Surgeon cites growing need for detection, treatment of diabetic retinopathy in India

Like many Indian ophthalmologists, Lalit Verma, MD, chose a career path that was largely influenced by his family’s wishes. In his case, however, ophthalmology was a way to avoid enlisting in the army.

“My father, a civil engineer working in a government department, had different plans for me. He wanted me to be an army officer,” Dr. Verma told Ocular Surgery News. “His meager income had to support a large family, and medical education was very expensive. Besides, it was very difficult to get admission into a medical college. But I was determined, and I even ran out of Defence College.

“I got interested in medicine watching my late grand-uncle give medicines to sick patients and the way they would bless him. This was in the early ’70s. The sheer smile on the face of patients, when cured, struck me somewhere that I should become a doctor.”

Lalit Verma, MD, believes government and public agencies should partner to ensure accessibility to quality eye care throughout India. Image: Verma L

Dr. Verma attended All India Institute of Medical Sciences, graduating in 1982. Upon graduation he was awarded the Gold Medal in ophthalmology; the recognition paved the way to a long and rewarding career. Dr. Verma is currently the director of Vitreo-Retina at the Centre for Sight in New Delhi and a senior consultant eye specialist and vitreoretinal surgeon at Apollo Hospital, also in New Delhi.

He specializes in vitreous and retinal surgery, endophthalmitis, laser surgery and fluorescein angiography. He has over 160 publications in scientific journals and has made over 400 presentations in scientific forums. Dr. Verma was recently honored with an Achievement Award from the South Asian Academy of Ophthalmology in August 2008. He was recognized again in May 2009, when he received the Distinguished Service Award from the Asia Pacific Academy of Ophthalmology.

Areas of interest

Dr. Verma’s interests include optimizing management of diabetic maculopathy, improving treatment algorithms for managing retinal vascular blocks, and economizing treatment of age-related macular degeneration and other forms of choroidal neovascular membranes.

He has also been instrumental in developing guidelines to prevent the occurrence of intraocular infections.

“These guidelines were developed through a series of discussions among the leading ophthalmologists in India. Following these guidelines can help reduce the occurrence of endophthalmitis significantly,” he said. The guidelines can be accessed by All India Ophthalmological Society (AIOS) members at www.aios.org. Dr. Verma serves as webmaster for the site.

A decade of improvement

The last decade has ushered in significant advances in the way eye care is delivered in India. Exclusive eye hospitals with cutting-edge diagnostic and surgical equipment have raised the standard of eye care in the country to rival international standards, Dr. Verma said.

“Highly skilled eye surgeons, state-of-the-art equipment, and at much lower cost than in Western countries, make India a preferred destination for eye care,” he said. “Medical tourism is on the rise in India.”

Dr. Verma conceded that quality, affordable eye care “is not always affordable by a large number of our countrymen.”

Disease awareness needed

Awareness of disease and recognizing potential symptoms are still a problem in India.

“Even today, a lot of the Indian public is suffering from blindness from curable causes. Large numbers of people are not able to undertake the treatment, as they cannot afford it, while others do not have access to skilled professionals,” Dr. Verma said. And often by the time a patient reports a problem, he said, “it is either too late or recovery is not as good as it could be.”

Although cataracts are widely recognized, diseases such as glaucoma and diabetic retinopathy often go undiagnosed in India. Dr. Verma said awareness efforts should include directing attention to these diseases and their potential to cause irreversible blindness, as well as counseling patients about the importance of timely detection and treatment.

“If detected and treated in time, blindness due to glaucoma and diabetic retinopathy can be prevented on a large scale,” he said. “The prevalence of diabetes in Indian populations is assuming alarming dimensions. According to [the World Health Organization], India will have the largest number of diabetics in the world, 80 million, by 2030.”

Government and public cooperation

Dr. Verma said government and public interests should cooperate to make quality eye care available in every district in India.

“Government needs to upscale its primary health centers to provide basic infrastructure and eye treatment facilities capable of diagnosing various eye diseases and refer the patients to secondary and tertiary health centers,” he said. “Private hospitals should raise the quality of their charity work. They should offer equally good quality eye care to needy patients at affordable costs.”

He suggested independent auditing of private facilities as an ongoing requirement to help maintain quality of care.

Role of AIOS

The AIOS takes a multipronged approach to advance ophthalmological technique and treatment in India, from knowledge sharing to acknowledging the outstanding contributions of ophthalmologists in India through a series of national awards.

The AIOS annual conference offers 10 to 12 parallel education tracks for 4 days, presented by eminent national and international speakers. The conference is attended by 4,000 to 5,000 ophthalmologists from India and abroad, Dr. Verma said. He is currently secretary of the organization.

“We also sponsor organization of CME programs in different parts of the country for our fellow ophthalmologists. Lots of procedures, wet labs and live surgeries are demonstrated in various ophthalmic forums throughout the country,” he said. He has also conducted 20 free eye camps.

As president of the Delhi Ophthalmological Society, Dr. Verma initiated a teaching program, the Delhi Ophthalmological Society Teaching Programme, to complement traditional ophthalmology education in India, particularly for students pursuing a postgraduate program in the field.

“Experts in different fields of ophthalmology deliver lectures for the students and also encourage discussions and solve their difficulties,” he said.

The programs are attended by large numbers of students, some traveling long distances to attend. Encouraged by the response, Dr. Verma plans to replicate this program at the national level.

Personal satisfaction

Dr. Verma’s decision not to follow the path of his father has culminated in a richly rewarding career. He derives not only professional satisfaction from his work, but personal gratification as well.

“Ophthalmology gives us the opportunity to give patients back their vision and, in turn, their lives,” he said. “I see youngsters performing much better in their academics, teens gaining their self-confidence, poor earning their livelihoods, people having better social lives after getting their vision corrected. What could be a better pleasure than seeing the happiness in your patients’ faces? The affection and blessings of patients and their families make you a happy and satisfied person at the end of the day.” – by Carey Cowles

• Lalit Verma, MD, can be reached at Centre for Sight, B-5/24, Safdarjung Enclave, New Delhi-29, India; +91-11-4164-4000; fax: +91-11-4165-1744; e-mail: lalitverma@yahoo.com.