Dr Yog Raj Sharma, hailing from City of Temples (Jammu), presently settled in USA, was in the news recently when his research paper on Retinal detachment which he co authored with other researchers was selected among top 100 publications worldwide in the last 120 years. In an exclusive online interview with Daily Excelsior Correspondent, he waxes eloquent on the subject and life experiences.
Excerpts of Interview
EC: It is a proud moment for us in Jammu that you made it to top 100 publications in the world. How do you feel about it?
YR : Our publication in 2005 in Acta ophthalmologica SCANDINAVICA is in top 100 in last 120 years on the most vital topic of SURGERY AND MANAGEMENT for RETINAL Detachment and only one from India (None from Russia, China, Africa ) and SE ASIA and of 195 countries, only 20 countries have contributed to this extremely rigorous and by a bibliometric study from America from Georgia Washington University School of Medicine, University of West Virginia school of medicine, Retina- Macula Institute, California and Stein institute of Ophthalmology California published as the lead article in journal of AMERICAN SOCIETY OF RETINA SPECIALISTS November , 2021. It is indeed overwhelming ! Infact singular biggest achievement in my professional career.
It is an honour for India , for Jammu, for Dr RP Centre for Ophthalmolic sciences, All India Institute of Medical Sciences (AIIMS) , for all the authors and me. I was the first the first author and all surgeries in the study were performed by me alone as I was the chief guide for Dr Sathiyan’s MD thesis.
This study used the STATE OF THE ART SURGERY for Retinal detachment (RD) Pars Plana VITRECTOMY (PPV) for all the study patients in eyes with prior lens implantation (Pseudophakik eyes ) with buckle or with out a BUCKLE ..prior to 1975 all RD surgeries were managed by scleral BUCKLING alone. PPV gradually became the equally good option or even better than standard BUCKLING . It was controversial if PPV in surging management of RD should be or without BUCKLE.. Our study suggested that no BUCKLING is required and in fact , PPV done alone is better for the patient in all aspects and time saving for the surgeon also and the best escapes the tedious and potentially eye deformation caused by the surgery .
This was a paradigm shift and I as most, eliminated traumatic deformational addiction of BUCKLING not only in RD but most of the PPV PROCEDURES that are performed for innumerable hence to before untreatable Retina- vitreous disorders ..In fact, after this I have never used BUCKLING ever – all surgeries by PPV including RD, of course.
EC: Who is your source of Inspiration?
YR: My biggest inspiration in life has been my wife, who was four years my junior at RGKAR MEDICAL COLLEGE, CALCUTTA from where I graduated. We got married in “75 at Jammu. Without her one hundred percent support I would only be less than 1 percent of what little I am.
Second inspiration in life has been my elder sister’s Pushpa Sharma’s daughter Ranjana Sharma, my neice. I call her in my heart and mind as ,” Bhagwaan Ji ” . She indeed is that alone. Her two children Rajni and Rajeev both are named so by me and first two letters ” RA ” are from niece’s name ‘ RANJANA ‘ . TIll this day that inspiration that was lit in ’76 has lasted . I have let her down in thought, word and DEED but never her .
After these two biggest inspirations and instrumental institutions of my life till date I will start chronologically from birth . First my mother Smt Devi ( from Katra ) for a life of sacrifice , simplicity and UNCONDITIONAL mother’s love of five children. I am the middle one . In ’62, she was operated at Amritsar for RD by Dr Niramkari and after surgery her head was kept immobilized in between sand- bags in the hope that Retina would reattach ; it didn’t and all vision was lost in that eye plus she suffered for nearly 3 years for the fear of imminent death !
Father a very frugal man who never would spend a penny on himself but also most difficult to please . I never could . I did tell him after my MBBS ,” YOU MAY BE A GOD AND I MAY BE A DOG BUT YOU ARE A WRONG GOD BUT I AM RIGHT DOG .
MY elder brother also suffered from RD when ~35 years age but was saved because I diagnosed he had RD and took him to PGI Chandigarh, where I was in residency in Ophthalmology. He was an avid sports enthusiast especially cricket, inspired me to learn better English. I was inspired and always encouraged by my younger brother late Sh Narender Sharma by his love and unflinching faith in me .
At SRML Higher Secondary School, I was inspired by classfellows , all in different non -medical sections . Late Sh Ravi Gupta for all smiles and genuine friendship which lasts till this day and with his entire family too. Ravi was a classfellow since 4th standard as was Subash Baru. Subash was brilliant THINKER and a great friend; both met him since -~ 84 but he teaches and lectures me on how to do things correctly. The biggest first inspiration of life was Sh Harish Gupta for his academic brilliance and highest IQ and I have seen ( my daughter has that IQ … I told this to Harish in around ~ 1996 ) ; I am very privileged that other than being my first real inspiration he is a very close friend who keeps me mentally active by his out of the
world high IQ ,his sense of Orwellian humour and his love for music and Shayri especially Faiz and Galib ; a very proud Jammu lover and he is a NATURE freak too.
At MBBS in Calcutta inspired by a junior Dr Ashok Rana. I appeared for honors examination and to my horror, got it to after 27 years in the history of Calcutta University : thus , my MBBS is MBBS ( HONs) .When I was appearing for this examination my senior and roommate Dr Kamlesh Khanna declared in his bombastic English that I am gone be mad.
Did residency at PGI FROM 76- 79 . Inspired by Asha, got grade APLUS and was awarded silver ( highest at PGI Department wise) and first order of merit by then PM, Shri Morarji Desai .
I missed one name: Dr Dheeraj Singh Dutta ; he was a big help in internship and house job in medicine .A lion of a man with a child’s heart, he loved me and taught me confidence and humility
79 – 84 YALE UNIVERSITY OF MARYLAND HOSPITAL AS FACULTY were inspirational in the sense that in learnt never to go by the appearances but see what lies beneath the surface . Since I have never been in awe of anybody by title, name , fame , money or anything, the only thing that matters is are you what you APPEAR to be or say that you are.
Retuned to Jammu in ‘ 84 ; that is another story – no job after then CM ,Dr Farooq Abdullah asked me take over as Head of Ophthalmology at GMC.
However, I was suddenly appointed as Assistant Director by Indian Council for Medical Research (ICMR) under the supernumerary research cadre scheme initiated by Prime Minister Indira Gandhi to attract eminent Indian scientists settled abroad to bring them back to India.
In ’86 joined as faculty at RPC , AIIMS and biggest inspiration there were the residents who I insist are the best in the world : they became friends, gurus and one Dr Fazal al- Gabaly formally accepted us as his parents: he was from Yemen and his full family is in contact and on a regular basis .
In ’94 daughter Rajni got MBBS admission at AIIMS , for the first time father was happy and since then I realised that she is a SAGE and christened her so in my heart and soul and this is till this day in thought, word and deed.
Dr Rajeev Sudan, our son-in-law got admission in AFMC Pune in 1997 and he is an inspiration for his integrity, straightforwardness humility and surgical skills. Vijay Kumar my cousin continues to be on inspiration for his love for silent nature and a God’s heart which sees and does the best always.
In 1994, got a lovely pet, which was brought from Jammu by my cousin Sh Vijay Kumar from my nephew Sudhakar Sharma, who had a Bull Terier and the pet was half Dalmatian. I am happy that I have the best cousin, best son- in-law and best daughter-in-law in the whole world; she is Kyala Amanda , an American .
Retired in 2016 .Inspirational figures have been late Sh Ramesh Aggarwal, Sanjay’s father , for his thought process, B S Jaiswal and younger brother B S jaiswal for purity of their Dogri and faith in me, Sh Anil Goswami for being the smartest IAS officer I ever met .
One of the biggest inspiration in life has been pet SARRY; she came from Jammu when seven days old in Feb ’94 and after doing my best to get rid of her, because Rajeev loved her decided to let her stay I gave her the her name “SARRY ” also after much thought. S for my mothers name SHANTI , A for wife’s name ASHA, R for daughter RAJNI, another R for RAJEEV (both RAJBI- RAJEEV are named after dearest niece RANJANA) and Y for YOG = SARRY. She was the queen of the house, always travelling with us in summer and winter vacation to Jammu. She lived till april 24, 2011; I have christened her ST SARRY and she was there on my facebook page before I put my photo there. She taught so much and next only to wife ASHA. Remember her every time; she taught love spiritually and innumerable things; thus second Guru in my life after wife Asha.
Lastly but big inspiration has been Dr S S Jamwal for being the perfect physician, perfect family man, Jammu and its culture loving people. Love them all.
EC: Do you visit Jammu? When was it last time you visited Jammu ?
YR: Between 1985 to 2015 for one month in summers and two weeks in winter as per AIIMS vacations and SOS. In 2017 ‘ Nov went to live there permanently at parental house at 96, Rehari but Jammu had changed – whattsapp and Facebook ruled all ; every person was a hero and the beauty, the aura had changed and VIBRATIONS were just not good. Everybody lied, age had no respect, everybody seemed in a rush, leave a few friends everyone had changed: nobody had time. In short it just didn’t gel ;I tried and tried but finally it dawned that to live in a totally selfish setup with zero or negative care for everyone made me return to Delhi in Nov ‘ 18 . But Covid brought me here in March ’20 and since then we are here.
Last visit to Jammu was in Feb ’20 to attend a niece’s marriage and it just wasn’t Jammu anymore . Sad but very true ; I think America is more Jammu of sixties than Jammu is ; look at Katra the Goddess town ; not against progress but dehumanisation of basic decency basic humanity is IRREVERSIBLY lost,: I hope I am absolutely wrong on this .
EC: What is Retinal Detachment?
YR: RD is separation of two layers of Retina .Retina is part of of central nervous system embryologically and function wise. Retina’ outer layer called retinal pigment epithelium layer ( RPE) and inner the retina proper. Normally both layers stay adjacent and attached and this is vital for normal vision. The Retina,’s central part is the macula and central part of macula is the five lutealis.
RD can of different types but commonest is Rhegmatogenous RD ; this implies that age related or MYOPIA related or trauma ,, surgical or otherwise related , has caused a break in the Retina . Ice break develops and if VITREOUS is liquified it seeps through the break into subretinal , thus causing separation of the Retina from RPE and thus separated Retina may be partial localised , subtotal or total Retinal detachment .
And once the detachment extends to the macula vision loss is total with only light perception positive from all directions
EC: Does this affect a large section of people?
YR: RD is more common in high myopes, after cataract surgery or after eye trauma. With the advent of intraocular lens transplantation (IOL) for eyes with cataracts the incidence of postoperative -RD has decreased very considerably unless INTRAOPERATIVE complications occur .
The average incidence is about 1 case in population of 1,000. It is the most common RETINA related disease which as a rule militates earliest possible surgery .
EC: What are its symptoms ?
YR: Symptoms – It is well to know that RD may be totally asymptomatic and vision loss may be sudden.
Typically the patient experiences flashes and floaters as the adherent VITREO retinal site experts a pulling force the Retina and the patient experiences flashes of light to floaters as the VITREOUS tug on the induces a micro bleed which while disbursing in cavity causes the patient to see floaters.
In most cases, alarmed patient sees an Ophthalmologist and best is most of the symptomatic (Posterior viterous detachment) PVDs are benign with no break . And another good thing is that a RETINAL break or multiple breaks. At present they can be safely treated by lasering the RETINAL break(s) or by freeze therapy termed cryotherapy. There is need to induce strong Retina-RPE adherence around the break (a) so that VITREOUS tug or traction forms no harm.
After the fluid has seeped into subretinal SPACE that detached Retina stops seeing because light is no longer focused on the Retina.A veil appears before the patient’s eye and progression can be both circumferential or posterior- wards to macula ., the veil seen before keeps enlarging, may be or may not be experienced and often passes unnoticed and as the macula detaches vision loss is total .
EC: Is its treatment expensive or bearable?
YR: These terms are relative .Nothing can be too expensive to preserve the vision. In Government hospitals the treatment is nearly free but the advent of (Pars Palava Vitrectomy) PPV entails use of disposable SINGLE use equipments for the best results. Thus in Government hospitals too a sum varying from approximately Rs 2000 to Rs 20000 may be required to be paid.
No patient is ever declined surgery and the hospitals generally have enough resources to be able to provide the best possible surgical amenities to all patients.
Private hospitals charge differently but never confuse the cost and the actual treatments provided.
EC: Do we have doctors and requisite infrastructure in India to treat this disease
YR: Most definitely . The availability of VR surgeons is an issue and the second is the cost of the equipment. The equipment is very expensive, add to that hospital location, building, staff etc while India is full of very competent VR surgeons, their placement in big cities makes them scarce in less populated locations and towns .
And this requires a concerted Government effort but also of medical councils and societies which have the patient interests first and foremost and far more than mere mercantilistic orientation alone.
The present available facilities in India are same as in the rest of the world”a best institutions . The problem is to make such facility available all across India
For example , the services available are grossly minimal and patient fall into Amritsar- Pathankot- Chandigarh-Delhi trap of UNNECESSARY visits, expenses and the lost time. I think JK Government bears a heavy responsibility. Unfair resource allocation, regional imbalances, political dominance and gross discriminatory government attitudes to Jammu are simply untenable .
EC: How did this subjext attract you?
YR: I never wanted Ophthalmology in the first place. I hated the subject.
In PG even I was hell bent on joining PG in medicine. When I came to America I was invited as Faculty at Ivy League University YALE UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF OPHTHALMOLOGY AND VISUAL SCIENCE. In America the scene was totally different; Ophthalmology was then as now number one speciality sought only by the best toppers in their medical school.
I also spent two years at University of Maryland Hospital. In US main area I was involved in is Cataracts and IOL transplantation. Here we published papers in the Lancet (3)American journal of Medicine investigative Ophthalmology and visual sciences, experimental eye research and biggest coauthored chapters on the subject of ” lens and intraocular lens transplantation ” in ” the year BOOK OF OPHTHALMOLOGY ” ‘ 82 AND ‘ 83.
This was very huge achievement because then there was no net ; it was number one book each year. At AIIMS I was posted in Retina section very much against my wishes. Then, I had learnt that if you get a lemon make a lemonade Retina happened to be by ACCIDENTAL coincidence !
EC: Are working conditions different between USA and India?
YR: Nearly 30 percent doctors are from India or of Indian descent . The working conditions are totally different because nearly 20 percent budget is alloted on health care compared to less than 2% (not sure of exact figures ) in India. So same treatment is available at primary level as tertiary level and because medicine here is totally insurance based and most costly in the whole world but it is worth it in india medical-legal issues are in near non-existence ; that is both the boon and bane too.
Lastly, a doctor earns more than a senator and in India doctor gets dry bread while MLAs live like Sheikhs of Middle East .
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