|Year : 2020 | Volume
| Issue : 9 | Page : 1728-1729
My career in academic medicine
Narsing A Rao
Department of Ophthalmology, Keck School of Medicine of USC, San Marino, California, USA
|Date of Web Publication||20-Aug-2020|
Narsing A Rao
Department of Ophthalmology, Keck School of Medicine of USC, San Marino, California
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rao NA. My career in academic medicine. Indian J Ophthalmol 2020;68:1728-9
After completing medical school at Osmania University, Hyderabad, India in 1967, I moved to the United States in 1968 to pursue my postgraduate medical education. The moment marked the beginning of a lifelong journey that would lead me to becoming the academic physician, researcher, leader, and mentor I am today.
I began my internship at Mount St. Mary's Hospital in Lewiston-Niagara Falls, New York. When one of my patients died of an unknown cause related to renal failure, I was invited by a pathologist named Dr. Charles J. Read to view the autopsy and determine the underlying cause for the disease. During the autopsy, Dr. Read found extensive retroperitoneal fibrosis around the kidneys with obstruction to the late patient's ureters. However, it was not clear what had caused the fibrosis. After reviewing the patient's charts and speaking with the late patient's family, I discovered the patient had been taking Methysergide (Sansert), a prescription for migraine headaches introduced in 1960 that was later reported to cause retroperitoneal fibrosis. The experience made a major impact on me and convinced me to pursue a career in pathology to understand pathogenesis of various diseases.
I joined the anatomic pathology residency program in 1969 at Georgetown University in Washington, D.C. During residency, I devoted my time to conducting over 200 autopsies and examining surgical specimens and biopsy tissues to correlate clinical features with classic light microscopic findings supplemented with electron microscopy and immunofluorescence studies. I intended to pursue a fellowship in neuropathology, but a chance encounter with a friend in the ophthalmology residency program at Georgetown University would alter my career path.
One Saturday, my friend invited me to a conference at Washington Hospital Center – enticing me with the offer of free breakfast and lunch. At the conference, we attended a presentation by a world-renowned ophthalmic pathologist and Director of Eye Pathology at the Armed Forces Institute of Pathology (AFIP), Dr. Lawrence Zimmerman. His presentation was a logical process for interpreting clinical findings succinctly based on microscopic changes in the enucleated eye with clinical diagnosis of infectious endophthalmitis. Moreover, his presentation of histopathology with special stains for bacteria, fungi, and parasites made such an impact on me that I considered pursing a fellowship in eye pathology at AFIP.
Within a week, I scheduled an appointment with Dr. Zimmerman at AFIP, where I shared my enthusiasm of his presentation and interest in pursuing a fellowship in eye pathology. Dr. Zimmerman was frank in stating that the AFIP was an Army institute and a foreign national would not be allowed to work there without the Department of Defense's clearance. I left the meeting disappointed, but my desire to pursue eye pathology persisted.
The next day, serendipity played a role in my career. My anatomic pathology instructor's husband happened to be Dr. Zimmerman's tennis partner. The husband conveyed to Dr. Zimmerman my deep commitment to pursue ophthalmic pathology as my academic career goal at Georgetown University. Subsequently, Dr. Zimmerman managed to acquire a special permit for me to spend a month at AFIP. Once there, I assisted senior ophthalmic pathology fellows in grossing enucleated eyes and examining histologic sections to correlate clinical findings with histopathology and pathologic diagnosis. In addition, I attended teaching meetings conducted by Dr. Zimmerman. A month of rotation strengthened my decision to pursue an ophthalmic pathology fellowship at AFIP.
During my month at AFIP, I also learned that most of the fellows had been trained in ophthalmology. To become a good eye pathologist, I would need to learn clinical ophthalmology to make proper interpretations of my findings.
Already in my third year of pathology residency, I knew that starting residency over as an ophthalmologist would be an extreme career choice. Nevertheless, while still in my pathology residency program, I applied for the ophthalmology residency program at Georgetown University. Doubting my chances of being admitted, I accepted a faculty position as an assistant professor in pathology. But a week after accepting the position, I received a call from the chair of ophthalmology. I was accepted into the ophthalmology residency program.
I swiftly turned down the paid faculty position with pathology and started over as an ophthalmology resident. The residency gave me another opportunity to rotate at AFIP for 12 weeks to study eye pathology.
At AFIP, I met a faculty member, Dr. Ramon L. Font. Dr. Font was impressed with my diagnostic acumen and asked me to look at cases with the intention of diagnosing pseudo-rheumatoid nodules for potential publication. I used submitted specimens and clinically provided patient serum to conduct lab tests. I then wrote a paper based on my observations. Because I did not know how to type, I wrote the paper longhand and asked my wife Sarojini to type the manuscript for me. We worked together on 34 drafts before the paper met Dr. Font's standards for publication. The paper, “Pseudorheumatoid nodules of the ocular adnexa,” was published in the American Journal of Ophthalmology in 1975. It was the first of over 500 peer reviewed papers published during my career. The multiple revisions to satisfy Dr. Font in the publication paved the way for my interest and helped me in future publications focusing on clinicopathologic studies.
I pursued an ophthalmic pathology fellowship at AFIP after completing my ophthalmology residency. During the fellowship, I pursued diagnostic and experimental ophthalmic pathology and published papers on experimental optic neuritis in guinea pigs under the mentorship of Dr. Zimmerman and Dr. Mark Tso. Subsequent work on correlating the histologic findings with 32P levels of uveal melanoma was technically intensive, requiring thousands of melanoma tissue sections. My wife had already shown a strong proficiency in creating the samples needed, so I enlisted her help late at night in the labs for many weeks.
After fellowship, I became a faculty member at Georgetown and founded the eye pathology lab. To this day, I consider the lab to be one the proudest accomplishments of my career. In addition, I continued my relationship with AFIP. In 1979, Dr. Zimmerman generously signed on as a co-investigator to my first National Institute of Health (NIH) funded grant, a 3-year R01 entitled “Pathology and Pathogenesis of Optic Neuritis.”
My time at Georgetown led me to collaborate with many faculty and researchers and widen my area of expertise. I collaborated with Dr. George Marak who had an NIH grant researching ocular immunology and developing an animal model for lens induced uveitis. His work introduced me to the field of ocular immunology and led me to switch my research focus from demyelinating optic neuritis to experimental uveitis and guinea pig animal models of sympathetic ophthalmia, a collaboration with Dr. Walden Wacker.
In 1982, Dr. Zimmerman stepped down from his role at AFIP and offered me the position. I was surprised and humbled by the offer but turned it down because I knew that running the ophthalmic pathology laboratory at AFIP would keep me away from seeing patients. Despite declining, I still consider Dr. Zimmerman's offer one of the most satisfying moments of my career.
A month later, Dr. Zimmerman called me with a new offer: Dr. Stephan J. Ryan, the chair of the Doheny Eye Institute, Department of Ophthalmology, University of Southern California (USC) in Los Angeles, CA, was looking to recruit an eye pathologist with expertise in experimental pathology. The opportunity would allow me to combine clinical ophthalmology and pathology practices with experimental work. When I visited Los Angeles, I was impressed by the only major eye pathology lab west of the Mississippi River, the vivarium facilities, and the overall offer. In 1983, I accepted the offer and moved with my family to Los Angeles, where I would research pathogenesis of uveitis with continuous NIH funding for over three decades and funding from Research to Prevent Blindness. In early 2018, I became the chair of the USC Department of Ophthalmology, now the USC Roski Eye Institute.
In my NIH funded research, I have looked at various factors involved in the underlying mechanism for inflammation and how to protect oxidative stress-mediated retinal photoreceptors damage.,, My experimental work and clinical research earned me international recognition and led me to serve in leadership positions for several national and international ophthalmology and pathology societies and earned medals from the American Academy of Ophthalmology, the International Council of Ophthalmology and others.
Today, my greatest pleasure comes from interacting with the many residents, fellows, and alumni I trained, who now excel in the fields of ophthalmology, uveitis, and ophthalmic pathology. I am forever grateful to my mentors and my wife Sarojini and owe my many opportunities to the support I received from each of them.
| References|| |
Rao NA, Font RL. Pseudo rheumatoid nodules of the ocular adnexa. Am J Ophthalmol 1975;79:471-8.
Rao NA, Tso MOM, Zimmerman LE. Experimental allergic optic neuritis in guinea pigs: Preliminary report. Invest Ophthalmol Vis Sci 1977;16:338-42.
Rao NA, Gamel JW, McMahon RT, McLean IW. Correlation of in vitro. P32. Counts with histologic features of malignant melanoma of choroid and ciliary body. Invest Ophthalmol Vis Sci 1977;16:98-102.
Rao NA, Wacker WB, Marak GE Jr. Experimental allergic uveitis: Clinicopathologic features associated with varying doses of S antigen. Arch Ophthalmol 1979;97:1954-8.
Rao NA. Role of oxygen free radicals in retinal damage associated with experimental uveitis. Tr Am Ophthalmol Soc 1990;88:797-850.
Rao NA, Saraswathy S, Wu GS, Katselis GS, Wawrousek EF, Bhat S. Elevated retina-specific expression of the small heat shock protein A-crystallin is associated with photoreceptor protection in experimental autoimmune uveitis. Invest Ophthalmol Visual Sci 2008;49:1161-71.
Rao NA, Saraswathy S, Chandramohan G, Bhat S. Small heat shock protein αA-crystallin prevents photoreceptor degeneration in experimental autoimmune uveitis. PLoS One2012;7:e33582.