I am delighted to inaugurate the Aravind Eye Hospital at Pondicherry. Aravind Hospitals have been serving a large number of people through their hospitals located at Madurai, Theni, Tirunelveli and Coimbatore. I understand that this is their second largest hospital complex which is designed to cater to about 1500 patients per day with 600 beds for free patients and 150 beds for paid patients. I am sure with this increase in their service facility their current contribution in eye-care which is about 5% will increase considerably. The mission of Aravind is not only giving sight to the visually handicapped, but also it is a centre of education and dynamic performance of service. During the past 25 years, this institution has created the best of doctors, nurses and other paramedical staff and has also given to many institutions. Once again I greet Aravind Eye Hospitals family, particularly Dr G. Venkataswamy, who has seen thousand full moons and has also given light to many thousands and the leadership to give the Vision.

Eye Care Mission

When I am in the midst of this gathering of doctors, and above all Aravind Eye Hospitals team, I was thinking what thoughts I can share with all of you. You may be aware, a Healthcare Technology vision document was evolved as part of Technology Vision 2020, a few years back. Prof M. S. Valiathan led the team in evolving the Healthcare vision document. A number of experts in the area of ophthalmology were involved in the task teams. Many important issues were brought in the document. It is said that in India, minimum 20 million people in a billion population are blind, while 25 million people are visually handicapped. The population growth coupled with increase in life expectancy will only lead to increase in the number of blind and visually handicapped. 80% of the cause of blindness is due to cataract. The other causes have been identified as cornea, glaucoma, diabetes and other vitreo retinal disorders and vitamin-A deficiency etc. The expert team had identified preventive technologies, diagnostic technologies and curative corrective technologies. One of the major recommendations is to develop eye lasers with slit lamps for post glaucoma and cataract patients treatment and large-scale production of cost effective vitamin -A tablets. Recently, laser treatment for diabetic retinopathy to arrest eye bleeding has been added. Above all, education and management system for eye care and also creating a human feeling to increase large number of eligible eye donors has been recommended.

A national mission for fast track treatment method has to be evolved involving mission-oriented doctors throughout the country. This team should organize series of eye camps, reinforcing many eye hospitals with technology to increase the treated population. In this direction, I have seen Aravind Eye Hospitals spearheading in bringing together multiple institutions. In doing so, integration of minds is possible and governmental support can be made easier. India already has a national programme for control of blindness and also Vision 2020 : The Right to Sight initiative (Global). Throughout the country and also around the world, each and everyone is sympathetic to the visually handicapped who need vision and prevention of blindness. This service oriented attitude towards visually handicapped can bring together a number of partners in the national mission.

Need for indigenous medical devices & systems

You are aware that approximately thirty percent of our population is still below the poverty line and medical care has to be provided to a large population. I was discussing this problem with some of my doctor friends and those connected with health care. I realized that the major problem in Indian health care delivery system including the area of ophthalmology is the near total dependency in medical imports of diagnostic and therapeutic equipment and devices including consumables. Every year, about Rs 3000 crores plus worth of medical devices and equipment are being imported. While the common man seldom buys anything imported, he is made to purchase or pay partly for the cost of the imported gadgets for healthcare. This clearly brings out that, we need to create an infrastructure capable to produce our own medical devices, consumables and equipment, based on the technology available and to be developed within the country, at affordable cost.

Basic research need to focus in the areas of - molecular genetics of inherited eye diseases, microbiology of eye infections, biochemical features of cataract, and stem cell technology for reconstruction of the damaged ocular outer surface. Our clinical research need to study the suitability of drugs and lenses, as also prospective and retrospective research on problems seen in the clinic. The Stem Cell technology is at the cutting edge, practised by no more than three or four centres across the globe. It involves the harvesting of stem cells from the limbus of the eye and explant - culturing them such that the resultant material can be used to reconstruct the damaged outer surface of the eye, thus enabling it to better accept a corneal graft. L.V. Prasad Eye Institute, Hyderabad has succeeded in translating this technology from the Petri dish to the patient's eye. Such advanced technologies need to be effectively deployed to provide critical eye care to the majority of the population.

Stem Cell : For Restoration of Vision

The recent identification and characterization of progenitors with stem cell properties has opened new avenues that may be useful for treating functional impairments caused by the death of specific cell population. Stromal and neuronal degeneration are the causes of deblitating visual impairment associated with many ocular diseases, such as degenerative diseases of cornea, retinitis pigmentosa (RP), age- related macular degeneration (AMD) and glaucoma. The stem cells may help restore vision in patient who have these diseases, by repopulating or rescuing the damaged ocular surface cells or retinal cells from further degeneration. The stem cells can be used for two different but complimentary ways to treat the degenerative diseases of the eye.

1. Cell Replacement:

Therapy Cell replacement therapy explotis the plasticity of stem cells progentors to replace cells and repair tissue damage by diseases or injury. The LV Prasad Eye Institute, Hyderabad have demonstrated the efficacy of the limbal stem cell transplantation in severe ocular surface injuries caused by chemical burns. Currently they have also successful in culturing adult bone marrow cells that differentiate into retinal neural cells. Confirmed with several immunohistological tests, these cells have the greatest chance for replacement and rescue of many incurable retinal diseases.

Ex vivo gene therapy

The ability to maintain and manipulate stem cells progenitors in culture suggest that genetically engineered stem cells can be used to target gene products to sites of degeneration. These gene products can include survival-promoting factors to rescue degenerating cells, factors that can act in an autocrine manner to promote survival and differentiation of grafted cells into site specific neurons or to deliver neuro transmitters to permit functional recovery. Ex-vivo gene therapy could be used effectively as a neuro protective strategy to prevent retinal cell loss in retinitis pigmentosa (RP), age-related macular degeneration (AMD) and terminal stages of glaucoma.

Emerging evidence suggest that multi potential stem cells progenitors hold considerable promise. Therapeutic applications of ocular surface (limbal) and retinal (neural) stem cells have special appeal for the treatment of otherwise intractable inflammatory and incurable degenerative diseases of the eye. The novelty of the approach lies in harnessing the pleuri potential capacity of the adult limbal and bone marrow cells, and the ability to use the cultured cells from the same patient so as to avoid past treatment immunosuppressive therapy.

Conclusion

We have the best doctors and technologists in India. We have core competence in design and software engineering. Emerging technologies in virtual reality and micro machines will transform the healthcare scenario. This transformation should lead to helping the people who cannot afford the modern medical care. If we remove their pain, then God will bless us. Friends, I am happy to share some of my thoughts with you and to inaugurate the Arvind Eye Hospitals, Pondicherry. May God Bless you.

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