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Interview: Dr Pravin K Vaddavalli — Strategies to Prevent Blindness

Dr Pravin Krishna Vaddavalli is Director of Tej Kohli Cornea Institute; Head of Refractive Surgery, Cataract & Contact Lens Services; and Consultant, Cornea & Anterior Segment Service at L V Prasad Eye Institute (LVPEI), Hyderabad.

Dr Pravin Krishna Vaddavalli
Dr Pravin Krishna Vaddavalli

Dr Vaddavalli has devised innovative modifications in lamellar keratoplasty and is involved in research projects in the field of keratoconus, lamellar keratoplasty and refractive surgery. His main areas of interest include LASIK (Laser Assisted in Situ Keratomileusis) and laser surgery, phakic intraocular lenses (PIOL), keratoconus, DSEK (Descemet’s Stripping Endothelial Keratoplasty), DALK (Deep Anterior Lamellar Keratoplasty), other lamellar corneal surgeries, paediatric cataract, cataract and corneal transplantation.

In an interview with India Medical Times, Dr Pravin K Vaddavalli talks about himself, his areas of specialisation, latest developments in corneal transplants and the next big change in this field.

You have an exceptional profile in the field of ophthalmology, especially in corneal surgeries. Tell us something about yourself. How would you like to introduce yourself to our readers?

My interest in cornea developed primarily because of its exceptional clarity and the amazing ways nature has designed it to keep it clear. This, along with the numerous diseases that affect corneal clarity and impact vision, does lend itself to innovative medical and surgical solutions that can restore vision. Every patient is a challenge, with a potential solution, some easy, some not so and the satisfaction one derives from restoring vision is the greatest high that one can get and nothing else even comes close.

What drew your interests to ophthalmology? Did you dream of providing better vision to people or did something else put you in this field?

Ophthalmology, especially the sub-specialty of corneal disease, is a very intuitive field; you see everything that is wrong right up front and the ability to restore corneal clarity by medication or surgery is unique as there is very little hidden away. So diagnosing a problem is a lot like pattern recognition and with experience this becomes easier and the solutions to these problems are becoming more and more innovative, which is what keeps the excitement alive.

Tell us about TKCI — its origin, journey so far and its future endeavours.

Tej Kohli Cornea Institute (TKCI) is a part of L V Prasad Eye institute and denotes the cornea service and everything associated with it and all the partners who work with it globally. TKCI was started with the munificence of Mr Tej Kohli from London, whose single-minded goal is to eliminate preventable corneal blindness in the world in the next 20 years.

It’s been a year and half since we began and already have started to make a significant impact in India and abroad in the field of corneal transplantation. Examples being, restarting the cornea transplant programme in Oman after a long hiatus and playing a central role in the development of an effective corneal transplantation programme in Myanmar and Cambodia. Similarly, we have identified 10 partners across the length and breadth of India and 8 international partners who we are working with very closely. TKCI has also begun to explore innovative and low cost solutions to increase its reach and efficiency to be able to do more with less.

Corneal Transplants are huge revolution in the field of corneal surgeries. What’s the latest revolution in that field? Also, what are its limitations?

The biggest revolution in the field of corneal transplantation in the last decade has been the move towards partial thickness corneal transplants instead of changing the entire cornea. With remarkable strides in this field, we are now able to change only the layer of the cornea that is affected in a patient with a similar layer from a donor. This enables better survival of the transplanted tissue and better utilization of eye bank corneas where one cornea can be used for more that one recipient. Now with cell biology generating renewed interest, the next big change in this field will come not from the operating room but from the lab. We are already at an advanced stage to grow an artificial cornea in the lab and this would significantly reduce the shortfall between demand of corneal tissue and perennial shortage of this vital ingredient in the fight against blindness.

What are the corneal surgeries available and how easily applicable are these in our hospital setups?

In addition to traditional full thickness corneal transplants, we now offer transplantation of only the affected layer of the cornea. We also have the world’s largest series of successful corneal stem cell transplants and offer advanced reconstructive surgeries and corneal prosthetic implants for end stage corneal disease. A lot of these techniques need many years of training but we are constantly providing training in these advanced techniques to the next generation of corneal specialists to carry the torch. Last year, we reached a unique milestone by becoming the first centre in the world to perform over 2000 corneal transplants in a year and this is only the beginning.

Do you believe in community ophthalmology for the prevention and control of blindness in our country? Do you organize camps?

Effective eye care is not possible without a strategy to access it by every member of the community. This needs an inclusive comprehensive approach to cover patients who traditionally would not be able to access or afford eye care. The pyramidal model of eye care where the base of the pyramid is in the rural community serves as the bulwark of our strategy to allow this. Eye camps are like a one time snapshot, rarely returning to the site where they are conducted and what we need instead is consistent quality eye care that is available all the time and to everyone.

What do you think is the strategy to achieve prevention of avoidable blindness?

We strongly believe that the scourge of blindness should be battled by both preventive and therapeutic strategies. A blend of world-class clinical care along with a strong research component to address the problems of the developing world and training of personnel are the key components. In addition community education and innovative solutions to increase follow up, foster gender balance and reduce drop out rates do go a long way in the prevention. Community screening and simple interventions at early stages of disease processes help reduce the effort and the cost involved in treating the disease rather than prevent it.

Since you have been associated with international associations like American Society for Cataract & Refractive Surgery and International Society of Refractive Surgeons, what do you think is the standard of Indian ophthalmology in reference to the global standards?

Indian ophthalmology stands at the crossroads today. Clinically, we are amongst the best in the world and our surgeons are amongst the most skilled I have seen. What we should develop is a strong research aptitude to be able to solve some of our problems, which no one else will address. It’s also nice to see the approach of indigenous companies who are investing time and effort in research and technology.

Tell us about the procedures you specialize in and your research interests.

I specialize in laser corneal surgery for eye power and treating corneal problems by new procedures such as corneal transplantation in layers called endothelial keratoplasty. I also have a keen interest in keratoconus and corneal reconstructive surgery.

What’s your message for the young doctors?

In addition to acquiring surgical and clinical skills, I would suggest that all young doctors spend some time serving patients who cannot otherwise afford or access eye care. This not only helps develops empathy but is very humbling and truly explores the real reason why we are in this profession.

by Usha Nandini

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