IN-SIGHT – Unbound: A Conversation with Dr Virender Singh Sangwan

Dr Virender Singh Sangwan at the IIC

Dr Virender Singh Sangwan is an internationally decorated ophthalmologist and pioneer in stem cell eye care. His book, UNBOUND, detailing his extraordinary life story, was launched earlier this month at the India International Centre in New Delhi. Sitting with Dr Sangwan in his windowless office adorned with awards and potted plants was not only a pleasure, but a captivating insight into his motivations and work ethic.

UNBOUND is available at: https://www.penguin.co.in/book/unbound/

Your reputation is international, having worked at LV Prasad Eye Institute (LVPEI), Harvard Medical School and the Flying Eye Hospital of Orbis International. Can you talk about your journey and decision to join Dr Shroff’s as Director of Innovation?

Dr VSS: "In 2009-2010 at LVPEI I was starting to think I wanted to do something different, and that I’d go to North India. In the process, I never knew exactly what it is I wanted to do. When I consulted people about this, they told me unless I did ophthalmology, there was no other good I could do, and therefore I should simply continue. One thought was to start my own big institute closer to home. But instead, I started seeking places to work which aligned with my values – values being that I have worked for non-profit organisations since the beginning.

"So, SCEH fitted this very well. Above all, I have known Dr Umang Mathur for over 20 years. I like his temperament and his personality. I thought SCEH would be the best place despite the travel time for me from Gurugram. When they asked me what title I wanted, I said not to give me any title and that I just want to work. The first year here went very quickly, I moved house and my daughter got married, then Covid-19 came.

"Before Covid, I was already not sure if I’d be here forever, or whether it was simply a stop in-transit. During Covid there was no chance of moving. But during this time, I had a realisation that this hospital had survived over 100 years and seen the ups and downs. Everybody here was continuing to work professionally during these times while I was thinking about what I could be doing next. So, why not continue properly here, rather than thinking about other places I could be? After that, I was clear that, OK, I would spend my functional life here and I’ll contribute what I can."

Going further back, why did you choose to specialise in eye surgery?

Dr VSS: "When I was studying in college doing my Masters in Ophthalmology, I thought that at that time it was a small branch of medicine and I would be able to start my own private practice. After that, when I started searching for more training I got my opportunity at LVPEI, then Orbis, and from that, Harvard. So, to date, I have never done private practice. But the real reason I specialised in eyes, my mother told me I think in 2013.

"We come from a very small farming community in a small village. My mother had a severe eye problem and went to a medical school, however, due to being a small village, she was not cared for that day. They said the doctor wasn’t there that day and to come tomorrow. It seems when I was 5 or 6 years old during this, I told my mother not to worry, and that one day I would be a very good eye doctor. In 2013 she told me I had proven that. And I had no idea I’d ever said this."

During your career, what is one of the most profound things you have witnessed in any capacity, from your colleagues or patients?

Dr VSS: "I have several profound stories and have had many such interactions, but one that stands out more recently, and which I also mention in the book, is of a young man from Maharashtra whom I first met in 1999 when I’d just started my practice in LVPEI. Both his eyes were damaged due to a chemical injury, and at that time we believed one eye was damaged beyond any repair. So, we decided to focus on the better eye, and made improvements in his sight over 10-15 years with different surgeries. In 2014, he lost the good eye from a major infection. So, 15 years later it felt like we were back to the original position.

"The man asked me, why don’t we try the other eye? I said, it’s the same as 15-years back and there is a big risk of losing sight completely. He agreed to the risk with a profound attitude of determination, that it was worth risking what he had left for one last chance. We used an artificial cornea, also known as keratoprosthesis, and he got back 80% of his vision in that eye within a week. Till today he has good vision and my relationship with him has lasted for over 25 years. When I moved from LVPEI to SCEH, he told me even if he lost his vision now he wouldn’t care. His house was built, his children were grown up and had graduated, and his life was done. He said that being able to see all of this was something I had given him."

Having pioneered research in the use of stem cells in corneal treatment, can you describe the pathway which led to the development of this technique and the impact it has had?

Dr VSS: "The journey to SLET is as simple as it is named – simple limbal epithelial transplant. In 2001 I had started doing cultivated limbal epithelial transplants, which means we take a biopsy and grow it in the lab, then wait for two weeks to perform transplant surgery using the grown tissue. That was how the surgery was described in Western countries, in one report from America and one from Italy. In 2001 this method was state of the art. After doing a lot of these procedures successfully, everywhere I went patients and doctors told me the treatment was unaffordable and inaccessible.

"One day, I get an email from a lady called Professor Sheila MacNeil from the University of Sheffield, where she is a Professor of tissue engineering. She wanted to work with me to make stem cell transplants safer by making a synthetic membrane, as the human membrane we were using could be contaminated. Within the synthetic membrane, they could create micro-pockets so that we could grow cells on the surface of the eye. Professor MacNeil was in the process of applying for a three-year grant to develop the membrane.

"In my first SLET paper, I credited Sheila for the idea because of that conversation. I tell my students now that when you talk to people outside of the field, that is when you get solutions you would never have thought of yourselves. I could have never have thought of SLET myself because everything was already going well for me – there was no need for me to change."

Finally, can you talk about, from your own perspective, the culture of Dr Shroff’s and its place in the heart of Old Delhi?

Dr VSS: "The system of values is the same as mine, my heart and SCEH’s values are both aligned. There is just a very genuine care for the patients, there is compassion and you see the people that work here are enjoying what they’re doing. The downside of SCEH is being based in Daryaganj – in the sense that if you tell someone in South Delhi or Gurugram that you work in Daryaganj, there is something underlying in their response. It’s an area they don’t want to visit and you may be met with a frown. But to me, it’s a fantastic place and I’m very blessed to have such wonderful colleagues around me who care for each other and who care for their patients. That is a fantastic part of the opportunity for me."

UNBOUND is available at: https://www.penguin.co.in/book/unbound/