“We want to eliminate avoidable blindness in one district at a time”: Dr. Jacob Prabhakar’s Interview by Mihir Jaiswal
Dr. Jacob Prabhakar is a world-renowned cataract surgeon and medical director of Ruby Nelson Memorial Hospital in Jalandhar, Punjab. He also serves at Mattisson Memorial Hospital in Hapur, Uttar Pradesh and Shimla Sanitarium and Hospital in Shimla, Himachal Pradesh. Dr. Prabhakar with his team relentlessly travels to different villages in India and world performing 300-400 cataract surgeries in a day. His one and half minute cataract surgery makes him one of the fastest cataract surgeons in the world. In this interview, he talks about cataract, its treatment, his vision, and the camps where he performs cataract surgeries.
Mihir: What is Cataract?
Dr. Prabhakar: Cataract is an opacification of the transparent lens of an eye. Every eye has a lens that is transparent like a crystal glass. Over the time, that lens becomes cloudy. As a result, the light that goes into the eye is obscured. It is a slow process.
Mihir: How does one find out about cataract?
Dr. Prabhakar: Cataract is mostly in old age. Sometimes, it is present at a younger age in form of developmental or congenital cataract. Since it is a slow process, the cataract patients start losing vision gradually, ultimately reaching where they are not able to see. When they go to ophthalmologists with complaints of vision impairment, they find out about cataract. Nowadays diabetes is a big problem in India. Diabetes can cause cataract. Slow progressive vision loss is the main indication of cataract.
Mihir: What is the treatment of cataract?
Dr. Prabhakar: The treatment of cataract is a surgery. We have to remove the opaque lens and put a new lens. There are several types of cataract surgeries. When I began my career, there was an intracapsular cataract surgery. This required a large incision into the eye. Patients used to get thick glasses. We, doctors, used to put lot sutures.
Nowadays we have high-tech procedures that are suture-less and have small incision. Phacoemulsification is one of the popular surgical methods nowadays. We use a machine to make a smaller incision. The machine breaks the lens using ultrasound; we then remove the lens, and put a foldable lens.
Mihir: Could you elaborate more on those procedures?
Dr. Prabhakar: Phacoemulsification is the most sort after procedure for cataract removal in the world. It is done using a Phaco machine. The machine uses a probe to make a small incision in the eye, make a tunnel to the opacified lens and then use ultrasound to break the lens into pieces. After that, the pieces are emulsified and taken out of the eye. Through the same small opening, we implant a foldable lens. There are many different types of foldable lenses and patients can choose which one to implant. In this procedure, patient can go back home the same day. This is an expensive procedure. Foldable lens is also expensive.
The surgeries that I do in rural areas are not phacoemulsification, but they are more cost effective. They are also suture-less and require only slightly bigger incision than phacoemulsification. Many rural patients have matured, hard cataract. They may also have damaged cornea, which makes phacoemulsification a little difficult. We remove the cataract in one piece through that larger (6-7 mm) incision, wash the remnant of the cataract, and through the same tunnel we implant a new lens. Because the incision is small, we leave the wound intact and it self-seals itself.
Mihir: What is the prevalence of cataract?
Dr. Prabhakar: When I became my career, there were about 15 million blind people not including vision impairment. Records estimate about 8.5 million such blind people right now. However, when I go to rural areas I don’t see much difference. Almost 60% of such blindness is due to cataract with others being glaucoma, diabetic retinopathy etc. In India, cataract surgical output has become almost double than what it was about 20 years ago, so there’s a great improvement.
Mihir: You perform high-volume cataract surgeries in rural areas of India. How do you identify areas to do surgeries in?
Dr. Prabhakar: We collaborate with several entities. Our work is with Hindu temples, Sikh temples, and Muslim communities like in Kashmir. We also collaborate with National Program for Control of Blindness and Visual Impairment (NCBPVI). Third entity is sponsors. We need sponsors who would pay for the surgeries. We are the service providers.
Sometimes donor would call us to their village to provide service or temples would organize a surgical camp for local people. They would advertise in surrounding 30-40 villages, and they would pay for the logistics. We have to take permission from local chief medical offices and district blindness control societies.
After several days of advertisement by a sponsor or a temple, on the day of the camp my team goes to the camp site. We screen the patient on the first day. Ours is a comprehensive approach. We perform complete eye check-up of patients; we check their blood sugar and refractive index. Some patients require glasses to correct vision and we provide them near-vision glasses. For patients requiring bifocals, we arrange glasses for them in 2-3 weeks. Patient with glaucoma receive drops from us. Patients with diabetes or other vision issues are sent to the base hospital for further treatment.
Primary bulk of patients would have just cataracts. We scan their eyes for cataract surgery including their power. We do thorough evaluation of patients to make sure that there would be no complications during the cataract surgery. We take their consults and take them to our hospital in buses. They stay in hospital for 2-3 nights. We keep them for a day and we do surgery on the second day. After that they stay for 1-2 days with us. We perform post-surgical checks, we give them some health advise, prepare proper records and we drop them back to the site of camp after feeding them.
Mihir: Is the total process of camp about a week?
Dr. Prabhakar: Yes, it is about a week.
Mihir: Is everything done by your team?
Dr. Prabhakar: Yes. It is all done by our team. Some of the camps may even last for 12-15 days. We recently did a camp in a temple with 3000 patients, so we performed several days of surgeries.
Mihir: When did you start going to rural areas and performing these surgeries in rural camps?
Dr. Prabhakar: Most of the backlog of patients requiring cataract surgery is in rural India. They generally do not have access to better healthcare facilities. Many entities like us perform this type of camps. I began this in 1997, when I was a fresh graduate. I used to take a long time to perform a cataract surgery. A German surgeon taught me small incision cataract surgery. Over the years, I made the surgeries more efficient by improving it. At that time, we were only doing the camps in Punjab. Subsequently, we started doing it in other part of India. Now we are going to Papua New Guinea, Ethiopia, Mongolia, Fiji, Mexico and other international places.
Mihir: How do you identify your team members?
Dr. Prabhakar: Ours is a mission hospital, so doctors are trained in our own center and we retain them. They are very dedicated. They have to spend long hours doing hundreds of surgeries during a day.
Mihir: How do you see the future? Do you have aspirations to better anything in your field?
Dr. Prabhakar: That is a good question. Our desire is to reach out to more people. No matter how much we have done, we have not seen end to cataract surgeries. We recently established a vision center in Fazilka district in Punjab. We want to eradicate vision challenges from that district. Most of our work is in such districts in Indo-Pak border areas. We want to eliminate avoidable blindness in one district at a time. In future, we want to create awareness and eliminate avoidable blindness. We want to support NCBPVI cause. We want to train more optometrist so that we can reach more remote rural areas.
