(MyStory 004): Meet Dr. Nabin Raj Joshi, a Nepalese Optometrist researcher with Industry in the US

My Story Episode 004 || © Vision Club 2020

About Dr. Nabin Joshi

Nabin Joshi is the lead vision scientist at Institute for Vision Research in Manhattan, New York City, working in advanced industry-related research and development for various multinational companies such as Johnson and Johnson Vision Center Institute (JJVCI), Bausch, and other companies. He has served as a lead scientist and a consultant in over 20 clinical trials and investigator-initiated research studies. Additionally, he volunteers at Children's Hospital of Philadelphia (CHOP), UPenn Medical School's Pediatric Sports Medicine and Concussion department. He completed his Bachelor's degree in Optometry from Maharajgunj Campus in 2009 and received his Doctorate in Vision Science/Physiological Optics from State University of New York College of Optometry in September of 2017.

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MyStory:

After completing my Intermediate in Science from Tribhuvan University at St. Xavier's College, Kathmandu, I was clueless about my future and at that time, applying to B.Optometry program at Institute of Medicine looked like a good option. The word on the street was that it was a program started with the help from a foreign university and the jobs were of plenty. Hence without any research, I took the entrance test and barely made the cut. Shortly after joining the program, I had an option of getting into an MBBS degree through the Ministry of Education scholarship, which I turned down (for better or for worse!).

After a few months into the B.Optometry program, I realized how inadequate and ill-prepared the country, and the institute were at running the program. We had a few instructors who were products of the same program. The fraternity was full of talent. Many of them are now making use of their talent inside and outside the country and are absolutely shining! But the lack of essential vision and clarity, created a lot of frustration, disappointment and occasional revolts.

Despite the shortcomings, looking back, the course allowed me to observe the entire spectrum of optometry and come to my own conclusions. It made me passionate, responsible and provided me a way to make a difference in peoples’ lives, while earning a living. 

After the completion of B.Optometry degree, I joined Kathmandu Medical College Teaching Hospital as an optometrist. I remember during my interview, Prof. Malla had asked me to investigate a referred patient suspected of neurocysticercosis for evaluation. Even though the patient had no ocular manifestations of the disease, I put forward a comprehensive history and possible signs and symptoms of the disease. And without hesitation, he asked me to start immediately. I enjoyed patient care and improved every day during my time at KMCTH where I worked for a little over 2 years. During this time, we as a department, were able to start an MD program in ophthalmology and I helped lay out the structure for academic and clinical part of the first year of the program, mirroring that of IOM. During the end, I was diagnosing and co-managing amblyopia, corneal ulcers, glaucoma, retinal and neuro-ophthalmological disorders. I took my work seriously, approached it (half-) intelligently and had excellent mentors who supported me.

Despite practicing at a high medical standard and spectrum of medical optometry and eye care, I always wanted to further my study of optometry and vision sciences. When the planets aligned, I applied to a bunch of optometry schools in the US. Unlike the rest of the world, where you can communicate with the college and professors to express your enthusiasm, the US degree programs are completely the opposite. Without prerequisites such as GRE scores, English proficiency etc., the universities rarely address queries. Hence, getting these test-scores expresses one’s seriousness and improves the chances of getting a serious response. If any of the readers are interested in applying to graduate schools in the US, getting these standard scores first is highly recommended.

I managed to get an offer to join SUNY College of Optometry and I moved to New York during the fall of 2012. During my 5 years at SUNY Optometry, I was able to understand the future of optometry, ophthalmology and vision sciences more thoroughly. I was able to work with a great mix of people and cultures, and a doctorate degree made me a little bit wiser, as well as objective.

I was part of multiple labs exploring glaucoma, myopia development, amblyopia, dry eye and contact lens research. I worked with Dr. Viswanathan primarily to diagnose glaucoma better and earlier with electrophysiology. I was able to present my findings in a number of international conferences where meeting Nepalese optometrists from back home were the highlights. I can’t remember much of learning or presenting during those meetings, but the fun we had, rekindling IOM memories is something that will stay with me forever. However, unlike a regular graduate student, my publication record is abysmal. Maybe, partly because I enjoyed making things work than writing papers, and the fact that my advisor was a busy man in university administration also did not help. I started working in the industry after a few years of joining my PhD and have continued since. In industry we are more concerned about whether something works or not and our findings tend to be binary, and there is very little room for statistical yoga.

Since 2017, I have been volunteering at Children’s Hospital of Philadelphia. The unit I help-out specializes in neuro-trauma in children. I advise them with any vision related questions/issues. I help them design methodology, train the researchers with ophthalmic instruments and help them with data or any statistical issues. We have presented our results on a number of different international platforms, pending publications.

Right now, I am working in the industry, developing new strategies to invent, improve and market glasses, contact lenses, IOLs and other medical drugs and devices. It is really exciting to create or engineer the future of ophthalmology/ optometry from an industry perspective. I consult teams from around the world and provide them scientific and clinical feedback to improve, invent and modify the designs of these medical devices which will be used in the future. In the meantime, I continuously learn from other specialties such as engineering, legal and industry standards and overall breadths of science and technology. Unlike most of the featured optometrists in this blog, I am not privileged to share my work because what I do is mostly proprietary and confidential. I cannot publish papers even though I complete 4-5 projects a year. Some of the work I do is published as patents (e.g., JJVCI) for different companies and they have ownership over it. The following briefly outlines what I do as a vision scientist:

I work in advanced industry research and development, which means our team’s goal will be to either significantly improve the existing product or create new product that is not currently available. These could be glasses, contact lenses, IOLs, or ophthalmic drugs. I am generally involved from the time of conceptualization which means we as a team decide what we are going to be doing next. This will involve serious discussions with the engineers, manufacturers and stakeholders. Following that, we generally venture into background literature search with other scientists and compile what is known in a given avenue and identify gaps that need to be filled. I will then design and conduct experiments, modify or build custom instruments with engineers and perform a series of studies to address each question, ultimately helping in the product design. All of these studies will then be periodically reviewed by the team and we may change course as needed. We will then perform multiple proof-of-concept experiments and work towards a prototype. The prototype is generally a very rough version of the final product, but it is the one which normally works (90-95% of the time). Then the following step will be to conduct a series of large-scale experiments to satisfy the reviewing boards. In the USA, the department will generally be the Food and Drugs Agency (FDA), and there are also other country-specific or Union based (e.g., EU) boards. Getting the product through the regulatory boards is always one of the biggest challenges where there are multiple legal and safety aspects involved. During this time, I might work with lawyers, scientists and others to satisfy the questions directed towards the projects. In my experience, some have succeeded, most have failed and some have been in dormant conditions, awaiting more data. Once a project is completed, we promptly move onto another area. This journey has taken me from presbyopia research to dry eye research to myopia control studies. Every day is a new challenge and is exciting. Additionally, during the projects we meet and discuss with professionals from the pharmaceutical companies, very bright independent researchers and big companies such as IBM, Verily from Google, etc., which are involved in healthcare field. For qualitative research, I have had collaborations with Ipsos and other boutique firms.

I work with a number of different professionals and everybody brings something different to the table. All the projects tend to be heavily multi-disciplinary. Industry, just like academia is full of smart and interesting people. Most of my co-workers are ODs, MDs, PharmDs, PhDs and a few are hardcore engineers, statisticians and bioengineers. Occasionally, and very rarely I work on the regulatory, legal and operations side. What I do changes every day and there is always something new to be done.

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