<p>Needless to say that visual impairments caused due to retinal malfunctioning are often irreversible. As the world observed the retina day on September 26, Dr Rajat N Agrawal, assistant professor of ophthalmology, study director, Artificial Retinal Implant Project, Doheny Eye Institute, Keck School of Medicine at University of Southern California, spoke to L Subramani of <em>Deccan Herald</em> on researchers that are starting to see some breakthrough in curing retinal conditions. Dr Agrawal holds a patent for artificial retina, which may be a significant cure for the most prevalent retinal condition: Retinitis Pigmentosa.<br /><br />How serious are retina related problems?<br /><br />Retina can get affected in various ways. We don’t have specific figures for retinal detachment and trauma, since they are so variable, but Retinal Degenerative Disorders (RDDs), which are caused by genetic defects resulting in gradual loss of vision in patients, give us a clue about the seriousness of this. Retinitis Pigmentosa (RP), the most prevalent amongst the RDDs, affects approximately one in 4,000 in the western world. However, due to certain factors, India, and specifically southern India, is likely to have at least 10 times more RP patients than those in the Western world.<br /><br />One of the problems with RDDs is that it affects young and economically productive people. Considering that India potentially has a significant number of RP patients, this increases the country’s healthcare costs and impacts productivity. <br /><br />What is happening to scientific efforts to cure the conditions?<br /><br />Retina is a complex organ in the eye. It is an extension of the brain in the development process. Hence, finding a cure for these complex diseases is not easy. In cases like retinal detachment or problems related to trauma, surgery may work. We have newer medications now to stop the progression of diseases such as age-related macular degeneration (AMD) and problems related to swelling in diabetic retinopathy.<br /><br />Though no treatment has been available for RP and allied disorders, we have been able to make a significant impact on development of newer treatments — such as gene therapy, stem cells, retinal transplantation and artificial retina — in recent years. These therapies have given hope that diseases such as RP and AMD can also have a cure soon.<br />Is artificial retinal implant a credible solution? How are you bringing it to India?<br /><br />It is certainly a good alternative for people who have otherwise no chance of getting their sight restored. The implant consists of an array of electrodes that simulate the role of the cone and rod cells in a damaged retina. Currently, we have implanted 60 electrode devices in about 30 patients in the US and Europe. I have worked on the development and clinical trials of the device for the last five years in Los Angeles, but now I feel it is time for the device to come to India for the benefit of so many patients.<br /><br />How do you envisage the clinical trials in India?<br /><br />I am in discussions with a few hospitals around the country regarding conducting these clinical trials. I, with my colleagues in Los Angeles, will decide the site for the trials after a careful analysis of the patient load at the hospital, the facilities at the clinic and in the operating room, and the availability of staff to maintain a regular schedule of testing and training with the patient.<br /><br />Q: You are also working on an Indian Retinitis Pigmentosa Registry.<br /><br />I have been working to develop such a registry for more than a year. I have contacted and received support from all the leading retina centres and retinal specialists in the country. The basic premise for the registry is to get all patients of RP together, which will make it easier for patients to be matched to the latest new treatments coming for RP. Having such a data is important for epidemiological studies.<br /><br />We also hear that you are in the process of forming a foundation for patients.<br /><br />Though lots of NGOs work for the welfare of the visually challenged, there is no organisation in India that supports those with retinal diseases. This is important since the issues retinal patients face are unique. Those with RP, for instance, usually encounter blindness in latter years of their lives and can’t be compared with those who go blind by birth. We have started this national not-for-profit foundation, called Retine India, to focus on such patients. This foundation will bring patients together with the physicians in the country, with the researchers in the field of retinal disorders and with other specialists working in the field of low vision and mobility training issues, healthcare workers, counsellors and other social organisations, to focus on these problems and find solutions for each patient.<br /><br />Patients will be regularly informed about the progress of research in the field, about development of newer techniques that will help them lead a more productive and independent life, about life management issues such as counselling on marriage, starting a family, etc.</p>
<p>Needless to say that visual impairments caused due to retinal malfunctioning are often irreversible. As the world observed the retina day on September 26, Dr Rajat N Agrawal, assistant professor of ophthalmology, study director, Artificial Retinal Implant Project, Doheny Eye Institute, Keck School of Medicine at University of Southern California, spoke to L Subramani of <em>Deccan Herald</em> on researchers that are starting to see some breakthrough in curing retinal conditions. Dr Agrawal holds a patent for artificial retina, which may be a significant cure for the most prevalent retinal condition: Retinitis Pigmentosa.<br /><br />How serious are retina related problems?<br /><br />Retina can get affected in various ways. We don’t have specific figures for retinal detachment and trauma, since they are so variable, but Retinal Degenerative Disorders (RDDs), which are caused by genetic defects resulting in gradual loss of vision in patients, give us a clue about the seriousness of this. Retinitis Pigmentosa (RP), the most prevalent amongst the RDDs, affects approximately one in 4,000 in the western world. However, due to certain factors, India, and specifically southern India, is likely to have at least 10 times more RP patients than those in the Western world.<br /><br />One of the problems with RDDs is that it affects young and economically productive people. Considering that India potentially has a significant number of RP patients, this increases the country’s healthcare costs and impacts productivity. <br /><br />What is happening to scientific efforts to cure the conditions?<br /><br />Retina is a complex organ in the eye. It is an extension of the brain in the development process. Hence, finding a cure for these complex diseases is not easy. In cases like retinal detachment or problems related to trauma, surgery may work. We have newer medications now to stop the progression of diseases such as age-related macular degeneration (AMD) and problems related to swelling in diabetic retinopathy.<br /><br />Though no treatment has been available for RP and allied disorders, we have been able to make a significant impact on development of newer treatments — such as gene therapy, stem cells, retinal transplantation and artificial retina — in recent years. These therapies have given hope that diseases such as RP and AMD can also have a cure soon.<br />Is artificial retinal implant a credible solution? How are you bringing it to India?<br /><br />It is certainly a good alternative for people who have otherwise no chance of getting their sight restored. The implant consists of an array of electrodes that simulate the role of the cone and rod cells in a damaged retina. Currently, we have implanted 60 electrode devices in about 30 patients in the US and Europe. I have worked on the development and clinical trials of the device for the last five years in Los Angeles, but now I feel it is time for the device to come to India for the benefit of so many patients.<br /><br />How do you envisage the clinical trials in India?<br /><br />I am in discussions with a few hospitals around the country regarding conducting these clinical trials. I, with my colleagues in Los Angeles, will decide the site for the trials after a careful analysis of the patient load at the hospital, the facilities at the clinic and in the operating room, and the availability of staff to maintain a regular schedule of testing and training with the patient.<br /><br />Q: You are also working on an Indian Retinitis Pigmentosa Registry.<br /><br />I have been working to develop such a registry for more than a year. I have contacted and received support from all the leading retina centres and retinal specialists in the country. The basic premise for the registry is to get all patients of RP together, which will make it easier for patients to be matched to the latest new treatments coming for RP. Having such a data is important for epidemiological studies.<br /><br />We also hear that you are in the process of forming a foundation for patients.<br /><br />Though lots of NGOs work for the welfare of the visually challenged, there is no organisation in India that supports those with retinal diseases. This is important since the issues retinal patients face are unique. Those with RP, for instance, usually encounter blindness in latter years of their lives and can’t be compared with those who go blind by birth. We have started this national not-for-profit foundation, called Retine India, to focus on such patients. This foundation will bring patients together with the physicians in the country, with the researchers in the field of retinal disorders and with other specialists working in the field of low vision and mobility training issues, healthcare workers, counsellors and other social organisations, to focus on these problems and find solutions for each patient.<br /><br />Patients will be regularly informed about the progress of research in the field, about development of newer techniques that will help them lead a more productive and independent life, about life management issues such as counselling on marriage, starting a family, etc.</p>
