Vitreoretinal consultant touts forward thinking ophthalmic practices

Lingham Gopal, MBBS, MS, briefly considered a career in botany. But after he was selected to take the entrance examination for medical school, he said he changed his mind and focused on a career in medicine.

In 1979, after graduating from Andhra Medical College, Visakhapatnam, Dr. Gopal said he had no specific reason to choose ophthalmology, but it was one of three residency program options presented to him during his counseling session.

“Circumstances made [ophthalmology] possible,” he said. “I must say that I would have enjoyed any subject and would have given my best.”

With ophthalmology, Dr. Gopal said he found a fascinating and enjoyable subject.

“The right mix of physics, with optics and lasers, medicine and surgery offers a satisfactory experience for any practitioner,” he said in an e-mail interview with Ocular Surgery News. “Also, technological advances have influenced the way ophthalmology is practiced, probably to a greater degree than any other specialty.”

Lingham Gopal, MBBS, MS is a senior vitreoretinal consultant at the Medical Research Foundation, a unit of Sankara Nethralaya. Image: Gopal L

Dr. Gopal underwent fellowship training in vitreoretinal surgery from 1984 to 1985 at the Medical Research Foundation, a unit of Sankara Nethralaya, where he is currently a senior vitreoretinal consultant.

He has published more than 100 papers in peer-reviewed national and international ophthalmic journals and has also written 15 chapters in various ophthalmic books. He has delivered more than 130 lectures at national and international conferences, and he has also won numerous awards for his surgical and research skills.

His areas of interest include retinopathy of prematurity, coloboma of choroid and vitreous substitutes.

Valuable mentor

Various mentors have played a large role in shaping Dr. Gopal’s career, with Dr. S.S. Badrinath being the most important, he said.

“He taught me everything I know today in the practice of vitreoretinal surgery. In addition to teaching me the skills of surgery, he taught me the concept of meticulousness to detail, uncompromising attitude when it comes to patient care, humane and sympathetic approach,” he said.

Dr. Gopal said Dr. Badrinath also taught him that an ophthalmologist must keep up with the changes taking place in the profession.

“It is essentially because of his initiative that a lot of forward-thinking changes were made at Sankara Nethralaya, where I practice. It is no exaggeration if I say that if I am what I am today, it is due in large measure to Dr. Badrinath,” Dr. Gopal said.

He said his foundation in ophthalmology was further laid for him at the Postgraduate Institute of Medical Education and Research, Chandigarh, where Dr. I.S. Jain, Dr. S.P. Dhir and Dr. Gangwar taught him the rudiments of the subject. Dr. Amod Gupta, currently the director of the Eye Institute at Postgraduate Institute of Medical Education and Research, Chandigarh, remains another role model to this day.

Research and technology projects

Currently, Dr. Gopal is creating a learning machine to predict ROP. The learning machine is software that ideally should be able to predict occurrence of ROP and fine-tune the screening strategy, he said.

He is also conducting studies on coloboma of choroid and retinoblastoma. The majority of his research in retinoblastoma is at the molecular biological level, looking at various markers and possible target molecules for future treatment.

As a hospital administrator, Dr. Gopal is involved with the technical matters of Sankara Nethralaya, which recently commissioned an expansion project of its institution in Kolkata. The new building has 50,000 square feet of constructed area and has 11 ophthalmic consultants. The physicians see 500 to 550 patients and operate on 60 to 70 patients daily. The expanded building features a community ophthalmology wing.

“One whole floor is set apart only for community ophthalmology work, and we are tying up with [nongovernmental organizations] to help bring patients from the villages,” he said.

A similar expansion project for Sankara Nethralaya at Bangalore is in the early planning stages.

Sea of changes

“Since I became an ophthalmologist in 1982, there has been a sea change in the way ophthalmology is practiced in this country,” Dr. Gopal said.

The most important change has been the improvement in the time lag that used to be seen between the developed countries and India in adopting new treatment modalities and approaches. He said there is a healthy aptitude to learn new things and adopt updated practices.

“While in the past we used to see only islands of excellence, today we see even individual practitioners adopting the best practices and being well-equipped with the latest gadgets,” Dr. Gopal said.

Research in ophthalmology in India also has increased in a large fashion, he said, because of the many multicentric trials being conducted in the country. Even basic science research has picked up momentum in many centers, as both the government and private industry are spending money.

“The future should be rosy. I anticipate that India will become a trendsetter in the future, with more new and novel ideas coming up,” Dr. Gopal said.

He envisions educational standards becoming more uniform throughout India, as more money is available for research.

“All these should enhance the quality of ophthalmology practiced,” he said.

Technological advances shape practice

Technology has been at the forefront of the revolution that has taken place in the practice of ophthalmology in India, Dr. Gopal said. The basic standards of practice have improved because of the availability of sophisticated equipment in the country.

“From the days of operating without gloves and with no microscope, we have come a long way,” he said.

Manufacturers in India have cost-effective local substitutes to expensive imported equipment, so every ophthalmologist now has access to the minimum acceptable equipment for both the outpatient and surgical practices of ophthalmology.

“Manufactures in India have been able to improve their quality significantly, and obviously, the cost is much lower compared to the multinational companies,” Dr. Gopal said. “That has helped the average ophthalmologists to buy some of the equipment which he or she otherwise was not having access to.”

Intravitreal instruments, such as scissors and forceps, are available from Indian manufacturers at a fraction of the price of the international manufacturers and of reasonable quality, he said, adding that the manufacturers can export their products to neighboring countries.

Today’s challenges

The most important challenge that ophthalmologists in India face today is tackling the high volume of patients while retaining the quality of care, Dr. Gopal said.

“The balance between the maintenance of quality care and still serving the needs of a large volume of patients is critical. It is easy to compromise on certain aspects of patient care,” he said.

Every ophthalmologist and institution has their own way of solving this problem, Dr. Gopal said. However, there is no one system or model that is being followed in India, and every model has its own positives and negatives.

“Building rigid systems in one’s practice could be important to prevent the sheer numbers from affecting the quality of eye care delivered,” he said.

Additionally, electronic medical records with built-in alerts also could play an important role in helping ophthalmologists manage the volume of patients, Dr. Gopal said. Keeping abreast of the current trends in practice management also could be an important challenge for the practicing ophthalmologist in India.

Outreach programs

In order to serve the needs of the underserved and indigent patients, Dr. Gopal is also involved with Sankara Nethralaya’s tele-ophthalmology outreach programs. The entire program was envisaged by Dr. S.S. Badrinath, who was also the president of the Telemedicine Society of India.

Qualified optometrists examine the patients in rural areas with the help of a van with the necessary equipment. The images of the anterior segment and posterior segment are then transmitted to the hub at Chennai via a satellite connection, where a qualified ophthalmologist screens them along with the history, vision record and IOP record.

Patients needing medical attention are referred to the main hospital, and those needing only spectacle correction are given the glasses with the help of a spectacle-dispensing van that accompanies the main tele-ophthalmology van. The van provides onsite screening facility and spectacle correction, and patients needing surgical treatment are brought for free to the hospital. — by Kristine Houck

• Lingam Gopal, MBBS, MS, can be reached at Sankara Nethralaya, Vision Research Foundation, 18 College Road, Chennai – 600 006 India; 44-28271616; e-mail: drlg@snmail.org.