R Venkataramanan

R Venkataramanan

R Venkat's Blog

R Venkat's Blog
"To be an Inspiring Teacher,one should be a Disciplined Student throughout Life" - Venkataramanan Ramasethu



Tuesday, April 27, 2010

Directions for Optometry Research in India

How can we define research?

According to Webster’s Encyclopedic Unabridged Dictionary research is:
“Diligent and systematic inquiry or investigation into a subject in order to discover or revise facts, theories or applications.”

Some more definitions of research

Research means:
“Seeing what every one else has seen and thinking what no one else has thought.”
“Respecting the past and building upon it.”
“Looking into the future with a boldness that defies tradition.”
“Finding connections between seemingly unconnected entities.”

Why is research essential?

Research brings with it:
• New ideas: concepts, techniques, devices
• New collaborations: internal and external
• Respect to the institution: grants and publications
• Respect to the profession: becoming known as a “thought leader

Areas of interest

Eye care professionals can choose to do research in any of the following areas of interest
• Optics
• Optometry
• Ophthalmology
• Epidemiology
• Vision Science

How is vision science different?

• Histology or neurobiology of the retina is neither optometry nor ophthalmology. It is vision science.
• Building a computer-aided seeing device for a robot is vision science (machine vision).
• Developing an understanding of visual perceptual illusions is vision science.
• Understanding how vitamin C helps collagen synthesis in the cornea is vision science.

Why optometrists should do research?

• Because we can make practical innovations that help clinical outcomes.
• Because we have the money and time.
• Because we are good at it in many parts of the world.
• Because our predecessors used research to reach where we are today.
• Because it is what will remain alive when we are gone.

Multiple Successes

Many eye care clinicians and scientists in India are doing excellent work in the areas of:
• Cornea and contact lens research
• Retinal research
• Glaucoma research
• Epidemiology research
• Psychophysics research
• Clinical optometric measurement and therapy
• Low vision aids and rehabilitation

How does vision science help optometry and ophthalmology?
By connecting the clinical application with a basic science concept.

• Understanding visual acuity by way of the modulation transfer function of the eye and neural apparatus.
• Using LASIK to correct higher order aberrations.
• Understanding how control of accommodation and myopia is implemented by color-opponent mechanisms that analyze longitudinal chromatic aberration.
• Understanding how macular degeneration is influenced by transaminase enzymes in the liver or by superoxide dismutase (SOD).

Multiple Failures

In a progressive country like India, if a child develops a corneal opacity from a mild infection, it implies:
• Failure of public sanitation systems!
• Failure of primary clinical eye care!
• Failure of preventive care (to boost the immune system of the child by nutrition)!
• Failure of political, legal, and market systems!
If a blind person is restricted to weaving baskets and making candles, it implies:
• Failure of the family support system!
• Failure of the educational system!
• Failure of human resource departments!
• Failure of innovation for assistive technology!
• Failure of corporations and economic growth!

Where have we gone wrong?

In understanding the underlying cause of the problem. Often this is not what we treat.

• The cause of myopia is ergonomic and biochemical but we treat only with lenses.
• The cause of cataract is free radicals from ultraviolet and poor nutrition but we treat only with surgery.
• The cause of macular degeneration is biochemical but we treat with lasers.
• The cause of underperformance in a visually impaired person is lack of will, but we rehabilitate lack of ability.

How can we fix the problem?

• By developing “thought clusters” to understand the logic of causation based on the literature.
• By asking the right questions and developing hypotheses.
• By designing and conducting experiments.
• By developing collaborations.
• By publishing the research in journals/ books.
• By teaching books that reflect latest research.
• By developing business, governmental and NGO partnerships to address the opportunity/ problem.

Logic of causation

• By developing “thought clusters” to understand the logic of causation based on the literature.
• Fact: Chromatic aberration is present in all eyes because of dispersion of white light.
• Fact: Monochromatic light impairs accommodation.
• Inference: Longitudinal chromatic aberration (LCA) helps accommodation.
• Hypothesis: Color-opponent neural mechanisms in the retina and brain process LCA to control accommodation.

From logic to experiments
1. By minimizing longitudinal chromatic aberration using an achromatizing lens, accommodation should suffer.
2. By impairing a color-opponent mechanism, accommodation should suffer.
3. By simulating the chromatic and luminance changes in open-loop (zero feedback), one should be able to stimulate accommodation.

Asking the right questions
For any question to become a meaningful hypothesis, it must be linked to a clinical or basic science phenomenon.
• For example if you were to know how aerobic exercise reduces IOP, many physiological variables would need to be investigated.
• If you were targeting an eye drop for preventing cataract, many possible mechanisms of cataractogenesis need to be considered.

Lit. Search, Proposal, IRB & Consent
• Prior to experimental design it is essential to search the literature (e.g. Pubmed: www.nlm.nih.gov) to determine the need, and background for the proposed research.
• A formal proposal of the research to be conducted is prepared and submitted to an Institutional Review Board for ethical review.
• After ethical review, informed consent should be obtained from subjects prior to data collection.

Experimental Design
A well-conceived experiment has 5 parts:
• Statement of the experimental objectives.
• Specification of the hypotheses to be tested.
• Definition of experimental units (subjects) and treatments.
• The experimental design.
• Method of analysis.

Often it is useful to gather pilot data to obtain an indication of the statistical power of the experiment.

Developing collaborations
Very often, collaborations depend on the seeker having:
• A special skill— such as computer programming or a deep understanding of the literature.
• A special device— such as a UBM or OCT.
• Access to a special population— such as young patients with glaucoma.
• An institutional affiliation or special qualification.
• Money to support the research.

How can we fund research?
• Ask industry to set aside a research fund for every college of optometry based on certain criteria.
• Ask philanthropists to “invest” in research.
• Ask the college administration to set aside at least 3 grants per year, each enough to support one faculty member and one student for one year for interesting research projects.
• Develop focus groups to gain the attention of the public in a particular area of need (e.g. preventing eye disease in the unborn children of anemic pregnant women).

Publishing the research
• Find a journal that has a history of publishing articles close to your topic.
• Preferably that journal should be edited by people who have similar credentials as the first author.
• Send first to a better journal, and if rejected, send later to lesser known journals.
• Start your own journal!

Writing books
• Prefer first to publish your work in journals.
• When sufficient evidence to support your cause is published, consider writing a book chapter.
• When the topic becomes popular in academic circles, write a book.
• Find a publisher that respects copyrights of others and offers a decent royalty.

Teaching that reflects research
• Very often what gets taught may not reflect the latest research.
• This depends on availability of the best books and current journal articles.
• While information that is 10 years old may be acceptable, information that is 20 years old should not be accepted unless it has born out the test of time.
• Who will guide what we teach our students?

Developing partnerships
• Very often, partnerships become sour when one party is weak.
• Partnerships require competence, trust & commitment.
• Partners need to recognize each others’ strengths and to complement each other to minimize weaknesses.
• When you know the mission cannot be accomplished without both partners, cooperation begins and success becomes likely.

In Summary
Readiness for research comes at a price. Some essentials and other “nice-to haves” include:
• Access to the peer-reviewed literature
• Time, intellectual support and financial incentives for faculty and students to engage in generating hypotheses and testing them
• Money for equipment, consumables, and paying subjects
• Competence to edit and write well and think critically
• Funding from government, foundations and industry
• Collaborations with respected departments across the globe

• Dr. Philip B. Kruger, SUNY- College of Optometry: 1990-Present.
• Dr. Benjamin C. Lane, Nutritional Optometry Institute:1998-Present.
• Dr. Karan’s Vision Care: 2002-Present
• SmartAnalyst (India) Pt Ltd: 2006-Present
• Ansal Inst of Technology: 2006-Present

Friday, April 16, 2010

Doctors are the messengers of GOD….Yes still they are and would be….

As I am penning this, I am deeply hurt,offended & bruised by the barbaric act recently in a renowned hospital at Kolkata.The story goes this way,following a ghastly accident on the Eastern Metropolitan Byepass the victims were rushed to a nearby reputed hospital where they were turned down and subsequently as one of the victims succumbed to the injuries,the mob went on a rampage and caused extensive damage to the hospital property mounting to a crore rupees.Also the doctors,staff and even few visitors in the premises were beaten up so badly that a few are still unable to recover from the shock.The sanctity of the ICU was totally disturbed and many patients under intensive care & critical care were physically and mentally harassed.

No doubt a loss of human life is a highly emotional loss to deal with and if that’s someone so close or nearby it might be even more deeply hurting.But should that justify someone resorting to such barbaric & hooliganistic approach that they would go to the extent of causing such severe damage to a hospital property that the hospital should remain closed for a considerable period and the patients already under care would go through such severe harassement.It is true that the hospital went through such a great level of assault on itself and it’s property with it’s staff,since they turned down a critically injured accident victim.But in general in any hospital whether it’s private or public it’s the front desk staff or the admin staff who would encounter the patients and in this case might be the staff on duty was being too professional and turned away a accident victim,as it would have involved certain legal formalities.

No doubt the life of a patient is the first priority and rest all formalities follow later, but does that mean in every situation when there is a loss of life the doctors would be assaulted.No I am not going to buy this argument at all….Let’s not forget there are innumerable instances wherein the doctors had put their personal safety and security in the back seat and had gone ahead to protect the patients interests. No doctor would ever harm a patient or cause any kind of discomfort to the attendants intentionally or unintentionally. There might be a few instances where it might have happened on the reverse, but one should remember the age old saying , “Every Saint has a Past & Every Sinner has a Future”.

We need not build temples and perform puja & arthi to the doctors…..but atleast lets not deny them the respect that they deserve.Afterall we all came in safely and would go back peacefully not only with GOD’S WILL but also with a genuine doctor’s care.

So I repeat, “Doctors are the messengers of GOD….Yes still they are and would be….”