Latest news with #AmarAgarwal
The Hindu
4 days ago
- Health
- The Hindu
'Why not skip the transplant?': Dr. Amar Agarwal on the global potential of Pinhole Pupilloplasty
In this interview, Dr. Amar Agarwal, chairman of Dr. Agarwal's Eye Hospitals and pioneer of Pinhole Pupilloplasty (PPP), explains how this simple surgical innovation is offering a low-cost, low-risk alternative to corneal transplants. With patients seeing near 20/20 vision post-surgery, Dr. Agarwal discusses its global uptake, success stories, and why PPP, which can be done by any eye surgeon with some training, could ease the burden on the world's corneal transplant system. Presentation: Ramya Kannan Editing and video: Thamodharan B
The Hindu
7 days ago
- Health
- The Hindu
Hole in one: Pinhole pupilloplasty emerges as alternative to corneal transplants
Sometimes, it is the small innovations in health care, the repurposing of familiar procedures that holds the hope for a revolution. It is in the latter category that Pinhole Pupilloplasty (PPP) falls. Having been described initially in 2018, it has only recently emerged as a possible simple, low-cost alternative to corneal transplants. Amar Agarwal, chairman, Dr. Agarwal's Eye Hospitals, who first described the procedure in 2018, says it was developed only as a technique to correct astigmatism and abrasions. 'For seven years now, we have been performing PPP to correct high levels of astigmatism – a condition where the cornea is conical. Since then, the technique has been picked up by ophthalmologists across the Russia, Vietnam too, apart from India. There is a small learning curve, but it will be easy enough for eye surgeons,' he explains. Those who have already started doing the PPP procedure will just have to apply it for corneal transplant situations, he adds. PPP uses the simple optics principle – of controlling the light that enters the eye, in order to clarify vision. The cornea is the transparent outer layer of the eye. It bends (refracts) light to help focus it, and the pupil is the dark circular opening in the centre of the iris. Its role, like the aperture in a camera, is to adjust size to control how much light enters the eye. While the corneal transplant tries to address the damage to the cornea, PPP tries to restore vision by tackling the pupil. In PPP, the size of the pupil is reduced surgically, to 1.5 mm, thus blocking peripheral vision and allowing focused central rays inside the eye, ensuring that the image is clear and without distortion. This can bring the patient back to near 20/20 vision immediately after surgery, Dr. Amar says. For instance, Subbalakshmi, a patient who has travelled from Australia to get the PPP procedure done in Chennai, says the moment the bandages were removed, three hours after surgery, she could see very well. 'Almost immediately, I knew the sharpness of my vision had improved significantly after surgery. If I was a 5-6 on a visual scale pre-surgery, after the procedure, I suddenly went up to a 9.5,' she says. Summoning another common metaphor to explain the scenario, Dr. Amar says: 'If you consider the cornea as the front window, and let's say it becomes damaged due to injury, or there is a tear, there is an opaque area, or the cornea is conical, which is what happens in astigmatism. What will happen is that the rays of light will not reach the retina comfortably. All these patients are going to need eye transplantation at some point.' The team at the hospital even worked with optics expert Jack T. Holladay to develop a pinhole pupil gauge, a tool used to gauge the pupil size suitable for each patient. 'When we did corneal transplants, we found that not all patients regained good vision, some continued to have a number of problems still – even if they could see, the vision was blurry,' explains Dr. Amar. 'That is when we said, 'hold on, why are we doing a transplant in this case, will PPP work better?' When we started seeing great results using PPP on these patients, it became clear that this was indeed a viable alternative to corneal transplants.' Since then, they have done a 100 procedures, and the results have been satisfactory. In contrast, corneal transplants come with chances of rejection, a long healing time, the need to take drugs for an extended period, and see-sawing visual fact, even no guarantee of restoration of vision,' he adds. While children with corneal injuries are ideal candidates for the procedure, it works on adults who have had corneal tears or scar formation as well, apart from injuries. 'In fact, if I have to choose between a corneal transplant and a PPP, I opt for the latter. Even when we perform corneal transplants, we do an extra PPP procedure, to improve the chances for the patient to see better,' Dr. Amar adds. Not all people waiting for a transplant will benefit from PPP, clarifies Soundari S., regional head, clinical services, Dr. Agarwal's Eye Hospitals. Some people will still require corneal transplants, but using PPP on those who will benefit from this procedure will make it possible to reallocate the available donor corneas to those who need them. Given that globally, there are more than 20 million people waiting for a donor cornea, and there is a desperate shortage of corneas, any other technique that can restore vision will come as a boon to patients, Dr. Amar says.
India Today
14-05-2025
- Health
- India Today
No transplant, no stitches: The eye surgery giving patients a second chance at sight
In a country where the shortage of donor corneas often stands between a patient and restored vision, an innovative eye surgery developed in India is offering new as Pinhole Pupilloplasty (PPP), the technique is changing the way ophthalmologists treat patients with severe corneal conditions, without the need for corneal transplants or lengthy recovery transplants are required when the cornea, the clear, dome-shaped surface that covers the front of the eye, becomes damaged or diseased to the point where it affects vision or causes Injuries from trauma, infections (like herpes simplex or fungal keratitis), keratoconus etc., would need corneal by Dr. Amar Agarwal, Chairman of Dr. Agarwals Eye Hospital, this groundbreaking procedure has not only found takers across India but is also gaining recognition on the global fact, the eye surgery earned Dr. Agarwal an international award at the ASCRS Film Festival in Los Angeles. Dr. Amar Agarwal won an international award at the ASCRS Film Festival in Los Angeles. The technique, now widely practiced in several countries, has been credited with restoring sight where traditional methods fall short."Some patients have very high astigmatism that cannot be corrected with usual methods, and toric intraocular lenses only work up to a certain level. This gave me the idea to create a pinhole effect in the pupil itself, which led to the first Pinhole Pupilloplasty," Dr. Agarwal told SIMPLER ALTERNATIVE TO CORNEAL TRANSPLANTIn traditional cases of corneal scarring, eye doctors often recommend a corneal transplant - a procedure that relies heavily on donor tissue, involves a long healing period, and carries the risk of graft pinhole pupilloplasty method uses stitches to change the shape of the pupil without needing a donor cornea, and patients recover much faster compared to traditional principle is simple: by reducing the size of the pupil to about 1-1.5 mm, similar to the tip of a pin, incoming light is focused more effectively onto the retina, bypassing irregularities in the cornea. Pinhole surgery instead of regular corneal transplant (Image 1: pre-operation vision. Image 2: Post-operation eye) The result? Sharper vision with reduced glare, especially for patients with complex eye issues like corneal scars, keratoconus, or radial keratotomy complications."With the pinhole technique, patients recover much faster, and long-term results are very promising. It removes the risks of rejection and prolonged medication associated with corneal transplantation," said Dr. MAKES THE PINHOLE TECHNIQUE UNIQUE?advertisementThe procedure uses very thin stitches to change the shape of the coloured part of the eye and make a small central opening (pupil). It may sound simple, but what makes it special is how precise and flexible it earlier surgical techniques such as the Modified Siepser's or McCannel methods, the pinhole pupilloplasty method requires fewer steps and causes less post-operative has distinct advantages in managing rare but difficult conditions like Urrets-Zavalia Syndrome (a fixed dilated pupil), silicon oil-induced glaucoma, and even cases of raised intraocular pressure where standard treatments fail. The procedure uses very thin stitches to change the shape of the coloured part of the eye (pupil) and make a small central opening. () "It's quicker and simpler, and the pupil tightens enough to reduce glare and photophobia. It's particularly useful in patients with higher-order corneal aberrations. Plus, it's reversible. We can undo it with a YAG laser if necessary," explained Dr. CAN BENEFIT FROM THE PROCEDURE?advertisementThe surgery is ideal for patients who:Have corneal tears that caused irregular astigmatismPreviously underwent corneal grafts and developed distorted visionHave permanent pupil dilation with glareAre living with keratoconus (conical cornea)Have had radial keratotomy in the past, an outdated refractive surgeryIt is also useful in situations where a pupil has lost its ability to constrict, causing overwhelming glare, or when the shape of the cornea is so irregular that glasses or contact lenses no longer AFFORDABLE OPTION FOR INDIA AND BEYONDFor India, where the gap between demand and availability of donor corneas remains stark, the pinhole pupilloplasty surgery has immense public health implications. Estimates suggest that over 1 lakh corneal transplants are required annually in India, but only around 25,000 are performed due to limited donor supply. () Estimates suggest that over 1 lakh corneal transplants are required annually in India, but only around 25,000 are performed due to limited donor supply.'With Pinhole Pupilloplasty, we can avoid transplant in many cases,' Dr. Agarwal noted. 'It dramatically reduces the dependency on donor corneas and also cuts down the complications of transplant surgeries.'advertisementNotably, while pinhole intraocular lenses (IOLs) are an alternative used in high-income countries, they come with a steep price tag and fixed designs. PPP offers a more cost-effective, adaptable solution for patients in India and other low-resource THERE ANY RISKS?Like any intraocular procedure, the pinhole method is not without a small risk of the suture (stitch) coming close to the natural lens, which may result in cataract formation. To avoid this, it is typically performed in pseudophakic eyes, which means eyes in which the natural lens has already been replaced with an artificial one, such as after cataract small downside is that it can be hard to check the outer part of the retina through such a tiny pupil. But with modern machines like Optos or Mirante, doctors can still get a clear and complete view without needing to enlarge the pupil. Pinhole Pupilloplasty marks a shift in how eye diseases are approached. () advertisementPinhole Pupilloplasty marks a shift in how eye diseases are approached, especially in a country like India where healthcare resources are unevenly distributed. By eliminating the need for corneal grafts in certain cases and offering near-instant results, this procedure has the potential to democratize vision care."Knowing that this technique is helping people regain sight and confidence drives me to do what I love, to research, innovate, and impact lives with the gift of sight," Dr. Agarwal awareness grows and training becomes more widespread, this homegrown innovation might well become a global standard in complex corneal care.
The Hindu
04-05-2025
- Health
- The Hindu
Conference to discuss advancements in retina care held in city
'RETICON 2025', a conference to discuss various advancements in retina care organised by Dr. Agarwals Eye Hospital, was held in the city on Sunday. Ashvin Agarwal, chief clinical officer, Dr. Agarwals Eye Hospital, said that, back in 2011, the conference was started as an initiative with an idea to spotlight advanced technology and foster discussions on retina care. 'Today in 'RETICON 2025', there is everything – from panel discussions to talks – to provide insights. It becomes important to highlight the issues [in the retina] and the advancements in treatment to not just current surgeons but also to budding retinal surgeons and young ophthalmologists. The conference is a cross pollination of ideas and discussions,' he said. Amar Agarwal, chairman, Dr. Agarwals Eye Hospital, says today in India, there are nearly two crore people with blindness and one of the biggest diseases in India is diabetes. 'Getting your eyes checked every six months should be a prerogative when you are diagnosed with diabetes. Because, even if diabetes is well-controlled in someone, he/she can get bleeding in the eye. But if we immediately get it treated, it can be solved easily,' he said. The conference focused on techniques, such as glued intraocular lens, scleral fixated techniques, and intravitreal injections, and also featured a wet-lab to provide practical training. Mohan Rajan, vice-president of All India Ophthalmological Society and chairman and medical director of Rajan Eye Care hospital, said: 'Such focus meetings are extremely important, useful, and informative.' Chennai North MP Kalanidhi Veeraswamy and Athiya Agarwal, director, Dr. Agarwals Group of Eye Hospitals, also spoke.
