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Retina expert is always ready for a new challenge
Watching his father serve others as a people’s representative, Rajvardhan Azad, MD, FRCS, said he knew that he wanted to continue that legacy, although he took a different route.
“He was a member of Indian parliament for a long time, and, during my childhood, I used to see him serving people, providing all kinds of facilities and amenities,” Dr. Azad told Ocular Surgery News in a telephone interview.
“I started in ophthalmology because there’s a lot of element of charity in ophthalmology and also a service component, and this goes well with my background,” he said.
Drawn to the challenge
As he entered the medical field, Dr. Azad said his father’s friend, Prof. L.P. Agarwal, who founded the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, was a prominent presence in his life.
 Rajvardhan Azad |
“He was my motivating force,” Dr. Azad said. “He had a catalyst role. That was how I got baptized into ophthalmology.”
In addition, he said the combination of medicine and surgery as treatment modality for ocular disease drew him to the specialty.
“From the beginning, I had in my mind that I should do something which is different,” Dr. Azad said. “Everybody was doing cataract and glaucoma, but there were few people who used to take up retina, and I have this inclination to see something which is a mystery.”
Dr. Azad took on the challenge of retina and vitreous and has continued to pursue novel treatments and techniques since the early 1980s.
His desire for a challenge was further sated as he concentrated in retinopathy of prematurity (ROP) and was elected to various positions, including president of the National Board of Examinations and secretary of the All India Ophthalmic Society (AIOS), in which he served for 6 years until his recent election to the position of vice president.
After 1 year, Dr. Azad will become president-elect and in 2010 will be installed as president of AIOS.
Retinopathy of prematurity
It is not only the challenge of ROP that attracts Dr. Azad but also the indescribable feeling of helping a child, he said.
He related the story of an infant with advanced ROP whom he treated with laser, despite the uncertainty of the results. The mother of the baby came in 3 months later and said the child recognized her. Today, at 8 years old, the boy has only slight nystagmus, Dr. Azad said.
“It’s entirely a different kind of feeling — giving eyesight to a child than to an adult,” he said. “[The boy] came and, according to our Hindu custom, he touched my feet, and I blessed him, and it was a different kind of feeling.”
Dr. Azad also traveled to Kuwait to assist in furthering its ROP screening and treatment and to expand his personal horizons.
“If you are only in your own house, you don’t know your importance,” he said. “It was a kind of a self-assessment for me.”
While he was there, Dr. Azad set up ROP units in four maternity wards and screened and treated premature infants for ROP.
“I have taken it as my mission,” he said.
At the R.P. Centre, within the All India Institute of Medical Sciences, the ROP department conducts screenings, performs laser treatments and investigates new developments in techniques, treatments and pharmaceuticals.
“The basic idea is you should screen all babies that are at-risk to develop blindness,” Dr. Azad said.
He said physicians in India do not adhere to the Western guidelines of screening infants who are less than 1,500 g at birth or were born earlier than 32 weeks’ gestation. Rather, he and colleagues issued their own guidelines in the Indian Journal of Ophthalmology, indicating that screening is necessary when a newborn weighs less than 1,600 grams or was born earlier than 34 weeks’ gestation.
Dr. Azad also warned that children with septicemia or who require prolonged ventilation also need close screening
“You want to catch all the babies who are at-risk to develop blindness, so basically the screening programs are different in different situations and different in different countries,” he said.
At the R.P. Centre, Dr. Azad is currently performing surgery on stage 4 and stage 5 ROP patients, “which is not done in many of the centers in the world,” Dr. Azad said.
He said he is using ultrasound biomicroscopy to visualize the anterior surgical space in these complicated cases.
“If the space is not there, I do [a] lensectomy. If the space is there, then I try to do a lens-paring vitrectomy,” Dr. Azad said.
In addition to treating current cases, he said he is working toward finding “the X factor” that pushes a child toward ROP.
“If there is a twin and one child develops ROP and the other child does not, why does it happen? I’m trying to analyze our data, and I’m trying to locate this X factor, which in a child results or develops into ROP and in another child does not,” he said.
Looking toward future treatments, Dr. Azad said his center is in the process of conducting a pilot study looking at selective anti-VEGF treatment in ROP patients.
Education goals
One of the challenges outside of the operating room that Dr. Azad is passionate about is the eduction of future physicians in India.
He was elected president of the National Board of Examinations, and he received the Dr. B.C. Roy National Award from the Medical Council of India for the Eminent Medical Teacher.
“I had not only ophthalmology in the national board. I had almost 42 specialties of medicine,” Dr. Azad said. “I took up the challenge. I revamped the entire board, made a lot of administrative reforms, made the academic reforms.”
Still today, Dr. Azad said Indian medical education faces the problem of unequal teaching and training standards at institutions.
“Some of our institutes are on par with any institute anywhere in the world,” he said. “Especially in our eye center, ie, Dr. R.P. Centre, AIIMS, we have everything that is available in any institute of the world. Then, on the other side, we have also institutes much below these standards.
“This is the biggest challenge: for us to bridge the gap,” he added.
This challenge of bringing these two extremes together is one Dr. Azad looks to undertake in his latest position with the AIOS.
“I am concerned with the postgraduate medical education — the standard of the education,” he said. “We need to bring it to a higher level.”
Resolving this problem may begin with additional training for faculty members in order for them to better serve postgraduate students, but medical education as a whole has a long road ahead due to the fractioned infrastructure, Dr. Azad said.
“Being a big country, lots of other factors are there,” he said, adding that health is a “state subject,” so in each state, things are different.
“The administration is different, the health grants are different, the medical educations are different and the directors are there. The various administrations are different,” he said. “These things are compounding the problem.”
Nevertheless, Dr. Azad said many new universities are opening and looking specifically at these aspects of medical education. In his upcoming years in the president’s council of AIOS and as president-elect and president, he said this will be a main focus.
“My endeavor will be to streamline the medical education in the country, and then the second thing will be to strengthen the training of our junior colleagues, training them in all the fellowships and provide them more opportunity to develop their skills,” Dr. Azad said.
Philosophy and future
Dr. Azad said he credits hard work and his wife as the sources of his continued success.
“These awards and these accomplishments, they keep on coming. What I have to do is hard work. That takes you a long way,” he said.
Dr. Azad’s wife, who holds a master’s in sociology, “has been a constant source of encouragement for me,” he said.
It is her strength that he said helps him and his children – a daughter with a master’s in business administration and a son studying ophthalmology at Aravind Eye Hospital – succeed.
“Looking back, I feel it was not possible without her,” he said.
In the future, Dr. Azad said he would like to continue to help those most in need, perhaps even in the role of public office.
“I want to help people,” he said. “At this moment, I’m only helping them through my medical expertise, but I don’t mind serving them as a people’s representative.
“I want a bigger canvas to help the people,” Dr. Azad said. “I would like to serve the people who are in great dire need of assistance.”
In Indian ophthalmology, he said he sees “great future and development.”
“I feel that very soon there will be a lot of very good things coming up, good innovations,” Dr. Azad said. “Lots of people are doing extremely good work, not only for the benefit of Indian ophthalmology but also globally.”
For more information:
- Rajvardhan Azad, MD, FRCS, can be reached at the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029; +11-26593187; fax: +11-26588919; e-mail: rajvardhanazad@hotmail.com.