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GUEST EDITORIAL
Year : 2014  |  Volume : 2  |  Issue : 3  |  Page : 127-129

Dr. B.T Maskati's 60 years of journey as an ophthalmologist


Professor Emeritus, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, Maharashtra, India

Date of Submission04-Aug-2014
Date of Acceptance04-Aug-2014
Date of Web Publication16-Aug-2014

Correspondence Address:
Dr. B T Maskati
King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-3897.138851

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How to cite this article:
Maskati B T, Maskati QB. Dr. B.T Maskati's 60 years of journey as an ophthalmologist. J Clin Ophthalmol Res 2014;2:127-9

How to cite this URL:
Maskati B T, Maskati QB. Dr. B.T Maskati's 60 years of journey as an ophthalmologist. J Clin Ophthalmol Res [serial online] 2014 [cited 2022 Dec 3];2:127-9. Available from: https://www.jcor.in/text.asp?2014/2/3/127/138851

Even before being accepted to medical school, I watched my older brother perform ophthalmic procedures, inspiring me to follow the same path. My elder brother, 10 years elder to me, is an ophthalmologist and a very good surgeon. I used to go on vacation and see his surgery. Gradually, I started assisting him. Upon my acceptance to medical college, I brought some of his tools, including a cataract set along to the KEM Hospital, Mumbai. While dissecting during the first 2 years of anatomy, I would use the instruments to remove the cataract in all the cadavers! It sounds funny, but that is how I got into it, and by the time I finished my 2 years of anatomy, I was so well-versed in ophthalmology that I used to teach the final-year students.

This kind of preparation allowed me to be one of only two students, out of 20, who passed the rigorous MS (Ophth) exam at 1 st attempt in 1955, the other successful candidate being the late Dr. Piyush N. Dixit, who later went on to head the Ophth Dept. at Nair Hospital, Mumbai.

By that time, I had published three or four papers, one of which was on histoplasmosis in the eye. The ocular lesion was such that it could have been toxoplasmosis or histoplasmosis, and the histoplasmosis test was positive. Nobody had described the macular lesion before, which is almost like toxoplasmosis. This is a fungal disease, which is occurs rarely all over the world.


  Teaching Legacy Top


In 1958, I joined K.E.M. Hospital as an assistant professor.

I eventually became a professor, head of the department and upon my retirement in 1983, as professor of Emeritus. I have taught undergraduate and postgraduate students who are all over the world now. Having traveled over the world, it is always a pleasure meeting my students in the remote places - their warmth when they meet me and recount the lectures of mine they still remember, is the biggest reward a teacher can hope to get.

Once, in 1983, I travelled to Lubbock, a small town in Texas in the United States, where my daughter was then living. A heart problem put me in the hospital; the cardiologist treating me turned out to be an old student he contacted KEM colleagues in the area and the next day, four of my former students arrived.


  National Board of Examinations Top


In addition to teaching students in the classroom or operating arena, I had an impact on how Indian medical students - not just within ophthalmology - received their certification when I helped found the National Board of Examinations (then called National Academy of Medical Sciences).

The aim of the board, established in 1975, is to raise standards in all of India and eliminate regional differences in testing. We wanted to equalize the standard of the postgraduate degree, and that is why we founded this National Board of Examination to the extent that if a student is from Mumbai, he is not examined in Mumbai. Currently, the board conducts postgraduate and postdoctoral examinations in more than 50 disciplines. It has made a big impact. And today, the diplomate of the National Board is considered equivalent or even more than master of surgery.

In 2000, the National Board of Examinations honored me with its first 'Outstanding Teacher Award'.


  Lessening Financial Burden Top


Another one of my greatest achievements was the elimination of customs duties on ophthalmic instruments, which I worked towards throughout my vice presidency of the All India Ophthalmic Society and achieved during my presidency.

When I was President, the duty on all the high-tech instruments, like microscopes, lasers and so on was 105%, which smaller town people and even big town people could not afford and recover the money from the patients, as the duties were so expensive.

During my vice presidency, I must have made around 20 trips to speak with government officials in Delhi and discuss this problem. I gathered all the statistics and files and found out that there are a number of people who can afford to go to foreign countries and get operated thus wasting the country's precious and at that time scarce foreign exchange. At that time, the then Prime Minister Indira Gandhi had introduced a 20-point economic program, in which one point said every Indian had the right to see.
"Because of that, I prevailed on the finance minister to relax this custom duty. In his budget, he made it 40%, but I was not satisfied. I went again, and in his final financial bill, he completely removed it. That was one of my greatest achievements, so that all over the country, young surgeons, small town people could afford a microscope and intraocular lenses, which were not made in India at that time.


  Squint and Cataract Camps Top


Another of my social concerns is not as easily solved, as it concentrates on surgically treating squint, or strabismus. Since 1968, I have conducted four to five squint operative camps every year for several decades in which I and other surgeons operated anywhere from 40 to 80 children over the course of 2 days. I was motivated to begin the first camp upon my realization of the impact of squint on girls of marriageable age in a dowry society.

In India, squint is a social, economic evil that you will not find elsewhere; In India, we have a dowry system. If the girl has squinting eyes, she will find it hard to find a match, without the father going bankrupt to pay a huge sum as dowry to get his 'defective' daughter married!

It is important to treat school-age children as well, who may feel a sense of insecurity when attending school in villages. In the interiors of India, people do not know that the squint can be 100% corrected, and so I made it as my mission to spread this knowledge in the remote interiors. The judgment of correcting the muscle is more important than the surgery. You must know exactly which muscles to correct and to the level of correctness to make the eyes totally straight. Hence, I have been teaching this technique to all eye surgeons attending my camps.

Today, at almost 90 years of age, I still conduct one to two eye camps per year. Now, of course, I do not perform operation for the last several years, and my son operates, but I still go for the evaluation of the patients.

I am happy that more ophthalmologists are performing squint surgery and conducting eye camps such as those pioneered by me.

Today, cataract requires more equipment, time and facilities than it used to, and so it is more difficult to do in a camp setting. In the "good old days", I must have done about 100,000 cataract operations in camps all over Maharashtra and neighboring states like Rajasthan, Madhya Pradesh, Gujarat, Karnataka etc., It took a mere 15 to 20 minutes for one cataract, and we used to do 250 to 300 per day, with six tables and six surgeons. We operated on makeshift tables with a hanging naked bulb as our only illumination, with cataract knife section with a Von Graefe knife, intra capsular cataract extraction with forceps or cryo and 3 sutures, including one 'preplaced' suture, i.e. a suture placed before removal of the cataract. A 2x or 4x loupe was the only magnification used.


  The Modernization of Ophthalmology in the Last Six Decades Top


Ophthalmology practiced today is a far cry from that which prevailed in the beginning of my career. However, some things have seen a complete circle. For instance, amniotic membrane transplants were done by us decades ago and then abandoned due to high infection rate, only to become popular again! Extra capsular cataract surgery gave way to intra capsular cataract surgery with the advent of the Cryoprobe and then was replaced by extra capsular surgery again, shortly before posterior chamber intraocular lenses (PC IOLs) were introduced.

Ocular therapeutics has changed tremendously - from simple antiseptic 'sulfa' drops to fourth generation Fluoroquinolones. Unfortunately, our infecting organisms seem one step ahead of the pharmaceutical industry with drug resistance increasing! Our anti-glaucoma range of drugs too has an expanded menu card, from the simple pilocarpine of the early fifties - however, drug compliance remains as vexed an issue as it was 6 decades ago! Intra vitreal injections have changed the treatment modality for posterior segment disorders, though their price seems to be prohibitive for the common man. I bemoan the fact that as far as original research is concerned, very little has changed in India; we continue to prefer clinical research over "basic" research, barring a couple of large institutes. Some examples of changes since the fifties and sixties are given in [Table 1].
Table 1: Some examples of changes since fifties and sixties in clinical practices in ophthalmology

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Speaking of institutes, youngsters today have an array of institutes from where they can sharpen their skills in various super specialties in the subject. Armed with these fellowships, they are making a mark in their chosen specialties all over the country. However, due to various causes - the full timer versus 'honorary' system controversy being one of them - teaching in the 165 medical colleges is at a new low. The tribe of good clinicians able to diagnose and treat a majority of eye conditions without expensive diagnostic tools seems to be dwindling!


  Take Home Message as I Ride Into the Sunset Top


Medicine was a noble profession when I joined medical college; the art and science of making the 'sick' well was all that was taught and all that we needed to learn. Now, the student invests so much money in becoming an accomplished eye surgeon and setting up a practice with the latest and most expensive gadgets, that the temptation to cut corners, indulge in 'cut practice' and cut the patients pocket seems to have engulfed the majority of youngsters starting out. Ethics has taken a back seat with the corporatization of ophthalmology; hiring of business managers, public relation firms and huge advertisements in print and electronic media have replaced the word of mouth publicity, which brought us our bread and butter.

I pray that better sense prevails and I am encouraged by numerous examples of dedicated eye surgeons still practicing ethical ophthalmology even today.



 
 
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Teaching Legacy
National Board o...
Lessening Financ...
Squint and Catar...
The Modernizatio...
Take Home Messag...
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