Medicine/Health
Man of vision
Dr Keiki Mehta’s Eye Institute offers the latest knowhow in rectifying optic problems
Once you step within the portals of this Eye Institute, be prepared to spend some time here. In the crowded entrance hall, on straight-backed chairs against walls, patients are waiting. Patiently. There is no place for you here so you walk into the belly of the anteroom where a chair has just been vacated. From the anteroom you advance into the main arterial passage and wait on a chair there, or a series of chairs as you move up the queue.
Nervous figures edge past you, solitary or in clusters, but they soon melt away into the cubicles that line the two sides of the long corridor. Up and down its length glass doors open and close, open and close, absorbing and releasing patients, doctors, clinical staff. What looks like chaos is choreography — creating a theater of charged movements for you tensed in your seat, a captive audience...
Till it’s your turn (at last) to be impaled by the chin to the various computerized machines of awesome precision lodged in successive cubicles, and monitored by doctors/trainees who are there to examine and evaluate every facet of your eye. Armed with all the data, your last stop for the final scrutiny is the cabin of the big boss, Dr Keiki Mehta, dour as a Scotsman, abrupt in his ways, but with a rich subterranean lode of humor that could emit sparks during the consultation.
He is 60 years old and heads The Mehta International Eye Institute and Colaba Eye Hospital in Bombay (in collaboration with centers in Texas and Boston, USA), where optimal levels of eye care (diagnostic, clinical and surgical) is available. Mehta directs several specialized clinics here for cataract, glaucoma, contact lens, child care, myopia, etc; and here for the first time in India a concerted effort has been made to assemble the most sophisticated equipment (from Japan, USA, Germany) in one co-ordinated institution.
With the advanced technology and expertise now available, Mehta is of the opinion that for the treatment of cataracts India is on par with any country in the world. "Indeed, at the American Society for Cataract and Refractive Surgery in San Diego, Indian doctors conduct instruction courses — four were held last year,” he says. "This is because Indian surgeons have more experience with cataracts.”
Cataracts can be soft or hard, Mehta elaborates on the theme. "In the hard category we have the medium hard and the suprahard. All tropical countries have a higher incidence of cataracts because of exposure to ultraviolet rays. The hard cataract is formed when the patient does not want surgery so long as he can see at least one finger up close with the affected eye, though it is advisable to operate at a much earlier stage.” Yes, the average Indian tends to be apathetic about eye care. "He will send his car for regular servicing, but won’t have his eyes checked even once a year.”
Here I admit that it is after a lapse of years that I’m consulting him. His retort is quick, albeit with tongue firmly in cheek as he deadpans: "It calls for a celebration.” Champagne? I’m tempted to ask, but my next question is decorous enough: do we have enough doctors in India to serve our needs?
By his reckoning there are 17,500 eye doctors in the country, plus or minus 10 percent. In rural areas the number is negligible, so that the rural eye services wing run by the Mehta International Eye Institute must serve a very real need. A 100 percent charitable organization, I learn from the brochure before me, the Netra Rukshak (Eye Saviors) aims to set up quality eye examination and treatment centers, using the latest technology. And to hold eye camps in Maharashtra, for minimum costing, that will virtually yield 100 percent visual recovery. For this training zones for doctors, administrators, nursing staff are on the cards. But its main task is to educate the villager about eye care.
"Our backlog of the corneally blind is enormous,” Mehta informs me, "so the Netra Rukshak plans to distribute pamphlets and make video films to increase awareness of the need to donate eyes after death.” The free 80-bed eye hospital set up in an Adivasi area is not yet functional. Some of the top eye hospitals in India he lists are: The All-India Institute for Medical Sciences in New Delhi, the Shanker Nethralaya in Madras and the Aravind Eye Hospital in Madurai.
With India having the highest number of certified blind in the world, what is the number one cause of blindness in our country? It used to be smallpox, I’m surprised to learn. "Today cataract is a major cause of reversible blindness. And one and a half lakhs are corneally blind, whose eyesight can be restored by a simple corneal graft. The success rate of corneal transplantation is almost 90 percent, but we need to round up more cornea donors. Also much depends on the special cells which line the innermost layer of the cornea — the endothelial cells. If they are deficient the operation will fail.” To evaluate the crucial cells, a new Advanced Specular Microscope has been installed in the Special Corneal Clinic here. "For the first time,” Mehta warms up to his subject, "specialized software has been developed to visualize, locate and assess the number and health of the endothelial cells. The double advantage is that we can now also objectively assess the state of the donor corneas.”
Which he’d said were in short supply, I remind him. How would he enthuse city donors for a better collection?
"A certified Eye Bank is attached to the Special Corneal Clinic, but it’s an uphill task.” And Mehta cites an example: Recently The Times of India issued special donor cards and collected 1,22,000 signatures. But of these, finally, only 375 eyes were collected! "The point missed here is that not just the would-be donor but his relatives must also be counseled, while the patient is still in hospital. We also need to check that those authorized to remove the eye after death are skilled enough not to make a botch of the job.”
If cataracts and corneal blindness are reversible, what caused irreversible blindness?
"Glaucoma is one. Raised pressure in the eyeball damages the optic nerve,” Mehta explains. Glaucoma is often diagnosed too late to prevent visual loss but at the Special Glaucoma Clinic its management has shifted from simple pressure checks to computerized evaluation and treatment. "Diabetes is the other enemy.” After 40, one in 15 is a diabetic, I learn to my dismay. "Diabetes affects the cornea, causes inflammation of the coats of the eye and in the retina it leads to bleeding, the formation of fibrous bands and retinal detachment. At our Special Diabetes Clinic the latest equipment assesses the retina, and a state of the art laser seals off the hemorrhaging sites, thus reducing the risk of blindness.”
Was it true that Parsis are particularly prone to eye disorders?
Mehta answers in the affirmative. As a small, inbred community we suffer from genetic weakness in certain areas of the body, namely the heart, the stomach and the eye. "Yes, Parsis have weak corneas. Yet an institution like the Parsee General Hospital in Bombay does not have its own Specular Microscope. It is also essential that a special glaucoma unit is set up there.”
What were his views on the hygienic factor in our method of disposing the dead?
"Ecologically the best method, the least polluting, but not always practical. In New Delhi we have no dakhma and bury or cremate our dead. In Bombay our Doongerwadi is hemmed in by proliferating housing complexes and the human encroachment on the habitat of birds evidently disturbs them.” It is evident that Mehta is entirely on the side of the birds. He speaks of how distasteful and even lethal to the feeding vultures must be the drugs we pump into the bodies of our terminally ill. "The Parsi Punchayet worthies should respond to this challenge on a war footing to change the scenario.”
I change the subject. Suppose I received a blow to my eye, what were the immediate dos and don’ts he’d prescribe?
"Step number one, is to apply ice to the injury. Then examine your vision — make sure it is in no way distorted or you see less. If so, dash off to your eye doctor. If not, visit him anyway within the week to check that the iris (the colored part of the cornea) has not moved backwards with the blow and there is no retinal tear.”
"Will the day be here when a totally blind man can be made to see?” I ask. At the back of my mind, I suppose, are the miracles performed by the Christ.
His answer thrills me. "By utilizing microchips and having the new implantable telescope (costing around Rs 40,000) fitted in the eye, yes, in the distant future the blind will see.”
Impressive images
The bio data of Dr Keiki R. Mehta, born in Hyderabad on October 3, 1941, makes impressive reading. That he holds a brilliant academic record comes as no surprise. He stood first in the MBBS exam from Ludhiana and first again in his Master of Ophthalmology exam from Chandigarh. He has a Diploma in Ophthalmology from Ireland, another from the Moorfields Eye Hospital in London, and has studied with Prof Franklin in Utrecht, Prof Binkhorst in Holland and Prof Galin in New York.
An innovator of advanced surgical techniques as well as tools (designer knives, forceps, rotators), Mehta has presented papers on original research projects in India and abroad and authored six books. He is the recipient of 12 awards, international and home-brewed; and in January 2002, the International Council of Cataract Surgeons at Barcelona, Spain, honored him with the Outstanding Recognition Award based on his pioneering work in cataract surgery, with special reference to his ‘Cold Phacoemulsification’ method. Today he works in an honorary capacity with several prestigious hospitals, societies and associations for the blind. A caring man, he was honorary eye consultant with the 100-bed Municipal Eye Hospital in Bombay for 17 years. He is the honorary ophthalmic consultant to the Governor of Maharashtra.
"Low Risk Techniques”
He sees eye to eye with his illustrious father. Dr Cyres Keiki Mehta, consultant ophthalmic surgeon, director of Netra Rukshak with a string of degrees trailing his name from here and abroad, sits in a cubicle at the Mehta International Eye Clinic not far from his dad. Junior has a confident, easy manner and one can picture him being cheery with his patients and kind to perturbed old ladies.
From the time he was three years old, Cyres wanted to be an eye surgeon. Dr Mehta is now 30 and has accomplished much in his field. New surgical techniques learnt on recent fellowships in America and Germany are practised by him in Bombay. At the Shepherd Eye Clinic in California he was trained by Dr Steven Bylsma in Laser Adjunctive Deep Sclerectomy (LADS), introduced here for the first time by Cyres at the Glaucoma International Congress hosted in 2001 by India. "This is a low risk, non invasive surgical technique by which even the most severe cases of glaucoma can be controlled without entering the eye,” says Cyres. "On an average I perform two such operations a week, so far with no complications.”
The entire procedure must require incredible skill. "A selected 1.4 mm zone of the diseased area of the eye, where an obstruction prevents the fluid from draining out through the normal channels, is thinned,” he explains, "leading to a gradual fall in pressure.” In conventional penetrative glaucoma surgery, a sudden drop in pressure affects the vision, which does not recover for two weeks to a month. "But LADS is kinder to the eye tissues and the visual loss does not occur,” says Cyres. "Later, if required, a simple outpatient laser procedure is carried out to increase the fluid outflow through this thinned area.”
Another field in which lasers are used worldwide today is vision correction. From Nuremberg, Germany, Cyres recently returned with extensive training in LASIK (Laser-Assisted in-Situ Keratomileusis), which is the most advanced method of correcting refractive errors like nearsightedness (myopia), farsightedness (hypermetropia), and astigmatism (where the cornea is oval in shape rather than round).
"In this advanced technique a thin flap from the cornea is folded back,” says Cyres, "then the corneal tissue is gently reshaped with laser, which results in a change in the shape of the eye.” The light rays now entering the cornea focus directly on the retinal screen at the back and do not fall short of it (as in myopia) or beyond it (as in hypermetropia). The flap or hinge is then placed back. Such is the magic of laser that no stitches are necessary, the entire procedure can be completed on an outpatient basis. "And once the correction is made, the cure is permanent,” says Cyres. "In myopia, for instance, the number cannot shoot up again.” For more details a free consultation may be scheduled with Cyres’ wife Vinifer, who works as the refractive co-ordinator.
"Untreated myopia,” Cyres explains further, "can result in a host of complications. For instance high myopes need a periodic retinal evaluation, where often degenerative patches occur which can lead to detachment.” For professional reasons, too, boys in the armed forces and the merchant navy, also actors, models and all performing artistes need to reduce their dependence on glasses and contact lenses.
So do prospective brides, I suggest. It was one more demand made on the girl by the future mother-in-law, if not the groom himself. "They take it very seriously,” I add.
"Well it is seldom in India,” laughs Cyres, "that anyone goes in for corrective vision for a whimsical reason.” And he recalls the case of an 80-year-old in California who underwent corrective surgery because he wanted to surf!
The lens lady
She fits you with invisible windows on the world. An optometrist, in the last 27 years of her practice she must have fitted, literally, thousands of lenses at the Colaba Eye Clinic. Looking young, and fragile as a porcelain figurine despite the white coat of many pockets, there is yet a quality of resilience about Dr Zenobia Keiki Mehta who with a group of technicians runs the contact lens department here — her other roles as supportive wife and mother she does not wear on her sleeve.
I got my first pair of lenses when the fitting of them was a tedious trial and error ordeal. Multiple lenses were tried on the fatigued and smarting eye in pursuit of the one that turned out to be the best fit.
And vanity was the unvoiced reason why you wore them. Dorothy Parker’s couplet, "Men don’t make passes/At girls who wear glasses” was taken to heart by college girls. Euphoric at the idea of dropping the unsightly crutches from their noses, collegiates opted for the invisible lenses as did a sprinkling of hardcore socialites. Also some professionals, who had reasons other than cosmetics for wearing them, like boys in the armed forces and performers on stage and screen. (Could you enact Cleopatra or Asoka in bifocals?)
Over the years, easier techniques evolved for the fitting of contact lenses. The use a new computerized corneal topographer (EyeSys, USA) with the latest software permits an accurate analysis of the cornea; and since the fitting is done on the computer itself (without tears) the patient can hope for the ideal pair.
"Contact lenses are now prescribed for therapeutic uses too,” says Zenobia when I call at the clinic to hand in my hard pair for its periodic testing. "For instance, when one eye is near-normal and the other has a very high power, with spectacles it would be impossible for the two eyes to function together.” Such a condition is called anisometropia, I’m told. And in answer to my spate of queries Zenobia presents me with loads of relevant literature.
Many are the therapeutic uses of contact lenses, I learn. They are prescribed for non-healing corneal ulcers, for abnormalities like keratoconus (bulging or coning of the cornea), for stabilizing unstable cornea following surgical procedures and for dry eye syndromes. For the very painful bullous condition (small blisters on the surface of the eye), there is no other known treatment. In all these cases the very thin, specially designed therapeutic lenses act as a bandage and allow the eye to heal.
You have a choice of soft or hard contact lenses, but it is best to let the doctor decide. For example, soft lenses (flexible, cushy, large enough to cover the white of the eye) are prescribed for high numbers, but are unsuited to astigmatism, my reading informs me. My old hard contact lenses (rigid, and small enough to cover only the iris) were upgraded to gas permeable (GP) lenses, which are hard but have some flextural ability and allow oxygen to go through the lens to the eye. This enhances the flow of tears and combined with the high wettability of the plastic used, the surface does not develop dry spots and less oil adheres to it.
New materials and uses for lenses are evolving. Bifocal contact lenses and colored cosmetic lenses are already on the market and "toric soft” lenses are recommended for wearing after cataract surgery. Also good to know is that infection with contact lens is rare and occurs if the case in which they are stored is contaminated, or the cleaning solution is unsterile or too little of it is used as an economy measure. Eye drops usually suffice to clear up the infection.
Children, I am surprised to learn, are the best patients for contact lenses. They accept them easily and lose them less than adults (I could write a skit on the number of times I’ve lost and found my lenses). As a rule, if the power required is above three dioptres and increasing, contact lenses are medically indicated for six-year-olds onwards. At this rate, perhaps spectacles will one day become obsolete!
"They well might, over time,” smiles Zenobia on my next visit to collect my lenses.
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