“I” to “EYE”—My journey : Indian Journal of Ophthalmology

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Guest Editorial

“I” to “EYE”—My journey

Joshi, MM; Joshi, Shrinivas1

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Indian Journal of Ophthalmology 71(3):p 682-685, March 2023. | DOI: 10.4103/IJO.IJO_426_23
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Destiny plays an important role in the life of many people. I became an eye surgeon and could achieve a few things in life by leveraging on my ability to treat people with blindness. I belong to the old school and always saw my ophthalmic skills as a way of healing people and never as a profession.

I belong to a small village where medical facilities were not satisfactory. I did my schooling in the vernacular medium in the village. As a student, I was said to be brilliant and I wanted to be a doctor and serve the community. Having finished my schooling in the district place of Bijapur and college education in Dharwad, I completed my intermediate science with very good marks way back in 1955. I intended to acquire knowledge in Ayurveda as well as Allopathy and fortunately in that year, Pune had started a degree course in BAMS where both Ayurveda and Allopathy were taught. In those days, our region was a part of Bombay’s presidency which included a part of Gujarat, Maharashtra, and a part of Karnataka. With my good marks, I got admission for BAMS in Pune and also for MBBS in the Medical College of Baroda (Baroda was a part of the erstwhile Bombay presidency). Initially, I joined the BAMS course. But when my admission for MBBS was declared, I was encouraged to join MBBS by one of my relatives. This is where I feel destiny had laid out plans for me in eye care. I joined the medical college at Baroda, fared well in my studies, and secured a third rank at the University in my final MBBS examination. Some doctors, whom we encounter in our impressionable formative years, leave an indelible mark on our minds. During our studies, I was very impressed by Dr. C. P. Munshi, was a general physician and a cardiologist. I wished to take up General Medicine and Cardiology and become a doctor like Dr. Munshi.

During our internship of one year, I was posted to the district hospital of Surat for three months. We had to rotate in different disciplines of surgery, medicine, obstetrics, gynecology, and also ophthalmology. When I was posted in the ophthalmic department which was headed by Dr. B T Maskati, a very popular and famous eye surgeon in those days, I worked sincerely, as usual, and Dr. Maskati was impressed by me. On one of our operation days, he offered me to do a small step, an iridectomy in an intracapsular cataract extraction. When I swiftly completed the step, he looked at me and said “well done.” In the evening of the same day, he told Dr. Limay, who was working with him in his private hospital and who was senior to me in my medical college, that I had the best of hands, steady like rock necessary to become an ophthalmic surgeon. I was reluctant as my first love was general medicine and did not consider this seriously. Dr. Maskati persuaded me to take up ophthalmology as my career. He offered me to work with him in his private hospital for six months and decide if I liked ophthalmology more than general medicine.

Destiny had its plan as always and I decided to take up ophthalmology. I joined the famous KEM Hospital in Bombay, as a resident Ophthalmologist. I completed my registrarship and passed my DOMS and MS at Bombay University. At KEM Hospital, I worked under Dr. B T Maskati who liked me immensely because of my sincerity and meticulousness in my work. He gave me ample opportunities for surgery. As a registrar, I had operated on squints, retinal detachments, ptosis, and dacryocystorhinostomy apart from routine cataracts. The eye surgeons of today may not be aware of the trials and tribulations of ophthalmic surgeries during our residency period. Intracapsular cataract surgery with a von Graefe knife with pre-placed sutures, Lens extraction with cryoprobe or forceps was a state-of-the-art technique and Bombay surgeons had their claim to fame in this.

Many patients from North Karnataka used to come to KEM Hospital for complicated surgeries of squints and retinal detachments which gave me the idea that I should start my practice in North Karnataka. I was interested in teaching, so I had an option of selecting between two places Hubli and Belgaum where there were Medical Colleges where I could get a honorary teaching post. However, I decided to start my practice at Hubli and joined the Karnataka Medical College as an Honorary Medical Officer, and post graduate teacher in 1969, I had to relinquish this post in 1974 when Karnataka took away the honorary teachers’ system. I worked in the Medical College from 9 am to 12 noon and I used to do my private practice after those hours.

With my skills in routine and complicated surgeries, I became popular and picked up good practice. I started seeing around 60 to 80 patients a day and operating on about 8 to 10 cases a day by the end of one year. In those days, surgical camps on a charitable basis were prevalent in North Karnataka and I used to see many unfortunate patients with complications who were operated on in the free eye camps conducted by self-styled unqualified ophthalmic surgeons [Fig. 1-3].

Figure 1:
Most great journeys start with a simple beginning—Charitable camps organized in remote villages of North Karnataka
Figure 2:
Mass camp surgeries balancing both quality and quantity in those days
Figure 3:
Community camps were comprehensive in eye care delivery which included glaucoma, squint, and childhood blindness apart from cataracts

In spite of my busy practice, I said to myself why should not I conduct safe free eye camps and give sight to the poor people who could not afford to go to private hospitals. I conducted my first free eye camp in 1971 under the banner of the Lions Club of Hubli. About 29 patients were operated on with the scientific approach of those days with sutures in every cataract operation. The results were 100% successful. Seeing this, many voluntary organizations like Rotary, Lions, and Citizens Forums were after me to conduct free eye camps. Using sutures for cataract surgery was very rare in those days and I was fortunate to be trained in suturing cataract wounds and continued the same later.

As a single doctor with only a few trained assistants, I could not take as many camps as desired by the public. My private practice was also growing and was neglected at times. I used to do camps every month in selected places like Ranibennur, Jhamkhandi, Kalaghatgi, etc., What started as a small effort then, has now grown by leaps and bounds. I am happy to say that we have crossed 2000 camps.

Doctors from the institutions like PGI Chandigarh used to come after their course to gain knowledge of private practice and surgical experience. However, after gaining confidence after a year, they started their private practice at their respective places. I then decided that I should induct my family persons and relatives as doctors who will not leave the institution and this can solve the human resource problem in the future.

Dr. Guruprasad, who is like my foster son, a brilliant student, had joined IIT Madras. I persuaded him to take up MBBS and be a doctor to which he and his parents agreed and he joined the medical college.

He completed his MBBS and MS in ophthalmology by 1985 and joined me as my first lieutenant. I sent him to Sankara Nethralaya, Chennai, to get his retina surgery polished.

I was fortunate that two of my sons-in-law, my son, and my daughter-in-law also joined me in this ophthalmic journey as my junior colleagues. They got specialized in various subspecialties and they formed the support system [Fig. 4]. Later, many bright ophthalmologists were recruited as consultants and my Institution started growing. When I was a lone practitioner, I used to work for 14 hours to 16 hours a day. I could finish my work of the day by 1 or 2 A.M., Fortunately, my wife Pramila was very cooperative and took care of the family responsibilities and supervised the education of our kids.

Figure 4:
The core team—Dr M M Joshi with Dr Guruprasad, Dr K V Satyamurthy, Dr R Krishnaprasad, and Dr Shrinivas Joshi

We have excellent academic activities in the institution and we regularly conduct two events.

  1. Eye to Eye program which trains the exam-going students of DNB and MS for three days and covers the entire syllabus including the mock examination. This has become very popular and about 120 to 130 students attend this program every year.
  2. The second event is Eye Fest, a festival that is like a mini-conference where 200 to 220 people attend every year.

Apart from the DNB training, we have fellowship programs recognized by Rajiv Gandhi University of Health Sciences, where we admit 17 ophthalmologists in different fellowships, like four in vitreoretinal and the rest of them in cornea and anterior segment and pediatric ophthalmology. There is a good demand for admission to these fellowships. Our well-trained fellows, have been practicing successfully across the country.

In 1974, the annual conference of Karnataka was held at Gulbarga, where Dr. Morris Crowl, a senior Ophthalmologist from the Kresge Eye Hospital of Detroit USA, was invited as a guest lecturer. He talked about Cryo surgery in ophthalmology. Fortunately, I had the experience of using Cryo technology in cataract operations and retinal detachment operations. Myself and Dr. Crowl had a lot of interaction and became good friends. I invited him to visit my institution at Hubli, which he did, and was impressed by the volume of the clinical work and the number of surgeries performed per day.

Dr. Crowl returned the favor and sent an invitation to visit him. In November 1975, I visited the USA for six weeks and visited many institutions of ophthalmology and learned about their working pattern. I was impressed by the procedure of vitrectomy in cases of vitreous hemorrhage, which did not have any treatment in our country at that time.

While returning from the USA, I bought Peyman’s Vitreophage along with me. In 1978, Mr. Samual of Madras manufactured a vitrectomy unit named “ Vijay Sucat” which I acquired and started vitrectomy in our institution on the cases of endophthalmitis and vitreous hemorrhage.

Though the technology of vitrectomy was in its infancy with low cut rates and thick cutters, the procedure of vitrectomy was a miracle in some cases which were considered hopeless. The microscopes of those times were very primitive and we had to perform core vitrectomy in some cases of endophthalmitis using indirect ophthalmoscope. I would continue with vitrectomy till I saw the glow. It needed great perseverance and fortitude to sail those uncharted seas. The joy of saving eyes from evisceration in cases of endophthalmitis and making a diabetic with blood vitreous to see once again made all the trouble seem worth.

The defining moment of my vitreoretinal surgery arrived when I used silicon oil to settle a detached retina in 1975. I had seen it being used in the USA and after my return to India, I started pursuing my efforts to procure medical-grade silicon oil. I did have my share of success with silicon oil in these intractable detachments and I presented my work at Udaipur ophthalmic conference. This was received with mixed feelings of awe and contempt, as the prospect of using silicon oil as a long-term internal tamponade was absolutely novel. To my knowledge, this was the first attempt in India. As technologies and techniques evolved, things got better and the element of luck reduced drastically in our surgical outcomes.

My eye care hospital was named by me “Padma Nayanalaya” for the fond remembrance of my mother. However, this name never caught on because the patients started referring to my hospital after my name. It was in 1995, after 28 years of its inception, I had to rechristen my hospital as M M Joshi Eye Institute. I was reluctant to do this but my well-wishers advised that this new name had better branding and ease of use. I feel that this also has some magic. The name has gone into the public psyche and I had to respect it. Today, people may not recognize me in person, but they still know my institution. If your work becomes bigger than yours, then you have achieved something. I truly cherish the honors and awards that have been bestowed upon me, specifically the lifetime achievement award by the All India Ophthalmological Society and Padma Shri by the Government of India. [Fig. 5, 6] Our 50th anniversary was celebrated for the masses with the musical legend S P Balasubramanyam. [Fig. 7]

Figure 5:
Dr Joshi receiving lifetime achievement award from AIOS
Figure 6:
The founder of Padma Nayanalaya gets the Padma award—Dr M M Joshi receiving Padma Shri from Shri Pranab Mukherjee
Figure 7:
MMJEI celebrating 50 years of eye care services at a musical evening by legendary singer Shri S P Balasubramanyam

With the new name, my institution started scaling up. [Fig. 8] A new workforce and the addition of the latest technology fueled its growth steadily. The revenue generated from my practice was always believed in plowing it back to the profession to acquire newer technology and gadgets. All newer technologies are very expensive, at all times!

Figure 8:
Teamwork always works

All these acquisitions were the first to be introduced in North Karnataka, be it Argon Laser in 1989 or Diode Laser in 2000, or Excimer laser in 2005. Now, we are replete with all the latest state-of-the-art technology one can boast of in ophthalmology. However, in the center of all this gadgetry, the soul continues to be compassionate due to the patient care and core competence of my colleagues.

Quality eye care with equity of eye care delivery always needs horizontal expansion. The main hospital in Hubli has been standing for five decades and we had to spread to other six cities of North Karnataka like Dharwad, Bagalkot, Koppal, Sankeshwar, etc., Also, vision centers started by us in around 15 towns fill the gap with a hub and spoke model of community eye care, with the dream of making North Karnataka avoidable blindness-free.

I am very happy that I have been able to impress upon my juniors the need to be ethical and kindhearted, whatever may be your sophistication in your craft. New management mantras and corporatization waves implore you and sometimes compel you to look at the balance sheet and return on investment. I am very happy to say that we have resisted this lure as an institution and have adhered to the mission statement “No blind shall go untreated for financial reasons.” This is a bold statement to make and a tougher one to follow. I have always believed in destiny and that what your gain will come to you regardless of what you do in life. The joy of curing blindness is the final emancipation which is way above the short-term profits and worldly pursuits.

About the co-author

Dr. Shrinivas Joshi

Dr Shrinivas Joshi is a young and dynamic member of the AIOS ARC South zone. After completing his post graduation, he did his surgical fellowship in Vitreoretina from University of Toronto. He is one of the first few Indians to be trained for artificial retina implantation ARGUS 2 at the Toronto Western Hospital. He has completed Executive MBA from IIM Calcutta. He is a recipient of multiple awards for his papers, posters and videos. He has been conferred with prestigious Rhett Buckler award by the American Society of Retina Specialists (ASRS) for six consecutive years. Postgraduate teaching, academics and research has been his incessant passion. He was a pioneer in formation of Karnataka Ophthalmic Teachers Academy to take the postgraduate education program to higher level. He initiated unique projects such as College Connect programme which linked 44 teaching institutes of Karnataka by conducting zone wise postgraduate education programs. He launched SOTY (Student of the year) at Karnataka Ophthalmic Society - a one of its kind PG event. In subsequent years concept of SOTY was replicated in other state conferences. With a motto that there is no higher religion than human service, he heads the community services at MM Joshi Eye Institute. With an aim to eradicate avoidable blindness in North Karnataka, he has a integral role in establishing multiple vision centres and outreach programs at various undeserved areas of various districts . Presently he is working as Consultant, Department of Vitreoretina Services and Director, Research and Community Services at M M Joshi Eye Institute, Hubli, Karnataka, India.

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