VS Sangwan likes to answer his patient's
questions thoroughly, and so he didn't 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. By
2002, it had touched revenues of `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.
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
Sangwan's help to use the library at the eye institute, and he spent long hours
in there reading. Richhariya didn't have a PhD. The management of Mahakal
Institute told him that he would not get far in academics without a PhD degree.
He did a 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 with out 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 their's 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 `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 Richhariya's
work in the US for an extra year. Rao had worked at the University of
Rochester, which had one of the world's 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. University of Rochester owns
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's reach
through academic partnerships with two IITs in India and the University of
British Columbia in Canada.
A
partnership with IIT Hyderabad had beg un 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-term b a si s. T he eye i n st it ute sp on
sors three MTech students for three years on research problems t hat have
relevance in ophthalmology.
After
Richhar iya joi ne d for iya joi ne d for mally, 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.
Source: THE ECONOMIC TIMES-1st August,2017