is the text of President, Dr. A.P.J. Abdul Kalam’s address at the inauguration
of the South East Asia Glaucoma Interest Group Conference at Chennai:
Light to See: A
I am delighted to participate in the inauguration of the
South East Asia Glaucoma Interest Group Conference organized by the Sankara
Nethralaya Medical Research Foundation. My greetings to Dr. S.S. Badrinath,
ophthalmologists, optometrists, medical social workers, medical technologists,
delegates from South East Asian countries and distinguished guests
participating in this Conference. I would like to talk to you on the topic
“Light to See: A Beautiful Mission”.
Glaucoma is a silent disease of the eye, and the most
important clinical sign is rise of intra ocular pressure. It is estimated that
over 65 million people are affected by glaucoma worldwide. Because symptoms
appear very late, only half of the affected individuals are aware of the
disease. There are two adult forms of glaucoma- the open angle glaucoma and
narrow angle glaucoma. Studies from India, Singapore and China have suggested
that Asians suffer more from the narrow angle glaucoma compared to other
populations who suffer from open angle glaucoma. Glaucoma has been identified
as a priority ocular disease requiring urgent measures of intervention to
decrease the burden of blindness in the Right to Sight by Vision 2020 initiative.
India has over 10 million persons suffering from various forms of glaucoma both
congenital and developmental. Indian scientists from Hyderabad and Madurai have
identified specific genes such as Opti-nuron and CYP1B1 as the main cause of
occurrence of glaucoma at birth or early in life. This research may lead to
genetically designed drugs.
Diagnosis of Glaucoma
The treatment of glaucoma begins with early diagnosis. While
traditional means of diagnosing and monitoring the treatment effect was
measuring intra ocular pressure, glaucoma researchers have realized that early
defect can be demonstrated by plotting the field of vision and through primary
damage, which occurs in retinal neural tissue around the optic nerve head. A
variety of devices are now available to accurately and reproducibly measure the
field and the retinal nerve fiber changes in glaucoma. It is essential to equip
eye care centres with these measurement devices particularly mobile clinics so
that they can use it for screening people in rural areas.
Primary open angle glaucoma is mostly treated by
medications. The primary narrow angle glaucoma is treated with laser iridotomy.
Advanced stages of both open and close angle glaucoma are treated by surgery.
During the last few years there has been marked change in glaucoma therapy due
to the availability of superior intra ocular pressure lowering agents that can
be applied only once or twice a day so that patients are better compliant.
However, I understand the cost of the drops is quite high. Specialist assembled
here should work out strategies in partnership with pharma companies to bring
down the cost of the drops for glaucoma medication.
The challenge in glaucoma management is proper diagnosis at
the appropriate time. Since narrow angle glaucoma is more prevalent in the
Asian population, a simple test like gonioscopy that estimates the
configuration of the anterior chamber angle will go a long way in detecting
this form of glaucoma early. This is important since a simple and cost
effective laser treatment such as laser iridotomy can cure the glaucoma. My
doctor friends say that doctors may sometimes want to monitor the intra-ocular
pressure on an hourly basis, and doing it the conventional way is cumbersome.
Would a device or probe be possible which could be inserted? Here is a
challenge that should attract biomedical engineers and would be of great use
for specialists. I firmly believe that learning gonioscopy must be made part of
the ophthalmology curriculum for all eye specialists irrespective of their
Glaucoma causes retinal neuronal dysfunction. Future
glaucoma therapy should be directed to prevent, delay or reverse decay of the
retinal ganglion cells and axons. Functional genomics and proteomics are likely
to play a pivotal role in early detection of glaucoma. 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 due to glaucoma. Stem cells may
help restore vision in patients who has glaucoma, by repopulating or rescuing
damaged cells. Stem cells can also be used for terminal stages of glaucoma. A
few of our ophthalmologists are already working in stem cell therapy. Gene
therapy approach is applicable to either lower the intra ocular pressure or
protecting retinal ganglion cells. This approach could reprogram the target
cells by transferring genetic material into them so that they lower intra
ocular pressure physiologically. Another promising therapy is use of nano
technology for targeted delivery of small-molecule therapeutic agents to the
back of the eye.
Nano technology is finding large-scale application in drug
delivery systems, biomedical application and nano structure and devices. The
low dimensionality of many nano-structures, in which electrons are free to move
in only two, one or even zero dimensions, has a profound effect on their
chemical, electronic and optical properties. The practical application of these
effects is only just beginning to be realized in such devices as lasers based
on quantum wires and quantum dots. By exploiting quantum behavior, researchers
can tailor the basic characteristics of the materials and devices to achieve
greater efficiency, faster speeds and high packing density devices for
electronic, photonic, catalytic, magnetic and biomedical applications. For
example, a neural stimulatory micro-system requires fairly uniform nano-sized
electrode arrays for focal stimulation of neural tissue for the treatment of
blindness. Using nano-technology research, ophthalmologists can find innovative
treatment methods for glaucoma. As you are aware, there are some leading
research initiatives in the world, which give promising hope in the treatment
of glaucoma, where convergence of technologies plays a major role: -
1. Applied nanotechnology aimed at the regeneration and
neuroprotection of the central nervous system (CNS) will significantly benefit
from basic nanotechnology research conducted in parallel with advances in
related biological sciences. (Surgical Neurology 63 (2005) 301– 306)
2. Hamsters blinded following damage to their optic nerve
have had their vision partially restored with the help of an implanted
nanoscale scaffold that has encouraged nerve tissue to regrow. (The New
Scientist 13 March 2006)
3. Optic nerve regeneration is the key to at least partially
reverse blindness from glaucoma.
Approach Through Traditional Medicine
Approach through the traditional medicine route is another
method to find a treatment regime for glaucoma. For example the extract of the
leaves of the Chinese tree Ginkgo biloba, while Indians lay their hopes on
Ashwagandha of Ayurveda for treatment of glaucoma. We need in depth work on
these and similar approaches. I understand that research is going on to try and
make a therapeutic vaccine against glaucoma. New innovative ideas of this kind
should be encouraged in eye care centres in South East Asia.
Glaucoma is one area where we need an approach called bench to bedside, that
is, basic research in the laboratory bench is needed in order to understand the
problem, so that it can be translated as treatment to patients at their
bedside. Scientists and ophthalmologists need to work hand in hand. I am happy
that some of our eye care centres like Sankara Nethralaya, Aravind Eye Hospital
and L.V. Prasad Eye Institute, are following this model.
Ophthalmologists as Teachers
Recently, there was a meeting of cured patients, their
doctors and a few social workers. One important result was discussed. The
relationship between the patient and doctor extends to patients’ families and
doctors in medical care. This in turn, transmits effective messages from one
family to another family on advice on how to prevent eye diseases, necessity of
periodic checks, dietary habits and need for life style changes including eye
exercise for good eye health. Actually, I believe this good contact between
doctors and patients is comparable to that of a teacher and student. I request
every doctor to play the role of a teacher in advising every family on eye
disease prevention particularly glaucoma and methods to maintain a healthy
vision. I hope you will find time for this noble action.
‘Defect Free Vision For All’ should be the mission of the
South East Asia Glaucoma Interest Group. Eye problems of patients can be
corrected, if diagnosed early. Since glaucoma occurs in the middle age group
population, this conference may consider a methodology by which the population
of this age group can be screened periodically through Eye Camps in their
region. Any one detected with glaucoma should be treated by specialists at eye
care hospitals in their region. This type of intervention will enable early
detection and cure of glaucoma prevalent among the middle age group resulting
in better productivity from this group.
Emerging virtual reality and micro machines and convergence
of technologies will transform the healthcare scenario. We also have amongst us
today, the best doctors in eye care from around the world. I suggest that all
of you join together and say, “Let there be no glaucoma” and I am sure the
world will become a much more lighted place and brighter.
For screening of rural people in South East Asia, I recommend deployment of
mobile clinics by eye specialists in Ophthalmology present in this Conference.
This will be an important contribution by this interest group in preventing and
treating glaucoma in particular and eye care in general. One of the great
qualities of human beings as envisioned by Almighty is to give and give. What
any one of us can give who is blessed with eye vision. When I see all of you
professionals of the South East Asia Glaucoma Interest Group, I find God has
blessed you all with the ability and mind to give vision to thousands and
thousands of our fellow citizens.
With these words, I inaugurate the South East Asia Glaucoma
Interest Group Conference. My best wishes to all the participants at this
Conference in their mission of making the region glaucoma free.
May God bless you.
(Release ID :22671)