A mission for vision

Sankara Nethralaya, Chennai, which has done pioneering work in providing high-quality ophthalmic care to the people irrespective of their economic status, marks another milestone in its growth.

CHENNAI, often called the medical capital of India, derives this distinction largely from the services provided by a number of charitable institutions. Sankara Nethralaya, the renowned eye-care centre, is one such. In the words of President K.R. Narayana n, it "is a wonderful example of social responsibility of private sector medical care".

In its continuing efforts to provide quality eye-care to the poor, Sankara Nethralaya dedicated to the nation on December 8 a well-equipped Rs.27.5-crore complex with a floor area of 76,033 square feet. Named the Kanchi Mahaswami Complex, the extensively renovated facility (it formerly housed Wellingdon Hospital), accommodates a community centre with 68 beds and five operation theatres equipped to perform over 20,000 cataract surgical procedures every year, half of them free of cost.

Sankara Nethralaya, described by Tamil Nadu Chief Minister M. Karunanidhi as "an eye-care hub in the country, and perhaps in Asia", was started in 1978 as a charitable institution by Dr. Sengamedu Srinivasa Badrinath on a call given by Jayendra Saraswati , the seer of the Kanchi math. Its primary aim is to "extend state-of-the-art, affordable ophthalmic care to the people irrespective of caste, creed and income". A unit of the Medical Research Foundation, it has evolved into a world-class tertiary referr al centre for complicated eye ailments. A major centre for vitreo retinal surgery in Asia, it is the first eye hospital in the continent to get the ISO 9002 certification.

The hospital started functioning in a small way, with 16 beds and one operation theatre, on the premises of Vijaya Hospital, Chennai. The Medical Research Foundation was set up soon afterwards, and the hospital moved to its own premises in 1979. A new bl ock to accommodate the increasing number of in-patients was constructed in 1982. Within a decade, a seven-storey building to take care of the growing number of out-patients and a hospital on the outskirts of Chennai as part of a rural out-reach programme were ready. In 1999, Sankara Nethralaya bought the nearby Wellingdon Hospital (Frontline, April 9).

According to Dr. Badrinath, Medical Research Foundation chairman and winner of Padma Bhushan, the hospital focusses on patient care, rural out-reach, research and training. Sankara Nethralaya treated 10,000 out-patients in 1978; now it treats two lakh ou t-patients and performs over 20,000 surgical procedures every year. The figures are expected to double in the coming year with the inauguration of the new complex near the main hospital.

According to Dr. Badrinath, free service for indigent patients forms the core activity of the hospital; patients with a monthly income of less than Rs.1,750 are treated free of cost. In 1998-99, 50 per cent of the consultations and 40 per cent of the sur gical procedures were done free of cost, forgoing a revenue of Rs.5.5 crores. The treatment provided free of cost since 1996 is worth over Rs.12 crores.

RESEARCH, an important part of Sankara Nethralaya's work, became focussed with the setting up of the Vision Research Foundation in 1983. Among the eye hospitals in the country it has the highest number of allied departments under one roof, 12. These depa rtments included microbiology, histopathology, molecular biology, ocular pathology, biochemistry and genetics.

Of the 286 ophthalmology-related research papers from India published in international journals between 1990 and 1998, 60 were from Sankara Nethralaya. According to Dr. Carl Kupfer, Director, U.S. National Eye Institute, Sankara Nethralaya's research wor k is of international standards and conforms to international norms and protocols. The Vision Research Foundation collaborates with various international research organisations based in the United States, Japan, New Zealand and Hong Kong.

The 12 departments have contributed immensely to the understanding of various eye diseases and their causes. For instance, the Biochemistry Department concentrates on the study of the biochemical changes in the crystalline lens that lead to cataract. Res earch in these departments have led to various discoveries, such as the detection of a new enzyme, dipeptidase, in the human lens; the association between cadmium accumulation and the formation of cataract in smokers; and the role of polysaccharides in c ongenital cataract.

The Microbiology Department has found new methods, such as the polymerase chain reaction for the early detection of the infective agents in ophthalmic specimens. This method can save vision for millions. Among the specialised investigations done at the d epartment are tissue culture, HLA (Human lymphocyte Proliferation Assay) typing and lymphocyte proliferation assays. The department also does rapid culture for early identification of micro organisms in the eyes, crucial in cases where even a slight dela y could lead to blindness.

The Department of Molecular Biology and Genetics has made several significant contributions. These include the identification of the genes responsible for Oguchi's disease and blepharophimosis-ptosis syndrome. Projects to understand the molecular genetic s of adult-onset cataract, glaucoma, diabetic retinopathy and retinoblastoma are under way.

Sankara Nethralaya has identified several genetic eye disorder genes and contributed immensely to the human genome project. It has identified defects in the DNA (deoxyribonucleic acid) language or mutation, in ocular diseases. In 1994, Sankara Nethralaya became the first institution in the world to identify a mutation in the rhodopsin molecule (in chromosome 3, leading to retinitis pigmentosa, which causes night blindness initially and total blindness eventually), inherited in an autosomal recessive man ner in a family.

In 1997, researchers of Sankara Nethralaya made the significant finding that mutations that cause retinitis pigmentosa were in chromosome 1 and that the mutations affected the transportation of vitamin A into the retina. Three more genes were mapped in c hromosomes 16, 2 and 4 recently. The blepharophimosis gene was found to be present in chromosome 7. According to Dr. Badrinath, Sankara Nethralaya hopes to come out with some radical results in research in the fields of cataract, glaucoma and diabetic re tinopathy in the next two or three years.

TRAINING ophthalmologists is another core activity of Sankara Nethralaya, which it does through the C.U. Shah Ophthalmic Post Graduate Training Centre. The teaching pattern conforms to the American Residency Training Programme. The centre has trained ove r 300 ophthalmologists, who now work in India and abroad. The hospital is certified by the National Board of Medical Education to train students of ophthalmology, microbiology and biochemistry for doctoral programmes. It is the only eye hospital in the c ountry recognised by the University of Edinburgh to conduct the FRCS (Fellow of the Royal College of Surgeons) examination.

Sankara Nethralaya is recognised by the Government as an 'institute of national importance' for its pioneering efforts to provide state-of-the-art facilities and raise diagnostic and treatment procedures in ophthalmology in India to international standar ds. Sankara Nethralaya was the first hospital in the country to perform the modern vitreoretinal operation (1979) and retinopathy of prematurity (1993). It set up the country's first ocular virology (1989), ocular genetics and molecular biology (1993) la boratories. Sankara Nethralaya procured argon laser and YAG laser equipment in 1979 and 1982 respectively. In 1997, it acquired an ultrasound biomicroscope, and in 1998 GDX nerve fibre analyser. It is the first hospital in India to possess these faciliti es.

Sankara Nethralaya is the first institution in Chennai to introduce the state-of-the-art excimer laser PRK (photorefractive keratectomy) treatment to correct refractive errors. LASIK (laser assisted in situ keratomileusis), its latest version, was introd uced recently. With the availability of these two procedures, the hospital offers permanent cure for myopia, hypermetropia, astigmatism and a host of other eye problems.

The number of donor eyes collected by Sankara Nethralaya's C.U. Shah Eye Bank is the highest by any institution in the country. Started in 1979, the eye bank procures, evaluates, preserves and distributes corneal tissues for transplantation and research. In 1999, it handled about 650 donor eyes. Since 1979, the eye bank has received 4,155 donor eyes and restored sight to 3,389 corneally blind persons. Corneal tissues that were not fit to be transplanted were used for research. According to Dr. Badrinath , Sankara Nethralaya will soon use innovative information technology approaches, such as telemedicine, to propagate its expertise to service providers all over the country.

Dr. Badrinath said that he was grateful to philanthropists such as Nani A. Palkhivala and his wife Nargesh, who have bequeathed all their property and personal savings, including the shares they hold in various companies, to the hospital. Among others wh o have contributed financially to build Sankara Nethralaya are the Jaslok, Tulsi, Tata Trusts, Mahyco, Sanmar, Larsen & Toubro, and the Kotharis and the Ambanis. The Tamil Nadu Government waived stamp duty of Rs.1.8 crores with respect to the transfer of ownership of the premises that now constitutes the Kanchi Mahaswami Complex.

Dr. Badrinath, who has helped replicate the Nethralaya experiment in Jalna in Maharashtra and Guwahati attributes Sankara Nethralaya's success to its dedicated team of doctors and medical social workers.