Dr Ajay Sharma 
Founder, Eye-Q Vision Pvt Ltd

Dr Ajay Sharma, Founder, Eye-Q Vision Pvt Ltd, has been establishing milestones in the field of ophthalmology by adopting the latest technologies way ahead of others, such as stitchless cataract surgery or phacoemulsification, fundus photography, etc. He has been redefining the concept of eye care by introducing an interesting & first-of-its-kind confluence of advanced technologies & cost-effective care across tier-III & tier-IV areas to enable people to access care at doorsteps. Dr Ajay Sharma shares his experience, vision and recommendations in an exclusive interview with Kusum Kumari of Elets News Network (ENN)

Please walk us through the reasons and other details behind establishing Eye-Q Hospital?

As such, I have been practicing ophthalmology since 1995, which I started from a small set-up. In 1999, I built a multi-speciality hospital, where the majority of the work was ophthalmology along with other specialities. In around 2004, we realised that we need to change, as Gurgaon (now Gurugram) started flourishing with the coming up of big chains and hospitals, such as Paras Hospitals. With the coming up of such big corporate hospitals that where empanelled with us, we knew we shall not be able to compete with them. Therefore, we decided to do something that we know and that is ophthalmology. In 2006, along with a couple of centres we started another centre. In 2007, I met my business partner Rajat Goel, who is from one of the Indian Institute of Management (IIM). In 2007, we started Eye-Q Hospital. Way back in 1990s, Gurgaon (now Gurugram) was just like tier-III and tier-IV cities. We thought of making social impact by providing services in far-flung places where in actuality the real need of eye care exists.

When we started, there were not many good eye practices, practitioners, technologies and devices/equipment. People were operating 20 to 30 years old equipment. Additionally, there was no appropriate infrastructure. As such, government programmes have been running ever since 1960s with the focus on prevention of blindness, Vision 2020 programme, etc. In order to make such programmes successful, some trust needs to be built. The entire methodology of conducting camps is a conventional technique, but when the era came of implantation of lenses the concept of camp surgery cannot be done. With the development of equipment, such as microscope, etc., and increased chances of infection, the concept of camp was decreasing. With the location of the best eye care facilities in tier-I and tier-II cities, people need to travel along with family members or friends. Therefore, we thought of delivering the same quality care in small towns, where the response was really good.

Eye-Q “ Key Objectives

Deliver quality care   Believes in adopting medical devices offering benefits in the long run   Aims at offering comprehensive eye care services

We established our first centre in Rewari. Within a month, our outpatient department (OPD) reached 100 as we charged the same or less, with the only difference being the comprehensive ophthalmology services offered. Patients not only received retina, glasses, medicines, cataract detection facilities, laser, etc., but were also offered all facilities during their waiting time, such as air-conditioned environment, water, etc. For them, such facilities were truly disruptions. Our efforts were appreciated by everyone.

Fundus photography

What major technological interventions have been adopted at the Eye-Q Hospitals? Please provide details.

Any technology which comes to India is adopted at the Eye-Q facilities. Ever since 1996, I have been personally involved in adopting the latest technologies. In 1995, I learned one of the technologies which even the best of eye surgeons and professors of medical institutes/colleges were merely thinking of practicing, which was stitchless cataract surgery or phacoemulsification. In 1996, I started practicing phacoemulsification despite expensive equipment, particularly when most of the doctors were still in the initial stages of learning across India. For me, this particular event changed everything. When we started Eye-Q, even then phacoemulsification was not done by 80 per cent of the doctors. We made phacoemulsification the baseline for every cataract surgery across all our centres. In this way, we set the benchmark. In retina laser, which again had very few experts and very few equipment, we started with fundus photography, fundus fluorescein angiography, green lasers, optical coherence tomography angiography (OCTA), etc. In 2003, we got laserassisted in situ keratomileusis (LASIK) quite early, when again LASIK came to India in 2000, but there were very few machines in north India when we started.

We also brought femtosecond LASIK, which is a blade-free LASIK, to make surgeries painless. We tried to adopt technologies that were costeffective and have the capability to deliver quality care to patients. For lenses, we have good lenses now.

What are the key reasons behind the lack of enough indigenous manufacturers in the field of ophthalmology?

Dr Ajay Sharma was one of the early adopters of phacoemulsification

In terms of indigenous manufacturers, other than one or two companies that are manufacturing eye care medical devices, we dont have many manufacturers in the Indian market. Appasamy Associates is the only company manufacturing eye care equipment. The second company is Aurolab for laser equipment.

As we always aimed to deliver quality care, we did not buy many machines as we never wanted to buy a machine that cannot deliver services. Across all our centres, we have slit lamps, few lasers and indirect ophthalmoscopes, which have been manufactured by the Indian manufacturers. Around 30 per cent of our equipment is from the Indian manufacturers and the rest is from the corporates.

As such, medical devices are capital intensive and need heavy investment in research and development (R&D); therefore, we do not have many indigenous manufacturers in the fray. We need medical devices that have been created after an intensive R&D, clinical trials, etc. These companies need R&D support from the Government of India (GOI), along with private companies. The GOI needs to start from medical colleges to create an intensive campaign around medical device manufacturing.

Personally, I have tried a low-price Chakshu, which is a phacoemulsification machine developed by three IIT students. Although it was developed very properly, it could have benefitted to many ophthalmologists. However, the innovators were not able to take it to the next level due to the lack of appropriate funding for research and inappropriate production facility. Therefore, the Government needs to focus on the innovation sector.

In intraocular lenses, Indian companies are giving strong competition to multinational companies. We lack a Food and Drug Administration (FDA) like stringent approval procedure in India. As such, ophthalmology is a huge sector, we need indigenous high-quality medical devices, else good ophthalmologists will go down and remain stagnant to top 10 per cent ophthalmologists. Since the markets have become competitive, indigenous manufacturing companies are increasing prices and multinational companies are decreasing prices.

In India, we lose around $37 billion annually because of lack of awareness regarding eye correction. What are the major socioeconomic impacts of eye care?

All Eye-Q centres are equipped with advanced medical devices, such as indirect ophthalmoscopes

The number of ophthalmologists present in tier-III or tier-IV cities is less. Additionally, there are also fewer facilities. As a result, we have witnessed many farmers in the rural belt, who due to the lack of easy options for eye correction witness severe impacts on productivity. In order to address such challenges, We have started small vision centres in villages or tehsils, where the patient gets his eye checked by a certified optometrist and through cloud talks to the doctor there and then. If there is any problem, which cannot be solved at these centres, then the patient will be directed to go to the hospital. Minor cases, such as glasses, detection of cataract, etc., are detected using small cameras by the Indian firms like Forus and other companies. These fundus cameras enable to take the picture of patients without dilating their eyes. Once these images have been clicked, they are immediately uploaded on our software and shared with the doctors. This enables immediate scheduling of an appointment, which ensures screening at the doorstep. Other activities that we are piloting are home health visits, which cover refraction, slit lamp examination, fundus photography, etc. We have created a box worth Rs 18 lakh that is carried by the optometrist during home visits.

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