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How a patient changed the way engineering is used in Indian ophthalmology

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The Economic Times | HARI PULAKKAT |  Aug 01, 2017 |

VS Sangwan likes to answer his patient questions thoroughly, and so he didnt find anything unusual when he first met Ashutosh Richhariya . It was 2004. Richhariya, who was running a business in Ujjain in Madhya Pradesh, had run into trouble with his eyes and hence his business. He had come to LV Prasad Eye Institute (LVPEI), Hyderabad, to get treated. Sangwan, one of the leading ophthalmologists in the country, was preparing to operate him when the questions began to flow. Richhariya first asked Sangwan about corneal dystrophy, the genetic disease he was suffering from, where unwanted material gets accumulated in the cornea. It often begins in childhood and progresses with age and Richhariya was losing his vision in one eye when he met Sangwan. His vision improved after the surgery but he developed astigmatism, a common occurrence after eye surgery. Richhariya asked why he had got astigmatism and why it could not be stopped. “I told him that there are many uncontrollable factors,” says Sangwan. Richhariya was not convinced they were truly uncontrollable. When he came for the first time to LVPEI, Richhariya had already founded an instrumentation company called Shubda ElectroMechanial Engineers in 1997.

*Why Adaptive Optics is Important*

By 2002, it had touched revenues of Rs 100 crore. Richhariya had to shut down the business when the eye problems started. His astigmatism after the surgery really troubled him, as his eye power was changing every two weeks. Then he got glaucoma and later cataract. Richhariya is an engineer and an MBA, and so could look at a problem from two vantage points. “I was really disappointed that there were so many uncontrollable factors,” says Richhariya. “So I wanted to use the tools of quality management to understand non-conformation.” He felt he could figure out the problems in the processes followed during surgery, and then find out ways of fixing them. Sangwan encouraged him. Richhariya decided to look at the eye more closely, especially from the vantage point of an engineer.Sangwan encouraged him. Richhariya decided to look at the eye more closely, especially from the vantage point of an engineer. Meanwhile, he had to earn a living. In 2012, he joined Mahakal Institute of Technology, a new engineering college in Ujjain, as a lecturer. While he taught there, Richhariya continued to research on the cornea. He had sought Sangwans help to use the library at the eye institute, and he spent long hours in there reading. Richhariya didnt have a PhD. The management of Mahakal Institute told him that he would not get far in academics without a PhD degree. He did masters in engineering and found a professor at Ujjain Engineering College , Sunil Punjabi of the department of mechanical engineering, to be his guide. Since Richhariya wanted to research corneal biomechanics, he sought the help of Sangwan, too, who also promised to be his guide. He asked Sangwan for permission to watch his surgeries. He took corneal samples and studied them. In a few years, Richhariya had mastered his domain, but he had to surmount some systemic problems.

*Bridging the big divide*

Engineers and doctors did not see eye to eye in India, and there was little collaboration between the two disciplines. So there were very few experts, not to speak of equipment, to help Richhariya in his research. He had found out mechanical stresses of the eye produced changes in refractive index and not just changes in shape as was believed by ophthalmologists. His theory was not easy to test without high-quality optical equipment. One world class Institute at Indore, the Raja Ramanna Centre for Advanced Technology (RR-CAT) had the necessary equipment. It was not far from his home town of Ujjain, and Sunil Punjabi used his connections to provide Richhariya access to do experiments there. As he worked on corneal biomechanics, Sangwan watched him closely and began to feel that he was a serious researcher. Ophthalmologists in India have their own battles with equipment. They were too expensive and poorly maintained due to lack of technical expertise. Expensive machines often stopped working in government medical institutions, as they run out of money to get equipment serviced. Top-ranking private hospitals maintain theirs at great expense. LV Prasad Eye Institute, for example, bought a phacoemulsification machine, used in all high-end eye hospitals for cataract surgery using ultrasound. It cost the Institute Rs 50 lakh but it is poorly maintained as there are no experts available. Service is often late. Its hand piece, which delivers the ultrasound waves, can last longer if maintained regularly in the hospital. When it breaks down, the manufacturer insists on replacement rather than repair, adding to the cost. “Engineers are as important in a hospital as doctors,” says Sangwan. He saw in Richhariya an engineer who could change things, at least in his institution.

*Overseas advantage*

Richhariya, however, had his own plans. He applied for a Fulbright Fellowship to go the US to work in the best labs in his discipline. Interviewers for the scholarship were amazed at his knowledge of corneal biomechanics. “Within 30 minutes they told me I would get the fellowship,” says Richhariya. Sangwan, meanwhile, spoke to institute founder Gullapalli Rao to sponsor Richhariyas work in the US for an extra year. Rao had worked at the University of Rochester, which had one of the worlds leading optics labs. He readily agreed to send Richhariya there. Rao also agreed to hire Richhariya to start an engineering division at LVPEI when he returned. David Williams of the Institute of Optics at the University of Rochester was then developing a remarkable new technique for imaging the eye in extraordinary detail. Called adaptive optics, it is now being used in state-of-the-art optical telescopes to compensate for distortions of the atmosphere. In telescopes using this technique, mirrors change their shapes a thousand times a second to counteract atmospheric distortions of celestial light. Williams developed similar techniques to compensate for the distortions caused by fluids in the eye. Richhariya worked in his lab to understand the technology. Specifically, he worked on an Adaptive Optics Scanning Laser Ophthalmoscope (AOSLO), which can image individual cells of the retina. “He learned not just to use the instrument,” says Williams, “but also trained to set up the instrument in India.” When he returned, Williams gave Richhariya the instrument parts, which he assembled himself at L V Prasad Institute. “It is difficult,” says Williams. “Not many in the world have this capability.”

*Resultant gains*

The instrument is now assembled on a large table top. The university of Rochester owns the intellectual property, but Richhariya is free to modify as he likes. LVPEI has begun to use it for its research and to detect retinal diseases at an early stage. Richhariya is now associate director of the engineering group, which works on instrumentation used in the hospital. He has expanded LVPEI reach through academic partnerships with two IITs in India and the University of British Columbia in Canada. A partnership with IIT Hyderabad had begun informally even before Richhariya started the engineering division. D Balasubramaniam, former director of the Centre for Cellular and Molecular biology in Hyderabad, had gone to IIT to give a talk in 2012. After retirement in 1998, Balasubramananian had become research director of LVPEI, where he had helped develop, among other things, pioneering techniques for using stem cells to produce corneal epithelia. This later became the largest successful human clinical trials of stem cells. “Balasubramanian threw some challenges to the engineers,” says Sumohana Channappayya, professor of electrical engineering at IIT Hyderabad. “He asked us, can we build an artificial eye? Or how can we help people who are visually impaired?” Some professors took the challenge and began working on eye-related engineering problems. Now, IIT Hyderabad works with LVPEI on long- t erm basis. The eye institute sponsors three MTech students for three years on research problems that have relevance in ophthalmology . After Richhariya joined formally, he also started a project with IIT Madras, on using lasers for eye surgery. Anil Prabhakar and Balaji Srinivasan at IIT Madras had developed a new generation of lasers called fibre lasers, which can withstand dust and reduce cost of equipment. These two institutions, along with the IIT Madras startup Unilumen Photonics, is working on a project to develop a pico-second fibre laser for ophthalmology, partly funded by the Department of Biotechnology. Unilumen will manufacture the product, when ready. LVPEI will also look at manufacturing other devices from its research. The adaptive optics device helps image the retina at cellular level and can catch degenerative diseases well before they become evident on other imaging equipment. One day, this could become a product that is manufactured in India. Meanwhile, LVPEI is developing a handheld device, along with the University of British Columbia, to catch eye infections early. Richhariya joined LVPEI in December 2012. he submitted his PhD thesis in 2013. It was so unusual that the Rajiv Gandhi Technical University, the Bhopal-based institution where he had registered for his PhD, took three years to find experts to examine the thesis. Richhariya got his PhD last month. – Courtesy

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