From individual patients to national eyecare systems, Tasmanian ophthalmologist Professor Nitin Verma has made it his mission to improve visual outcomes in developing countries. Now he’s bringing his unique knowledge to the RANZCO presidency.
Thirty-five years ago, while on his fellowship as a young ophthalmologist in Germany, Professor Nitin Verma co-developed one of the world’s first foldable intraocular lenses (IOL) made from silicon.
Under the guidance of the renowned Dr Günter Fromberg, the lens signalled a new generation in IOL technology that could be produced at a much cheaper price, while also being conducive with the emergence of smaller incision cataract surgery.
Importantly for Verma – who was born and raised in India where he also conducted his medical training – the Fromberg-Verma (FV) silicone IOL created a new pathway for developing countries to access advanced, western-developed ophthalmic technology.
Back then, in 1985 when cataract surgery wasn’t common in developing countries, Verma implanted his FV IOL in a young Indian boy with significant ocular trauma. Last year – 34 years on – he met with a surgeon from that same hospital who informed him the boy is now a successful engineer, with the same IOL still in place.
For Verma – who assumed the RANZCO presidency this month – this anecdote encapsulates his reasons for choosing ophthalmology, leading to a career that’s made a difference on a much larger scale across the Asia-Pacific region.
“I was initially drawn to ophthalmology because it’s a fine art that can produce spectacular results. Cataracts are often the benchmark when you’re talking about outcomes in ophthalmology, and even though I’ve done plenty of procedures in my time, that’s still something that continues to fascinate me,” he says.
“Closing the gap between the developed and developing world, the haves and have nots, has always been a passion of mine. Throughout my career I’ve been interested in how we can adopt technology from advanced countries for those living in poorer countries.”
Verma takes over the presidential reins from Associate Professor Heather Mack, the first female to hold the position in RANZCO’s 50-year history, and whom Verma has praised for improving governance standards, her attention to detail, collegiality and work ethic.
Verma himself has had a long affiliation with the college as a council member and long-term board member, while also serving as vice-president between 2018-19.
He’s also left an indelible mark on many eyecare programs across the world. The most notable include practising oculoplastics on leprosy patients in India, founding the East Timor Eye Program, overhauling the public ophthalmology service in Papua New Guinea, working with Aboriginal and Torres Strait Islanders in the Northern Territory and providing remote emergency eyecare to people stationed in Antarctica.
For the past 18 years till now, he and his wife Anu have lived in Tasmania. Verma practises privately at Hobart Eye Surgeons, while also fulfilling roles as a Clinical Professor at the University of Tasmania School of Medicine, and Clinical Associate Professor in Ophthalmology in the University of Sydney. He recently stepped down as head of ophthalmology at the Royal Hobart Hospital, but still continues to practise there.
First exposure to ophthalmology
The son of an army engineer, Verma’s childhood was spent in different parts of India, with his father sent on different postings throughout the country. His father was also involved with water management projects and non-government organisations (NGOs).
“To a large extent I learned a lot from my parents, and my father was also an Olympian. He represented India in sailing at the 1972 Munich Games.”
Verma went to medical school at the Christian Medical College in Vellore, South India, and in his fourth year became enamoured with ophthalmology.
“The exact nature of ophthalmology appealed to me. Those days we were talking millimetres when other surgeons were talking in feet and inches. Even though ophthalmology was fairly underdeveloped in 1977-1978, one could see its future,” he recalls.
As part of his internship, Verma worked at a leprosy hospital, his first major exposure to ophthalmology. This involved facial reconstruction and eye lid work in patients with lagophthalmos and facial nerve palsy.
During his ophthalmology training at the All India Institute of Medical Sciences in New Delhi, Verma continued this and was the only trainee who would conduct eye camps in leprosy colonies due to his dual oculoplastics and cataract skills.
During his early years, he met Dr Fromberg, which led to his fellowship in Germany and development of the FV IOL when he was just 27 years old. There, his eyes were opened to the significant disparity between first and third world countries, and it got him thinking about how poorer countries could benefit from what the world has to offer.
“I believe [the FV IOL] was the second foldable IOL in the world. It was also cheap and made from silicon and it could be sterilised with autoclaving, so it was suitable for developing countries,” he says.
“It was produced when phaco was about to come on the scene. At that time incisions were large, and people were asking why we were making a flexible lens. But it wasn’t until the late 1980s that acrylic IOLs came in, and when phaco became the standard of care, flexible lenses became the standard of care, so our lens was produced a few years ahead of its time.”
After his fellowship, Verma returned to India, and in 1993 went to Papua New Guinea where he was tasked with rebooting and running the country’s ailing ophthalmology services and training program.
“In 1997, we left because I had been held up too often with guns. The third armed hold up happened when I came home one day. The guard took his time opening the gate and suddenly there were three guys around the car. They held a gun to my head and told me to get out and took the car.
“I walked home and there was a phone call from the Royal Darwin Hospital who had been asking me to work for them. They asked if I had made up my mind, and by September 1997 we left for Australia. But Papua New Guinea was one of the best parts of our life because we did so much there, we started some NGOs that are still running, and we have seen parts of the country that most locals wouldn’t have.”
In Darwin, Verma oversaw three hospitals and serviced 29 communities, where he formed a greater understanding of the eye health issues facing Aboriginal and Torres Strait Islanders.
“I’ve been Closing the Gap my entire life and we have our own gap in New Zealand and Australia that we need to continue to work on,” he says.
“[RANZCO] is one of the original endorsers of the roadmap for Closing the Gap for vision, and its annual update is launched at RANZCO Congress each year. Soon, we’ll also be launching our Maori action plan. New Zealand is often seen as the exemplar of equality, but there’s more to be done to ensure true equity of access for Māori and Pacifika.”
Bigger than ophthalmology
Verma believes ophthalmology in Australia is well regarded internationally, underpinned by a robust health system, strong training program and some of the world’s leading professionals.
Within that, he believes RANZCO’s main function extends beyond educating ophthalmologists and the broader eye health workforce.
“It’s also education of the community and the government to ensure we can maintain the high standards of eyecare that we are used to in Australia and New Zealand,” he says.
“It’s important to remember it’s a much bigger playing field than ophthalmology and optometry. We can’t have these standards without patient organisations, orthoptists, technicians, practice managers, ophthalmic nurses, researchers and administrators.”
In addition to new technology, artificial intelligence and new drugs, he believes one of the biggest challenges facing ophthalmology is the rapid change brought about by COVID-19 and what that will mean for the point-of-care.
“I believe the point-of-care will slowly be moved to the home. Patients will still come in for examination, but there will be a lot more home monitoring. We need to rethink what’s going to be the new ‘business as usual’, while maintaining the same standards we’re used to.”
With a small population dispersed over vast distances, Verma says Australia faces unique challenges in terms of access to care for rural and remote communities. But he says the country needs to look beyond its borders as well.
In 2000, he set up the East Timor Eye Program, which is perhaps his most notable project yet. It set out to make Timor Leste self-sufficient in eyecare services by 2020 and eradicate preventable blindness by 2025.
“Prevalence of blindness has come down from 7.7% to 2.9%, that’s the impact of the program,” he explains.
“Very soon we will be handing the whole program over – equipment, buildings and systems – to the Ministry of Health. It’s taken 20 years in a post-conflict country to create this program from scratch, integrate it with the existing programs and health system, and make it sustainable.
“I’m passionate about our workforce development within Australia and New Zealand as well as our wider areas of responsibility in improving eyecare. But we need to change our focus from going on missions, to projects that make these countries self-sufficient. If we can create basic services to address the major causes of visual problems – which are uncorrected refractive error, cataract and now the scourge of diabetes – we can empower these countries to handle their basic eye problems and the rest can be managed remotely.”