Passion for quizzing has helped me a lot in my profession as an ophthalmologist: Dr. Navin Jayakumar
Have you ever come across someone who is an ophthalmologist by profession, but a pianist and a quizmaster by passion? A rare combination indeed. Well, this man who dons many hats, is an integral part of HT School. We are talking about the legendary quizmaster and renowned ophthalmologist Dr. Navin Jayakumar, our go-to mentor and one of the driving forces behind Quizverse, HT School’s one-stop-platform for quizzing wizards. So far, he has been the face of all major quizzing events of HT School, starting from ClassAct 2022, the Hindustan Times Republic Day Quiz to the ongoing Smartacus 2022, the Hindustan Times National Interschool Quiz. Recently, Dr. Jayakumar has added another feather to his cap: He has been elected as the president of the Indian Neuro Ophthalmology Society. In this interview, he shares his insights, experiences and lessons from all spheres of his life, be it the study of the human eye or the intriguing world of quizzing.
As the new president of the Indian Neuro Ophthalmology Society (INOS), how do you plan to further the society's mission of providing a platform to researchers and healthcare professionals for knowledge sharing?
Ours is a very young organization, currently in its fourth year. We hope to increase awareness of our specialty particularly with our colleagues in related fields like neurology, neurosurgery, ENT, radiology, etc. Also, networking amongst ourselves across India is also something I would like to focus on. We are also strengthening our relationships with like-minded national and regional organizations across the world. This will improve our ability to cross consult with experts around the world.
India witnessed a growing interest in the field of neuro-ophthalmology from the mid-50s. Where does India stand now in terms of research and advancement in this domain?
With its sheer numbers, India offers a unique opportunity to study a disease in its entire spectrum. Also, clinical patterns of any disease have differing presentations in India as compared to Western literature on the subject. Therefore, there is an increased interest in international collaborative research.
Now, there is an improvement in the way we use steroids, which are required for many conditions. Also, there are a lot more immunosuppressive and immune-modulating drugs available for certain optic nerve conditions now compared to yesteryears. In terms of investigation, genetic testing is undoubtedly a blessing as it allows us to reach a conclusive diagnosis of conditions which we were able to only presume earlier. For example, there’s a condition called Leber Hereditary Optic Neuropathy which causes a drop in the vision of young people. Earlier, we only knew it was an atypical optic neuritis. But now we know that it is a disease of the mitochondria, an organelle found in large numbers in most cells, thanks to the advancement in the study of genetics. We are able to detect mutations in mitochondrial DNA as well. All these have made a big difference to diagnosis and treatment.
Why did you choose ophthalmology as your area of specialization?
I was always interested in medicine from my school days. My role model was my grandfather who was a well-known ophthalmologist and superintendent of the Government Ophthalmic Hospital in Madras, the second oldest eye hospital in the world. He used to have his clinic at home with patients visiting in the evening. So, I had the opportunity of doing many things for them starting from applying eye drops for them to dilating their eyes and handing out cotton when they were waiting. Basically, I had the chance of making myself useful. All this fascinated me and probably nudged me in this direction.
Moreover, I was always interested in biology in the general sense. Those days, we used to travel from Calcutta (now Kolkata) to Madras by Coromandel Express during summer holidays. To keep all the kids quiet throughout the journey, my mother would buy books for each of us. When I was asked about which book I would prefer, I had said, ‘I have this book on the human body full of pictures in it. That’s my reading material for the train. I don’t need anything else.’ So, she decided that this child was going to be a doctor.
With decades of experience in the field of ophthalmology, what neuro ophthalmological conditions do you see increasing alarmingly in India?
I don’t think there are conditions that are increasing alarmingly. However, COVID-19, which is affecting many parts of the body, can also affect the optic nerves. We can’t say that optic nerve conditions are on the rise, but more cases are reported and diagnosed nowadays as people are aware of them and medical science has improved. Increased awareness and improved diagnosis make diseases seem more common. For example, optic neuritis, or inflammation of optic nerves, is an early manifestation of a neurological condition known as multiple sclerosis. We make this diagnosis more often now than 40 years ago because we have better diagnostic tools. Let me share a classic example here.
It was the year 1996 when I was doing my observership in San Francisco. A legendary neuro-ophthalmologist, Prof. William Hoyt gifted a book as a farewell gift to a Russian doctor who had come there for some training. Prof. Hoyt had authored that book on optic nerve conditions some 30 years before in the ‘60s. Interestingly, he had made notes on the side before giving it to her, describing what an ailment was thought to be earlier and what it has turned out to be now. For instance, there was a photograph of the back of the eye in the book, with the nerve and the retina showing little bleeding areas. The image happened to be that of a small child. Back then, the cause was described as idiopathic or unknown. However, by 1996 Prof. Hoyt knew that it was a condition called Shaken Baby Syndrome, where a parent or caregiver severely shakes a baby mostly because he or she wouldn’t stop crying. Violent shaking can cause bleeding in the eye or the brain. Knowledge about this psychological condition, which wasn’t there during the 60s, has made it more detectable now.
What are the most common neuro-ophthalmological conditions these days?
The conditions that are more common now are optic neuritis (inflammation of the optic nerve), papilledema (nerve swelling in the eyes caused by an increased fluid pressure inside the brain) and diplopia (double vision usually caused by weakness of the nerve supple to the muscles that rotate the eyes in different directions). Quite often, neuro-ophthalmic conditions can reveal more serious ailments like brain tumours or aneurysms. I once uncovered blood cancer in a young man from his droopy eyelid. Fortunately, he is healthy now! Diagnosing a disease from unlikely symptoms is like playing chess where you think two steps ahead of the opponent.
What is your favourite moment as an ophthalmologist?
I donated blood for my patient who needed an eye surgery. I donated in the morning and operated on her in the afternoon! That’s something I will remember forever. Actually, she had a severe infection which was about to spread outside the eye and could affect her brain too. One of her eyes had no vision which had to be removed. But she needed blood because she was severely anaemic. Her blood group wasn’t readily available that day and I was the only person with the same blood group. That’s how I ended up donating blood to my patient.
Dr. Navin Jayakumar, the ophthalmologist, pianist, and quizmaster! How do you juggle your profession with your interests?
Although there are only 24 hours in a day, one has to MAKE time. Even 30 minutes or an hour a day is hugely important. I use it for something that I like to do. Actually, if you are really passionate about something you will be able to squeeze it in somehow or the other. I make time for quizzing and playing piano. My piano lessons were from the Calcutta School of Music. Oddly enough, my quizzing career started as a quizmaster, not a quizzer. A senior in college needed questions to be set for an intercollegiate quiz and I volunteered. That’s how it all began. Also, I have acted in one TV serial but I am not going to repeat that mistake for sure – I’m a poor actor! These apart, I also do voice overs and play an emcee or anchor quite often for events like book launches. In Chennai and Bengaluru, I anchored the book launch for Vikas Swarup’s (an Indian diplomat) Q&A, which became the basis for the Oscar-winning movie Slumdog Millionaire. More recently I was in conversation with the author Amish for the Chennai launch of his book War of Lanka (part of the Ram Chandra series). I love to learn new things and that has helped me meet quite a few interesting people along the way.
How has your knowledge as a medical professional helped you pursue your passion for quizzing or the other way round?
Quizzing definitely helped in passing my FRCS examinations. Using my quizzing experience, I was able to spot potential exam questions in my text books! Also, quizzing in India is unique in that it promotes lateral thinking enormously. In my field this is a big advantage when examining a patient and considering various aspects of a case. Basically, the habit of finding answers to questions and the ability to make an educated guess enhance correlation capacity, which is very important in the medical profession. For instance, if a patient comes with five different symptoms, we don’t associate them with five different diseases. Instead, we have to join the dots to link them with one disease that is triggering all the symptoms. The way quiz questions are set in India helps us do that.
If you ever host a quiz on ophthalmology or eye health, what would be your favourite questions?
Well, that’s an interesting question. I have created questions for the topic. Here are they:
1) If you look inside the eyes, you can see part of the brain. Serious or joking?
2) Approximately what percentage of the brain is related to vision and other eye-related activities in some way?
A. 5
B. 20
C. 50
D. 90
3) Neurons or nerve cells pass information to each other as electrical signals like one wire touching another. TRUE or FALSE?
4) What is the coloured (in this case brown) part of the eye called? And what is the opening in its centre called?
5) How many muscles control the movement of each eye?
*Find the answers to these questions at the end of the interview.
How can parents inculcate the healthy eye habits in their kids from a young age?
Parents need to encourage their children to engage in an hour of outdoor activity daily and reduce screen time. A break from screens, books or any vision-related activities for two minutes after every 20 minutes is also essential.
*Answers
1) Serious. Our eyes are a direct extension of the brain and the visible retina and optic nerve are the only parts of the brain that can be seen directly.
2) B. 50% of our nerve cells in the brain is directly or indirectly related to vision, which assists in visual learning.
3) False. Neurons are connected to each other and tissues so that they can communicate messages. However, they do not physically touch—there is always a gap between cells, called a synapse. The signal that is carried from the first nerve fiber (presynaptic neuron) to the next (postsynaptic neuron) is transmitted by chemicals called neurotransmitters.
4) The coloured part is iris and the opening in the centre of the iris is pupil. Light enters our eye through this opening.
5) Six muscles. Four muscles control the movement of the eye up, down, inward (towards the nose), and outward. Two muscles (called the oblique muscles) make the eye rotate inwards and outwards. These muscles work in a coordinated manner to move the eyes equally in different directions. Sometimes if the nerve supplying these muscles is damaged by disease, then the eye movements are uncoordinated resulting in squinty eyes and double vision.