The Hindu Business Line : No greater gift than vision

`Get me Rs 100 crore and I'll wipe out blindness from Tamil Nadu,' is the impassioned plea of Dr J. Agarwal, who was awarded the Padma Bhushan this year for his services in ophthalmology.

Dr J. Agarwal (seated) and Dr Amar Agarwal.

He asks you to close your eyes "for five minutes only", adding, "I assure you, you'll not be able to do it. So just imagine the plight of the blind people. The greatest gift I can give anybody is vision; I have nothing more to give."

This is the response of Dr J. Agarwal, Chairman of Dr Agarwal's Eye Hospital, Chennai, who was awarded the Padma Bhushan this Republic Day. He takes this award — the only Padma award for an ophthalmologist this year — as "an honour and tribute to the ophthalmologists who have been working relentlessly to combat blindness in the country," recalling the immense gratitude of the "few patients" to whom he has given "the gift of vision."

This includes the 19-year-old totally blind boy who was given a corneal grafting and "he saw his mother for the first time in his life."

And the young graduate woman blinded by an eye disease in 1976. "She needed a corneal graft and I told her she'd have to wait till a donor cornea was available." As she was leaving, the body of a 12-year-old girl was brought in. "She was dying in the GH with a heart problem; the father wanted her eyes to be donated and the doctor said: `Take her to Dr Agarwal'. We stopped the young woman and wanted to do the surgery immediately. But her father asked us to postpone the operation by two hours because the man who wanted to marry her insisted that he would marry the woman when she was sightless, lest somebody say that he had married her only after she got vision."

So a room was given to the Christian family, a priest summoned and a simple ceremony was performed before the woman got a corneal grafting. "Subsequently we operated on her second eye too; now she is a mother of two children and working as a teacher," says Dr Agarwal, adding there are 12 million blind in India and 75 per cent have curable blindness, of which 90 per cent is cataract.

And then he startles you with an impassioned plea: "Get me Rs 100 crore and I'll wipe out blindness from Tamil Nadu, where there are 9 lakh blind people. I will create 20 hospitals in the villages — not the cities where there are enough doctors — where free treatment will be given."

When you mumble that this is not that huge a sum, he says, "Then get it for me; this is my dream. I've tried for 15 years to collect this amount but have now given up and decided I'm incapable of raising this money," says the man who has put in 50-odd years in the profession.

The ophthalmologist says cataract is the commonest cause of blindness, followed by corneal blindness due to injury, infection, disease, ulcers, chemicals, bow and arrow and gilli-danda, and above all neglect. "In the villages they treat eye injuries with milk, or juice of a plant which damages the eye."

Dr Agarwal came to Chennai in 1957, after an MBBS degree from Jaipur and a PG from Aligarh University. "My wife and I came here with nothing; she later went to London to train as an ophthalmologist. I started my practice, and shifted in 1976 to the present location to start a two-bed hospital."

Today with his son, daughter and daughter-in-law all specialising in ophthalmology, this hospital has 50 beds, and Dr Agarwal's Eye Hospital has expanded to 11 centres, including Bangalore, Thiruvananthapuram, Jaipur, Salem, and Tiruchi.

Fantastic medical advances

He says that in 50 years the speciality has "changed vastly and unimaginably. Many diseases that we thought we could never treat are now being treated. The most fantastic advance is vitreous surgery." The vitreous is a jelly-like substance inside the eye that keeps the shape of the eyeball intact. Earlier there was no treatment for haemorrhage in this region, due to diseases, particularly diabetes. "We could only tell the patient, take rest. Now we're going into the eye and sucking the blood out. If left untreated, this causes blindness," he adds.

Another advance is treatment of myopia through laser. Till recently they could help people above 40 through laser surgery in correcting either near or distance vision. "But just recently we've started doing conductive keratoplasty which can treat both age-related near vision problem (presbyopia) and far sightedness (hypermetropia). In this procedure we use a radio frequency probe that is thinner than the human hair," he says.

But, adds Dr Amar Agarwal, Managing Director of the Hospital, "the most exciting thing will be the advent of stem cell surgery". His wife Dr Attiya Agarwal recently grafted stem cells from the healthy eye of an eight-year-old boy into the other eye blinded by... of all things... mango pulp. The child was playing with a ripe mango and squeezed it, sending the mango juice right into one of his eyes.

This blinded the child "as the mango pulp contains chemicals", explains Dr Amar, adding that there have been cases where when trying to squeeze the last bit out of a perfume bottle, it was shaken before spraying and "it exploded like a bomb, blinding the user."

For an unbelievable eight months the child, hailing from a poor family in Vellore in Tamil Nadu — his mother is mentally retarded and the father has a hearing and speech impairment — lived with his injured eye totally shut and even went to school. Finally when he was brought to the ophthalmologists in Chennai it was decided to take the stem cells from his healthy eye — "near the cornea, at the junction of the white and black portion of the eye" — and transplant them on the injured eye. The child is now able to open his eye and vision has returned.

"The future of medicine is going to be stem cells in all specialities and in ophthalmology too, there are unbelievable possibilities. We've been doing stem cell research for two years and a text-book written by Dr Sunita (sister), Dr Attiya and me on this subject will be published in the US soon," he adds.

Had the child been brought to them earlier they might have been able to save his vision by washing his eye with a special solution, applying ointments, etc. Another case at the hospital is that of a woman from Andamans who was blinded by the adverse side effects of the antibiotics she was taking. "This can happen; suddenly and for no fault of yours, your doctor or manufacturer; you can get a reaction called the Steven Johnson syndrome and go blind in both eyes. In such cases we can use the stem cells from a relative where the tissues match or even from an unrelated donor."

As Dr Attiya has done on a patient from Tata Steel in Jamshedpur, who came to them six months ago, with both his eyes blinded by a chemical injury. "He came to us six months after the injury and could not even open his eyes, and would scream when I tried to open them for examination." She decided on stem cell transplant, but both his father and brother who had brought him refused to give their cells, "even though we explained to them that this would not affect their cornea or vision, but we could not convince them," says Dr Attiya.

But she was able to convince two of her blind patients to donate their cells. "Now I have prepared his eyes with the stem cells and he is ready to take a corneal grafting, because his corneas are also gone," she explains. A corneal graft without this preparation with stem cells will not work. As Dr Amar explains, "That would have been akin to building a house without a foundation." After a gap of three months, she hopes to do corneal grafts on both his eyes.

But while the younger Agarwals are excited at the fantastic future offered by stem cells, the Padma Bhushan awardee is still dreaming about eradicating blindness in Tamil Nadu. As B. Sudha, Director at the Hospital, puts it, "some of the people he has treated have come from the road and were so poor that they had to be bathed and shaved before they could go into the theatre for treatment."

Response may be sent to rasheeda@thehindu.co.in

Picture by Bijoy Ghosh