sphere aphakic glasses were distributed to all operated cataract patients,” Prof. Mohan said.

However, during the past 2 decades, he said the many centers of excellence have created state-of-the-art facilities in India. Phacoemulsification, LASIK for the correction of refractive errors, treatment of retinal disorders, vitreoretinal surgery, corneal transplants, and oculoplastic and cosmetic surgery are some specialty services available at most district-level towns, and fewer patients now opt for eye treatments abroad.

“There is an upward trend to excel, and the bar is constantly being raised. Many young ophthalmologists are enthusiastically pursuing training in subspecialties of ophthalmology. I see a great future for ophthalmology in India, and I see Indian ophthalmologists as being the torch-bearers in international ophthalmology,” Prof. Mohan said.

Technology shaping practice

Throughout his long career, Prof. Mohan also has seen a number of changes in the technology available to ophthalmologists in India.

“In view of the heavy burden of ocular morbidity due to trachoma, corneal ulceration, keratomalacia and avoidable blindness due to smallpox, hypermature cataract and secondary glaucomas, and the high cost of technologies, upgrading the facilities was a great struggle in the immediate post-independence era. However, as the economy improved, technological upgrade became a reality,” he said.

Prof. Mohan said a significant milestone in the technological development of ophthalmology in India was the growth of the department of ophthalmology at the All India Institute of Medical Science to the Dr. R.P. Centre for Ophthalmic Sciences, New Delhi in 1967.

“The Centre grew between 1967 and 1985 to a 300-bedded eye hospital with 12 operation theaters, 25 full-time faculty, with basic sciences and community ophthalmology wings, and to providing training to 72 junior residents and 25 senior residents; one of the largest residency training programs in the world,” he said.

Systematic postgraduate training and postdoctoral workshops on subspecialties of ophthalmology were started here. He helped train teachers, prepare the curricula, and formulate priorities and guidelines for nationwide research in ophthalmology.

In 1976, the government of India launched a centrally sponsored National Programme for Control of Blindness and recognized the Dr. R.P. Centre for Ophthalmic Sciences as the Apex Institute at the top of the organization. In the 1980s, 10 regional institutes of ophthalmology equipped with modern technological facilities were established throughout India, he said.

In 1988, during his presidency of the All India Ophthalmological Society, Prof. Mohan was also instrumental in obtaining the customs duty exemption on sight-saving ophthalmic equipment.

“This helped immensely in modernizing private clinics, nursing homes and hospitals. It also stopped ‘brain drain,’ since many eye surgeons were leaving the country for 3 years or more to serve in the Middle East and other countries, so as to bring back expensive equipment without paying customs duty, under transfer of residence provisions,” he said.

Today, Indian-manufactured surgical instruments, IOLs, and ophthalmic and optical equipment are as good as any and have found a place in the competitive export market all over the world, Prof. Mohan said.

Challenges ahead

Prof. Mohan said among the challenges for ophthalmologists in India is increasing awareness so that all patients may access the benefits of modern technology.

Cost is another challenge for ophthalmologists in India. Modern treatment, despite being a fraction of the international cost, is still out of reach of the majority of people.

“Health insurance is in its infancy, and insurers try to minimize their own expense by going for the cheapest alternative, rather than help improve the quality of service provided.” Prof. Mohan said.

Another challenge for ophthalmologists is the heavy investment required to establish a modern ophthalmic facility. The prevalent fee structure does not make it a profitable and attractive proposition to regularly upgrade ophthalmic technology.

“Again, to become an ophthalmologist is itself a big challenge. There are very few postgraduate seats for residency training allotted on merit to open candidates. Some have to pay a huge capitation fee to get admission in a postgraduate course,” he said. “Similarly, facilities for further training in subspecialties of ophthalmology are limited, and so are the job opportunities. It is hoped that with the projected boost of the economy, these challenges will gradually get sorted out.”

Contributions to ophthalmology and society

The government of India recognized Prof. Mohan’s contribution in ophthalmology and service to the nation and honored him with one of the highest civilian awards, the Padma Shri, in an investiture ceremony by the president of India in 1985.

“I have performed to my best potential and am fully satisfied as a Karam Yogi in the fight against blindness. I could not have asked for more. My son, Dr. Rishi Mohan, and daughter-in-law, Dr. Indira Mohan, and their little daughter, Avantika Mohan, hopefully, will carry on the fight against blindness, like their forefathers,” he said. “I am optimistic that, as current trends suggest, India will play a leadership role in delivery of clinical services and research in the developing world and will put forth outstanding biomolecular, policy development and manpower research.” – by Kristine Houck

Madan Mohan, MS, FACS, FAMS, can be reached at M.M. Eyetech Institute, 29-30 Lala Lajpat Rai Marg, Lajpat Nagar – III, New Delhi 110024 India; +91-11-29847700; fax: +91-11-29847600; e-mail: mmohan@mmeyetech.com or contactadmin@mmeyetech.com.