As a young boy, Dr. Rajeev Ramchandran remembers spending a lot of time with his aunt. In the 1970’s, his father had returned to India to visit his sister, Dr. Ramchandran’s aunt, and noticed that she was having trouble seeing her university books. She was taken to a local eye doctor who discovered that she had not one, but TWO eyes with detached retinas. Surgery did not fully repair the retina and eventually she immigrated to the United States. Once here, she received sight saving surgical treatment at Wills Eye Hospital, in Philadelphia, by Dr. Luv Sarin, who also was from India. Dr. Sarin was one of the first individuals to perform a vitrectomy, which was a new retinal surgical technique, to reattach Dr. Ramchandran’s aunt’s retinas and preserve her eyesight. As she was receiving surgical care, Dr. Ramchandran’s aunt stayed with her brother for a few years and helped care for Dr. Ramchandran as a child. Seeing his Aunt’s sight being saved, motivated him to help people in the same manner by becoming a vitreoretinal surgeon.
Growing up in Rochester, NY, Dr. Ramchandran saw his community elders sitting around a dining table as the initial team to inspire and help bring LV Prasad Eye Institute to life. As a child, he also learned the value of community service through being involved in weekend soup kitchen service activities organized by leaders in his community. As an adult who returned to his hometown after his training in ophthalmology, Dr. Ramchandran continues to be active in the India Community Center (ICC) of Rochester, serving as a board member and past chairperson. Through the ICC, he not only celebrates and educates the larger community about his Indian Heritage, but also continues the tradition of his community elders to serve those in need by organizing group service projects through his committee called DOSTH or Developing Ourselves Serving Together Harmoniously. ‘DOSTH’ means ‘friend’ in Hindi, a widely spoken language in India, and through the work of this committee Dr. Ramchandran encourages friendships among the volunteers as well as with the organizations and communities helped. Just as friends uplift one another, Dr.Ramchandran started DOSTH with a vision for it’s volunteers to uplift the Greater Rochester community and the organizations that support its growth and sustainability. Currently, DOSTH has organized Red Cross blood drives at the ICC and monthly group food packaging/ delivery services at the Peoples Pantry, Rochester’s largest food pantry.
Dr. Ramchandran is now Associate Professor of Ophthalmology at Flaum Eye Institute (FEI) of the University of Rochester Medical Center (URMC). As the Director of Population Health at the FEI, he is implementing a unique perspective on how to approach eye care. He began our call with a profound statement, “Our current of healthcare system is organized and sustained by holding a sign to attract sick people”. His approach to healthcare is to be proactive and preventive, ‘to reach people at risk for eye disease before they become patients’ and evaluate and triage them for further care as appropriate with a concerted effort to reach out to the underserved. Dr. Ramchandran feels if he can reach people before they need to become his patients, he could save sight for many more people!
One of the tools that Dr. Ramchandran uses is the FEI Vision Van. This van travels to schools that serve children from underserved communities in Rochester, NY and delivers eye care for school children who do not pass their New York State mandated school vision screening. Using equipment from the Vision Van FEI optometrists can provide the eye care services these children need, and can also, when needed, provide glasses that are donated from the FEI Glasses for Kids fund. The FEI Vision Van also serves other at-risk populations by allowing for eye exams to be performed at Senior Living Communities for older adults, and at rural primary care offices for those with diabetes. In addition, having mobile equipment allows Dr. Ramchandran and his outreach team to conduct community screenings around Rochester. In a recent visit to an at-risk community, the team was able to identify glaucoma in 20% of the patients screened. In addition to the outreach using the van, Dr. Ramchandran has initiated a teleophthalmology based program to evaluate people with diabetes for diabetic eye disease, namely diabetic retinopathy, the leading cause of blindness in the working age US population. In partnership with URMC’s Primary Care practices, Dr. Ramchandran has placed specialized digital cameras that can take pictures of the retina through undilated pupils at primary care practices serving low income, underserved populations with diabetes that have low rates of obtaining the recommended annual eye exam. Through this initiative, named Tele-I-Care, Dr. Ramchandran evaluates these pictures for eye disease remotely and sends his recommendation to the primary care practices and patients to get them to more urgently see an eye doctor if disease is found and thereby proactively prevent permanent vision loss. The Tele-I-Care program has doubled the rate of annual exams for diabetic retinopathy in safety-net primary care clinics.
Meanwhile, the simple basics are just as important in vision health and eye care. Food and nutrition are a vital part of keeping the eyes healthy. Diets rich in green leafy and different pigmented vegetables, tree nuts, and cold water fish, such as salmon, have nutrients that are beneficial for eye health. The URMC has started a food pantry to help patients identified as having food insecurity. The Flaum Eye Institute, will be the first non-primary care department to help bring awareness to nutrition and provide food insecurity screening for their patients so that those in need can be guided to the food pantry at the end of their eye care visit. Dr. Ramchandran has also formed an interdisciplinary team of experts in nutrition, epidemiology, and community based big data analysis to understand what grocery store loyalty card transaction data can tell us about household eye healthy food purchases.
Besides all the wonderful things Dr. Ramchandran is doing for the community, he is also an active board member of many different organizations worldwide. The success of the FEI Vision Van and Tele-I-Care program also comes from learning about other successful programs from other important vision organizations world-wide, such as the Prevent Blindness, Lions Club International, and the L. V. Prasad Eye Institute (LVPEI) in India. Dr. Ramchandran is on the board of Prevent Blindness as Chair of the Scientific Committee, is Vice Chair for Vision 2020 USA, and sits on the board of the Indo-American Eye Care Society, the foundation board for the LVPEI. Many important conversations are taking place regarding how to promote and raise awareness of eye care across the globe by the World Health Organization and the International Agency to Prevent Blindness. In developing countries, many organizations have long been increasing awareness and addressing eye and vision problems at a national level, but in the United States, most health care organizations do not see eye and vision health as needing more awareness or support. Yet, there are so many people in the US, especially in underserved communities, with treatable eye problems who do not realize the need to access or at times have access to care and lose vision living just a few miles away from centers providing state of the art sight saving eye care, such as FEI. Dr. Ramchandran is currently leading a national dialogue through Vision 2020 USA to raise awareness of how to identify and address social determinants of health that may limit populations at risk for vision loss from receiving eye care. This dialogue will also include a briefing to Congressional staffers on the status of children’s vision in the US and highlight work being done to address vision related health disparities and health equity for the future adults of our nation.
So, what is next for this amazing and talented doctor? What is he most excited about? As his continued commitment to community service, improving the eyes health of at risk populations, and increasing the early detection of eye disease is expanding locally, he is also broadening his national and international collaborations. Working with Dr. Yao Lui at the University of Wisconsin, Dr, Ramchandran is joining a national effort to improve the implementation of.teleophthalmology to increase screening rates for diabetic eye disease supported by the National Institutes of Health. He is also working with Dr. Joshua Stein at the University of Michigan to contribute to a national data repository of de-identified eye health related data to be able to ask and answer questions related to vision-related health at the national level. In addition, Dr. Ramchandran is elevating the importance of an eye exam by demonstrating how looking into the eyes, can tell a lot about the health of the body and mind. Working with Dr. Steven Silverstein, Director of Research in the Department of Psychiatry and founding Director of the new Center for Retina and Brain (CRAB) at URMC, Dr. Ramchandran is studying how various neurologic, psychiatric (such as schizophrenia), and cardiovascular conditions can be identified and monitored by analyzing retinal images. This new area of study, called “oculomics,” uses ophthalmic biomarkers and combines information from ocular screening tools and health and behavioral data to allow the eyes to tell us about our overall wellbeing and health. Drs. Ramchandran and Silverstein have also recently started collaborating with a team from the National Institutes for Mental Health and Neurosciences (NIMHANS) in Bengaluru, India, to further explore vision issues in those with schizophrenia in addition to investigating what the anatomy and functioning of the retina can say about schizophrenia and other mental health diseases. This exciting new area of study is harnessing new technology and science to raise the importance of an eye exam to more than just checking one’s vision health. We cannot wait to see what else the future holds for this incredibly intelligent and inspiring doctor. We hope he can continue to encourage the public to have their vision tested more regularly before needing to become his patients and we hope he will continue to inspire his students and colleagues as they forge ahead into new territory, new ideas, and new solutions in the world of vision and eye health.