Rajenda Apte, MD, PhD, is the Paul A. Cibis Distinguished Professor of Ophthalmology and Visual Sciences. His areas of specialty include age-related macular degeneration, diabetic retinopathy and retinal vascular diseases, retinal surgery, macular holes and retinal detachments.
Dr. Apte sees patients at two convenient locations:
Barnes-Jewish Center for Outpatient Health. 4901 Forest Park Ave., 6th floor. Please call 314-362-EYES (3937) for an appointment.
Center for Advanced Medicine – South County, 5201 Midamerica Plaza. Please call 314-273-0020 for an appointment.
What happened in the course of schooling to influence you to choose your specialty?
Growing up, I always wanted to be a pediatrician. However, during one of my rotations in medical school, we had a patient who had severe cataracts in both eyes. He was an elderly gentleman who didn’t say much. His family described his visual difficulties, as well as the fact he was thought to have dementia or a neurodegenerative disease that made him withdraw from the world.
After his cataract surgery, his family said he didn’t stop talking for the first week. It had been his poor vision that made him quiet and withdrawn. The cataract surgery drastically improved his quality of life, because he now could see. That transformation was amazing to me.
The ability to have an impact on a person’s life, as well as the scientific and clinical aspects of the specialty are the reasons I chose ophthalmology.
Did you always know you wanted to go into medicine?
Yes, I did. When I was a child, my primary care physician would let me play with his tools and stethoscope. He was very encouraging and told me stories about what a doctor does. It was a fun experience and he was influential in me wanting to become a physician.
What brought you to Washington University?
When you look around the country, there are very few universities where one can successfully meld a clinical surgical practice with leading-edge research. Washington University offered that top collaborative environment, which is what drew me to come here in 2003.
Which aspect of your practice is most interesting?
As an ophthalmologist we work with eyes – a sense organ that people value highly. If you can change a person’s vision, you change the quality of his or her life. Macular degeneration will affect more than 20 million by 2020. Glaucoma affects 65 million people globally, and diabetic retinopathy continues to affect more people every year.
There has been a revolution in therapy from the time I started training. For conditions like macular degeneration, diabetic retinopathy and retinal detachments -- I can think of 10 treatments we can do right now that we couldn’t do when I was a resident. In a matter of 10 or 15 years, the technology, research and our understanding of the disease in my field has rapidly advanced.
What are the new developments in your field you are most excited about?
For 20-25 years we focused on individual pathways in terms of what genes or what proteins can cause various diseases. We have made extensive progress by blocking or changing those pathways, but research is now showing is that there are multiple factors that cause certain diseases.
Let’s use macular degeneration as an example. We began a therapeutic approach that focused on blocking one molecule called VEGF. We use drugs that are essentially antibodies that stop this excess protein and prevent abnormal blood vessel growth and bleeding in the eyes.
This approach has been successful in improving patient’s vision and preventing blindness.
What research are you involved in right now?
We are examining the idea of cholesterol metabolism – lipids being involved in eye disease. When you look into a patient’s eye with macular degeneration, you actually see the lipid deposits underneath the retina.
Seeing these deposits underneath the retina was the way for a physician to diagnose macular degeneration, but the interesting scientific question is why the deposits are there.
In the past 10 years what we’ve been able to show is that people with the right genetic background, risk factors, and age (over 50), are more prone to developing these lipid deposits.
What we discovered is that there is dysfunction in the immune system that is not able to clear these lipids. This creates an environment of inflammation, eventually leading to more advanced stages of the disease where neurons in the retina die.
Blindness can also be caused when abnormal blood vessels grow and bleed in the wrong part of the eye.
I am confident in 10 to 15 years the next frontier will have therapies to help maintain optimal functions for a lifetime. These therapies will not only give patients short-term and long-term vision gains, but also stop the slow decline of visual function by restoring normal physiology.
Is there a connection between someone with high cholesterol and developing macular degeneration?
That’s a really important question and the relationship is not that simple. It is related to how cholesterol is regulated at a tissue level. There are people who may have normal cholesterol in their blood stream, but they have an inability to handle cholesterol in their eyes. So, despite having normal cholesterol levels, they would then be more prone to these lipid deposits.
We first examine the susceptibility someone has to macular degeneration and use that information to target cholesterol homeostasis in the eye.
Where are you from?
I was born and grew up in Mumbai, India, which is a city of about 20 million people. I did my training in different parts of the United States -- Dallas, Washington, DC and Baltimore, where I finished my final step of training as a retina surgeon.
My wife is from Dallas and we met when I was a graduate student and she was finishing her degree at the University of Texas -- we were in the same research lab. She continued on to dental school and is now a practicing dentist in St. Louis. Both of our children were born here, so I am quickly becoming a St. Louis native.
Which particular award or achievement is most gratifying?
It’s nice to occasionally be recognized with awards, but it is always good to keep in perspective the reason for the award.
The teaching awards mean the most to me, because that tells me I am making a difference in the lives of the students I am teaching and that are the future of our field.
I received the President’s Award from the American Society of Retina Specialists. I cherish this award because it was from my peers, and to be recognized by others in my field means a great deal to me.
What is the best advice you’ve received?
There are two bits of advice for career and life that have stuck with me.
Career advice I’ve received from my mentors, -- “You have to think long-term 5 to10 years down the road -- because any difference you make to your profession, to the public health or to science is not going to be achieved overnight.”
In terms of life advice, remember to keep in perspective what is important to you personally. For example, don’t worry about things that break around the house – because those items can always be repaired. You should worry about your children, keeping them safe and teaching them what they need to learn as they grow up – because you can’t go back in time and fix that.
If you weren’t a doctor, what would you like to be doing?
As an immigrant to this country, I have always been fascinated by discussion in the news about the constitution. I don’t think it happens as much in other places. I do a lot of reading about law and if I grew up here, and was not a physician, I could see myself going to law school and choosing academic law as a career path. Or if I went in the direction of non-academic law, it would be in the area of human rights. I find that aspect of law very fascinating.