Dr. Suvira Jain: On Healing Eyes and Touching Lives

by Tan Sher Lynn

Arenowned clinician, skilled surgeon, respected teacher, sought-after speaker and beloved mother - Dr. Suvira Jain, indeed wears many hats. To learn more, CAKE Magazine sat down with the compassionate doctor to discuss what each role means to her.

As an Ophthalmologist

Dr. Jain obtained her MBBS from Jawaharlal Nehru Medical College, Belgaum, Karnataka, and her Diploma in Ophthalmic Medicine and Surgery (DOMS) at the College of Physicians and Surgeons Bombay. She then pursued her Fellowship of the Royal Colleges of Surgeons (FRCS) in Edinburgh, United Kingdom, where she gained a different perspective in looking at her subjects.

Through this training, she learned to see her patients as a whole person – not only through clinical lenses, but also with compassion. This shaped her practice to ensure that not only her patients’ medical needs were met, but their human needs as well. This

In an industry largely dominated by men, rising to the top can be challenging for women ophthalmologists.

also gave her the opportunity to gain recognition as a compassionate clinician. Steered by a sense of purpose to return to her homeland and serve her people, Dr. Jain decided to return to India after staying in England for about seven years.

“Following my heart and instinct, I returned to India and joined the KBH Bachoo Ali Eye Hospital in Parel, Mumbai, which is my parent institute,” she shared. “I’ve been working here for the last 19 years as clinical head of the cornea department. Being in an institute, I can continue learning, as well as sustain my interest in academics, teaching and patient care. I also have the honor to work with the underprivileged people in my society. This has been my greatest sense of accomplishment.”

“The reason I chose ophthalmology has always been the people – being able to improve people’s vision and seeing them satisfied after surgery. Truly, being an ophthalmologist has enabled me to touch people’s lives in such an impactful way.”

As a Teacher

To Dr. Jain, teaching is as equally important as treating patients. “By equipping students with the necessary skill set to operate well and establish themselves as ophthalmologists, I am able to touch many more lives,” she said.

In June 2004, she conceptualized and established the Phaco Training Academy at KBH Bachoo Ali Hospital. Since then, the Academy has successfully trained more than 750 qualified ophthalmologists, including residents, from all over the country.

“We accept students at any level, work out a customized program and equip them with the skills required to perform the best phacoemulsification possible, making sure that they understand the principles and become very good at the techniques,” shared Dr. Jain.

She added that she always encourages her students to learn new things and improve themselves. “It is intimidating to do something new, but

we need to face our fears and just do it. When students make mistakes, we guide them and lift them out of the storm. In any stage of our lives, we need to remember to stay teachable. Our lives and profession are a learning journey,” she said.

The Phaco Training Academy organizes a live surgical program for challenging cases once a year, and a retreat every two years. In her book The Art of Phacoemulsification – The Passion, The Essence, The Quest, Dr. Jain describes her expertise and experiences, with the aim of supporting and inspiring trainee surgeons. She has also operated in many live surgical sessions during conferences, teaching the audience every step of the procedure.

“Has all this been easy? Well, it was definitely not easy,” she quipped. “To be able to stand out there and work amongst an entire institute filled mostly with men, it took a lot to be taken (even slightly) seriously. It took a firm and infallible belief in who I am and what I stand for. It took intense commitment to my profession, hard work, and the desire for continuous selfimprovement,” she stated.

“But throughout this journey, I have had the privilege to be encouraged by my mentors, respected by my seniors and team of doctors, and treated as equal by my colleagues. I am also blessed with the complete faith of my patients, and the love, respect and trust of my students.”

As a Mother

For Dr. Jain, the biggest feather in her cap was finding the time, commitment and love to lead and guide her children, despite her workload.

“When I was in studying in England, I was raising two small children at the same time. Having obtained my FRCS after toiling for months was really a huge sense of accomplishment, pride and relief.” She added that it is important for children today to see their mothers work hard and excel in their profession. “They respect that a lot in you. Through our example, our children will have a clear sense of what they want to be when they become young professionals,” she said.

Dr. Jain shared that Isha, her first born, worked toward setting up forums for women to engage in public speaking when she was a student in Bangalore. She also worked with underprivileged kids in the schools there, encouraging them to study law.

Meanwhile, Meha, her 22-year-old, wrote at 18 in an interview application that “in emulating my mother, I attempt to make sure that every decision that I make is guided by how its implementation would first affect others, then myself. I push myself to embrace my maximum potential in the hope that one day I would become one tenth the person she is”.

“My daughters have watched me grow, struggle and rise above various circumstances,” said Dr. Jain, sharing that she has been a single mom for a decade. “I do not moan about the difficulties of being a single mother. Instead, I take it in stride and get things done. My commitment to my profession has taken much of my time, but somehow I managed to be there for my daughters when they needed me, be it emotionally, socially or financially.” Dr. Jain would often text her daughters to say, “Mom’s got your back. You have nothing to worry about. It’s all good”. And today, the roles have been reversed. “I have a daughter who tells me: ‘I got your back, Mom.’ So, life eventually comes back full circle. Whatever you give, it comes back to you,” added Dr. Jain.

As a Woman

According to Dr. Jain, sometimes it can be a challenge for women working in ophthalmology to be taken seriously. But they can overcome it by being good at what they do, being clear about what they believe in, and staying on top of the industry.

“With this, there will be no question of people not taking you seriously. And even if there are still people who don’t, it doesn’t matter. You will be confident, you will be clear, and you will be happy,” she said.

Dr. Jain stressed that women ophthalmologists need to realize that firstly, they are ophthalmologists. “They need to focus on getting their clinical and surgical skills right, focus on driving their own potential and giving their best. That’s how I live my life and how I inspire my students. Gender is immaterial. Professionalism is all that matters,” she shared.

“Truly, we should all strive to live fully and die empty. As my mother wrote in a poem: ‘Our fingerprints do not fade from the lives that we touched’,” concluded Dr. Jain.

About the Contributing Doctor

Dr. Suvira Jain is a thinking ophthalmologist, with a mission to deliver new age, top-of-the-line eye care to her patients with care and compassion. As a person, she is no-nonsense, hard-working, dedicated and compassionate. As an ophthalmologist, she has not only acquired exemplary clinical knowledge and surgical skills, but has also been deeply involved in research and teaching, with a tireless inclination to keep abreast with emerging and meaningful technology. She is also a prominent speaker and has presented numerous scientific papers in both national and international ophthalmic forums. To date, she has performed over 80,000 surgeries, taught more than 750 students and given over 100 presentations. [Email: drsuvira@gmail.com]

Dr. Marcus Ang The 2019 Artemis Awardee

by Chow Ee-Tan

A young, accomplished ophthalmologist from Singapore who demonstrated care and service to an exemplary degree was the recipient of the 2019 Artemis Award from the American Academy of Ophthalmology (AAO).

Dr. Marcus Ang, consultant ophthalmologist at Singapore National Eye Centre (SNEC) specializing in cornea and refractive surgery, was recognized for his pioneering years of work in providing free vision care for people across Asia, particularly the elderly in Singapore. Driven by his goal to develop innovative and sustainable eye solutions, Dr. Ang has dedicated much of his time to caring for others in – and outside of his clinic at SNEC. The young doctor is the force behind the non-profit organization Global Clinic Ltd., which ventures beyond local borders to provide free eye care and surgery in developing countries around Asia.

Dr. Ang also founded and leads the Mobile Eye Clinic (MEC) Project, which aims to bring free eye care to the elderly who lack mobility in underprivileged communities in Singapore.

Beyond Caring & Service

When contacted by CAKE, the busy doctor, who is also associate professor of Ophthalmology and Visual Sciences at Duke-National University of Singapore, expressed his gratitude for the recognition, saying he was, indeed, very honored to receive the award.

“This prestigious award has been conferred to many ophthalmologists in

In addition to being a skilled hunter, the Greek goddess Artemis was also a protector of the vulnerable.

the past who have done amazing work in their field,” he shared. “So, I’m very lucky to be recognized among some of the greats. To me, personally, it is a recognition of my contributions to the field of ophthalmology, outside of academic and clinical work. Thus, it is a great honor,” said Dr. Ang.

He added that career-wise, it’s validation of the importance of global ophthalmology and community work in the field of ophthalmology, which he believes will support his current programs and help them progress to greater heights.

The Artemis Awards

The Artemis Award was created to acknowledge the contributions of individual ophthalmologists above and beyond what is required or expected. Since 2014, the Academy has annually honored young ophthalmologists with the Artemis Award in recognition of their tremendous work to help disadvantaged communities obtain vision care.

The award is named after the Greek goddess Artemis, who was the protector and nurturer of the vulnerable and suffering.

The selection criteria are tight. The Academy’s Senior Ophthalmologist Committee considers nominations that meet the qualifications and selects the winner based on several criteria, such as nature of the service, the sustainability of service, the length and consistency of service, and the scope of impact.

In the Service of Community & Ophthalmology

According to Dr. Ang, both the Global Clinic and the MEC Project were born out of very different circumstances, but with the same goal: To provide eye care in communities where access is difficult, both in his home country and beyond. Going beyond his role as director of vision projects at the Singaporean non-profit organization, Global Clinic, Dr. Ang has undertaken voluntary ophthalmology work in the community, leading volunteer missions all over Asia. He regularly organizes missions and travels to countries such as Indonesia, Thailand, Cambodia, India and Myanmar to provide free cataract surgery.

This had helped needy beneficiaries overseas who cannot get medical care due to poverty or inaccessibility.

On his mission to Myanmar in 2017 with Global Clinic, Dr. Ang and his team of 20 medical professionals helped almost 3,000 patients and completed more than 270 operations in five days. In his home country, Dr. Ang also initiated the MEC Project in 2013 under the auspices of the Singapore Society of Ophthalmology, to provide free eye care to the elderly in underprivileged communities in Singapore.

“We provide primary eye care with optical corrections, such as spectacles if required, as well as accurate diagnosis of conditions in the community so that the beneficiaries don’t have to travel to tertiary hospitals for treatments,” explained Dr. Ang.

When he first started the program, Dr. Ang and his small team went doorto-door, surveying and examining the elderly using portable eye equipment. “Today, we have evolved into a MEC bus that has a more comprehensive clinic, providing access to eye care right at the doorsteps of our beneficiaries,” he shared.

Surveys had shown that of the elderly patients who went for a regular eye screening, only 25 to 30% sought further treatment as advised. The MEC program managed to raise this follow-up rate to almost 70%.

Indeed, the program has grown significantly. Since its inception, more than 5,000 people have benefited from Dr. Ang’s MEC program. The underprivileged elderly are receiving their regular free eye care, and the program enabled some patients with reversible conditions such as cataracts to receive timely surgery or other basic procedures such as laser treatment.

Achievements that Matter

Dr. Ang’s volunteer efforts have not gone unnoticed in the past. He was the recipient of awards such as the Healthcare Humanity Award in 2012 and the Young Eye Care Ambassador Award in 2013. In 2017, Singapore President Halimah Yacob honored Dr. Ang with the country’s Volunteer and Philanthropy Award – the highest recognition for volunteer work in the nation.

Still only in his late 30s, the list of achievements and accolades under Dr. Ang’s belt is impressive to say the least. But among all his international and local awards, what means the most to him are the ‘patient appreciation awards’, which are awarded every year by patients to recognize the doctors for their service and clinical care.

“I have achieved this several years in a row now, and I’m glad that my patients appreciate my clinical care on a daily basis,” shared Dr. Ang. In the future, he wants to continue to reach out to more elderly patients with eye disease in certain communities. He disclosed that there are bigger plans for 2020, with the Mobile Eye Clinic programs launching in Myanmar and other regional countries. However, Dr. Ang admits there are plenty of challenges in his charity works. “Perhaps one aspect that people don’t see is that with each mobile eye clinic (which is the ‘face’ of the program), is a project that requires a lot of coordination behind the scenes to make sure that patients receive the care and follow-up that they need. Thus, sustainability in this program is a big effort that requires a lot of commitment,” he said.

His passion for humanitarian work has led him to teach young doctors, nurses, optometrists, ophthalmic technicians and medical students who are engaged in building sustainable programs, including education and patient care in developing countries throughout Asia.

“What gives me the most satisfaction is interacting with beneficiaries and volunteers, and seeing everyone coming together for a common cause,” he concluded.

About the Contributing Doctor

Assoc. Prof. Dr. Marcus Ang, MBBS, MMED, MCI, FRCS, PhD, is consultant ophthalmologist at the Cornea and Refractive Service, Singapore National Eye Centre. He is Secretary of the Asia Pacific Academy of Ophthalmology (APAO) Young Ophthalmologist Committee. He is a graduate of the APAO Leadership Development Program (LDP) as well as the American Academy of Ophthalmology (AAO) LDP Class XX. He currently serves on the APAO YO and LDP Standing Committees and several AAO Committees, such as the International Committee and AAO Myopia Taskforce.

Dr. Ang is heavily committed to charity work in the ophthalmology field in Singapore and throughout Asia. As founding director of Global Clinic (www.global-clinic.org), he regularly organizes missions to provide free eye-care and cataract surgery in countries such as Indonesia, Thailand, Cambodia, India and Myanmar. He also serves on the Board of the International Agency for Prevention of Blindness as well as Project ORBIS Singapore. He has been commended with the President’s Award for Philanthropy in Singapore, and Prevention of Blindness Award from APAO.

His contributions and achievements as a young ophthalmologist have led to him being awarded recently with the Artemis Award from the AAO 2019. [Email: marcus.ang@singhealth.com.sg]

Ocular Health vs Aesthetics NLIGHTENMENT In the Eye of the Beholder Eyelid Cosmetic Enhancements and their Associated Ocular Adverse Effects

Is ocular damage worth the price of beauty?

by Gerardo Sison

While many cosmetic enhancements are widely and readily available today, the quest for beauty can often come at a price. Procedures such as eyelash extensions, eyelid tattooing, and eyelash dyeing can lead to adverse effects, ranging from temporary irritation to long-term ocular damage.

Although ophthalmologists might not experience these cases on a regular basis, it is important to be aware of these cosmetic procedures and their possible risks.

Dr. Majid Moshirfar, a cornea specialist and clinical director of Hoopes Durrie Rivera Research Center, Utah, USA, provided some insight on the adverse effects of these procedures so that providers can be better prepared to advise and treat these patients.

Are eyelash extensions safe?

34 the cosmetic procedures for this is the eyelash extension, which involves attaching fake lashes to the base of natural lashes using an adhesive. These adhesives, however, may contain a cyanoacrylate base and are often mixed with latex and ammonia. According to Dr. Moshirfar, these ingredients can be quite toxic and cause adverse reactions. “I see about five to six patients per year with reactions to eyelash extensions,” shared Dr. Moshirfar. “Formaldehyde-emitting compounds like glue adhesives may cause severe damage to the eye, such as toxic conjunctivitis and conjunctival erosion.” Reports have found that many patients experience itching, inflammation around the ocular area, and watery eyes after receiving eyelash extensions. More severe cases have even reported temporary loss of vision. “Note that many patients do not consult after receiving eyelash extensions even if they have red, itchy eyelids, which may be a symptom of blepharitis,” added Dr. Moshirfar.

Complications of Eyelid Tattooing

Another trending cosmetic enhancement procedure is eyelid tattooing, otherwise known as blepharopigmentation. It involves injecting pigment granules into the upper layers of the skin to mimic the look of eyeliner or eyeshadow. This procedure may appeal to those who want a permanent makeup solution or those who are physically unable to apply makeup due to conditions, such as arthritis or Parkinson’s disease. Still, this procedure does not come without risks. “Allergic blepharitis, granulomatous reactions and allergic contact dermatitis have all been reported in the literature,” said Dr. Moshirfar. “What is worse is if the chemicals reach the eye itself. Improper application of eyelid tattoos may severely damage the ocular surface and periorbital area leading to corneal erosion and meibomian gland loss, as well as dry eye.”

Because eyelid tattooing involves using a needle to inject a foreign substance in the skin, many patients may experience irritation and inflammation from the needle, as well as the pigment. Most often, the dyes used are also not uniformly approved, which can cause even more concern for possible allergic reactions. Therefore, it is important to advise patients to look for experienced, certified practitioners if they want to undergo this procedure. If done in a healthcare setting, patients are also more likely to receive proper anesthesia and sterilization.

What about eyelash dyeing?

Eyelash dyeing, or eyelash tinting, is a beauty treatment that gives the eyelashes a fuller appearance. Although it is not permanent, eyelash dyeing can simulate the lash-darkening appearance of a mascara for a few weeks. However, the dyes can often contain ingredients such as stearic acid and acetyl alcohol, which can act as irritants especially for those who are more prone to allergic reactions.

“While allergen testing may be appropriate prior to these procedures, it is not a fail-safe test,” explained Dr. Moshirfar. “Besides allergic reactions, eyelash dyeing can cause ocular surface problems which can increase the possibility of a decline in vision.” Other adverse reactions can include loss of eyelashes and swelling of the eyelids. Patients who have undergone laser-assisted in situ keratomileusis (LASIK) or other refractive corneal procedures may also need to be more careful. “The risk of an adverse reaction leading to worsening of any dry eye condition is higher in these patients than in the general population,” noted Dr. Moshirfar.

The procedure involves applying a protectant like Vaseline around the eyes to protect the surrounding skin from getting stained. The dye is then mixed with hydrogen peroxide to help deposit color onto the eyelashes. Using a fine brush, the mixture is applied and allowed to set for 10 minutes.

“Eye care specialists should consider toxic and allergic reactions when patients manifest with conjunctivitis, blepharitis or corneal issues after eyelid or eyelash cosmetic enhancement procedures.

”– Dr. Majid Moshirfar

Some products can be applied at home and are marketed for longterm use. These products may contain silver pigment, which can lead to discoloration of the conjunctiva, cornea and skin with prolonged use. Given that eyelash dyeing products are easily accessible to the public, adverse effects may be more common than previously thought.

Treatment and Prevention of Adverse Effects

When patients choose to undergo cosmetic enhancement procedures around the eyelid, they are putting themselves at risk for adverse effects, including ocular damage that can’t be undone.

“Eye care specialists should consider toxic and allergic reactions when patients manifest with conjunctivitis, blepharitis or corneal issues after eyelid or eyelash cosmetic enhancement procedures,” said Dr. Moshirfar. “For patients with known allergies, advice should be given to refrain, as much as possible, from exposure to dyes and other chemicals.” In regard to treatment, Dr. Moshirfar said artificial tears may be used initially for dry eye. “Allergic reactions can be treated with systemic anti-allergies or topical eye drops,” he added. “Whereas granulomatous reactions are more difficult to treat, secondary infections can be treated with local or systemic antibiotics depending on the severity. After an allergic reaction, the patient must be advised not to undergo any other cosmetic procedures because of the high risk of an adverse reaction.”

Although these enhancement procedures can be successful for patients, it’s best to ensure that the patient chooses a licensed practitioner who knows what she’s doing. “A person seeking cosmetic enhancement procedures involving areas around the eyes should go to a reputable licensed esthetician, eyelash technician or cosmetic practitioner who is experienced in these procedures,” advised Dr. Moshirfar. “Poor technique can lead to injury to the eyelids, eyelashes and glands.”

As with everything else these days, you get what you pay for. And this especially rings true for cosmetic enhancements.

About the Contributing Doctor

Dr. Majid Moshirfar is a board-certified ophthalmologist, corneal specialist and refractive surgeon. He earned his medical degree from Georgetown University School of Medicine in Washington D.C. and completed his ophthalmology residency at the University of Illinois College of Medicine in Chicago, where he received the Best Resident Award. He then completed two Fellowships at the John S. Moran Eye Center, University of Utah. Since then, Dr. Moshirfar has established his own cornea fellowship program at the Moran Eye Center, which is currently training a total of 38 fellows. Based in Salt Lake City, Utah, USA, Dr. Moshirfar specializes in cornea transplant, vision correction surgery and intraocular implants at Hoopes Vision. He has been a leader in developing complex procedures and techniques involving the cornea and anterior segment. As an internationally renowned specialist, Dr. Moshirfar has also authored more than 200 peer-reviewed publications and contributes on the editorial board of multiple scientific journals. [Email: cornea2020@me.com]