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Focus on P. Kumar Rao, MD

P. Kumar Rao, MD, is an associate professor of ophthalmology and visual sciences. His areas of specialty include diabetic retinopathy, age-related macular degeneration, retinal detachments and uveitis.

Dr. Rao sees patients at:
The Eye Center in South County, 13303 Tesson Ferry Road, Suite 100.
The Eye Center in the Center for Advanced Medicine, 4921 Parkview Place, 12th floor, Suite C.

FOR AN APPOINTMENT, PLEASE CALL:
314-273-0020 (South County)
314-362-EYES (Center for Advanced Medicine)

What happened in the course of schooling to influence you to choose your specialty?

When I was in high school, I had a friend who died of lung cancer. Watching her deal with the disease and her physicians, before eventually passing away, definitely made an impact on me. Because I happened to be working as an orderly in the hospital she was admitted, I was able to see her not only as my friend, but also as a patient in the system --which was an unusual experience. Most of her friends knew her only being sick at home, not what it was like for her to be in the hospital. It was at that point that I decided I wanted to go into medicine.

How I ended up choosing ophthalmology is a different story. Initially, surgery interested me and I enjoyed the rotations through the various surgical specialties. I liked the idea of being able to manipulate tissues to affect change and often, directly cure a disease.

During my ophthalmology rotation in medical school, I found the patients that came through the ophthalmology clinic were so tremendously grateful for the restoration of their vision and independence. It was this experience that drew me to this specialty.
Dr. Rao and his family in Palm Springs, CA


What brought you to Washington University?

Initially it was for training purposes. I came here for my fellowship in vitreoretinal diseases, and the faculty was kind enough to invite me to stay.

Which aspect of your practice is most interesting?

What I find most interesting is the variety of my practice. I am fortunate to take care of patients who suffer from age-related diseases, so some of my patients are older. But eye disease affects younger people also, so I see patients with diabetes and inflammation of the eye. The diversity of patient problems and the manifestations of various diseases in the eye are always fascinating to me.

What kinds of treatment are you able to offer someone with diabetes?

One affect of diabetes on the eye is called diabetic retinopathy. Diabetic retinopathy has multiple manifestations. One of them is swelling within the retina. Imagine the retina is like film in a camera and if it becomes swollen or soggy, it won’t work properly, and this may cause people to lose vision. For the swelling, we can offer laser therapies to seal or improve the flow of blood through the eye and eliminate of some of the swelling. We can also inject medicine directly into the eye.

Another manifestation of diabetes is the the attack on the body’s blood vessels. When this happens, the blood vessels die, and when it occurs in the retina (or film in the camera), vision loss occurs. The retina has an unusual response when it’s not getting enough blood -- it creates a chemical messenger within the eye. This messenger stimulates tissues inside the eye to generate new blood vessels. Unfortunately these new blood vessels are still abnormal and can break open and bleed.

If there is a lot of bleeding inside the eye, this creates scar tissue that can contract and pull the retina off the wall of the eye – this is retinal detachment. Laser therapies and injections are available to seal or improve the blood flow in the eye and reduce the swelling. Retinal detachment is repaired surgically by removing the scar tissue and putting the retina back in place.

What new developments in your field are you most excited about?

The last 10 years have really been an explosion in anti-vascular endothelial growth factor (VEGF) therapies. There are multiple diseases in which the VEGF level within the eye is too high.

I mentioned that for people with diabetes, the dying retina gives off a chemical messenger to make new blood vessels. VEGF is one of the messengers that it makes, and we can now intervene with these anti-VEGF medications to slow down that process.

In the age-related macular degeneration, we find that these anti-VEGF injection treatments also help control the most devastating form of macular degeneration, the wet form -- where abnormal blood vessels grow underneath the retina. There’s been an explosion of the development of these anti-VEGF molecules to the point where I can stabilize, and in some cases, bring back vision through some injections. Ten years ago I could not do that.

There have also been tremendous advances in micro-surgical techniques over the years. We’re now able to use instrumentation and viewing systems that allow us access into the eye to manipulate tissues in a more gentle fashion and with much more efficiency. There is a whole cadre of people within our department who are working very hard to bring new therapies to use on a multitude of eye diseases. It’s a very exciting time to be here.

Do you see a cure for macular degeneration down the road?

Ten years ago, all I could do was watch people’s vision decline from macular degeneration. We had some therapies that slowed the rate of the decline, but people continued to lose vision. There are now anti-VEGF medications that can somewhat halt the progression of wet macular degeneration.

Also, there is research with molecules to prevent the disease from occurring, instead of just arresting its progression. I’m hoping in the next 10 years we will see that revolution as well -- it’s on the horizon.

Is the aging of the population the reason for seeing more macular degeneration in people?

Certainly, macular degeneration, hence the name, age-related macular degeneration, becomes much more prevalent as the population increases in age. That goes across any developed country, and any population study. If you look at the rates of macular degeneration, they always increase as the population ages.

There are also hereditary issues, but it’s very hard to determine those because we are all living longer.

What are the precautions that someone with a family history of the disease should take?

Once a year he or she needs to be screened by an eye MD – someone who looks at the back part of the eye.

Another of your specialties is uveitis. Can you explain this condition?

The white part of the eye is called the sclera and the retina is the film in the camera -- it lines the inner walls of the eye. Between the retina and the sclera is a highly vascular tissue called the uvea. It also is an area where inflammation can develop within the eye.

This uveal tract can allow inflammatory cells to accumulate and that can cause a lot of damage to very delicate structures within the eye. One can compare it to rheumatoid arthritis – an autoimmune disease where the body attacks itself. But in this case, the body is attacking the eye.

Many of the principles that are used to try and control inflammations in other parts of the body can also be applied to treat uveitis.

Where are you originally from?

Our family left India in 1968, when I was three months old. My parents tell the story that they had seven dollars and some change in their pockets and were able to make a life for us in America.

My father is also a physician, and I’m sure that’s part of the reason I decided to go into medicine. When we moved here, my father took an internship position in the Niagara Falls area. We then moved to Washington D.C. and eventually out west. According to my dad, his original intention was to make his fortune in a year or two, and then go back to India. That was his plan, but it didn’t work out that way.

What kind of doctor is your father?

He’s an ophthalmologist. For a long time, I was against going into ophthalmology. But he said to me, “Before you make your choice, just keep an open mind and see what this life is like.” So I did the ophthalmology rotation and was able to understand why he enjoyed it so much.
Scenic photo taken by Dr. Rao in Palm Springs, CA


Is there a particular award or achievement that is most gratifying?

I was named Teacher of the Year twice during my tenure here -- most recently in 2011. That’s the award I am most proud of because it is voted on by the residents.

What is the best advice you’ve ever received?

There are probably two pieces of advice. The first was from a very special high school science teacher, who was also one of my cross country coaches. He told me to set goals in my cross country practices to learn what it feels like to meet a goal that I set. He would follow-up during practice and ask what my goal was, after practice ask how I did against my goal, and how I felt. He then would tell me to set a goal for my school work that night. That was a turning point for me. It was nice that he took the time to help me put it all together.

The second piece of advice came from my father (in addition to suggesting I consider ophthalmology as a specialty). When I finished my fellowship and joined the faculty here, he pulled me aside and said, “No matter what happens with the politics or the job, please do me a favor and just take care of the patients. If you do that, every else will work out.” I try to follow that advice and I think it’s very true.

Cactus photo taken by Dr. Rao


If you weren’t a doctor, what do you think you would be doing?

When I was growing up, there was a TV show called "Wild Kingdom". I wanted to be the photographer who went out in the jungle and captured the lions roaming around.

Part of what we do as ophthalmologists is imaging. I can take pictures of the front and back part of the eye -- they are beautiful images.

I would not say I’m a professional photographer by any means, but the camera does end up in my hands a lot during family holidays.

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Copyright 2013 Washington University School of Medicine