11. Cataracts

My eyes opened half an hour before my alarm was due to ruin my slumber, I only have the constant horning to blame, which starts in the early hours of the morning and continues throughout the entirety of the day. I don’t know how I haven’t adjusted to the loud noises that originate from the main road yet, bearing in mind back home I live just around the corner from Heathrow airport and directly under the flight path. I don’t even notice the planes fly over anymore, almost as if I’ve developed a niche type of selective hearing – with the only exemption being when the back-garden door is open, and the thunderous sound of the passing plane disrupts any ongoing conversations and completely over powers the sound of the television. Knowing my alarm was going to go off 30 minutes later made it near impossible to fall back asleep but didn’t stop me trying. My efforts were unsuccessful, in case you were wondering, so I lay in bed and thought about how Jose Mourinho was feeling after being sacked as Manchester United manager – though I’m glad this has finally happened as change was very much needed!

I’m starting to notice how much more energised I am in the mornings and throughout the first half of the day as a result of the large breakfasts I’ve been consuming on a daily basis. For about 2-3 years I’ve typically skipped the first meal of the day, which results in abnormally loud rumbling from my abdomen as midday approaches. By not having breakfast, I also normally find myself in a rather lethargic and tired state throughout the morning until I manage to get a meal in. On reflection, perhaps I should try and employ a more regular and healthy eating regime for 2019 – new year, new me or something like that. Today I am posted in cataract clinics, which is commonly known as a ‘cloudy lens’ in your eye that develops slowly over time and results in poor vision. Patients with a cataract often describe their vision as looking through a frost or fogged-up window, and this can eventually intervene with simple daily tasks such as driving, recognising faces and the ability to read.

In the clinic the majority of consultations I was able to sit in were centred around patients who were being referred for cataract surgery, or patients who were having post-operative check-ups to ensure prior surgical intervention was successful. One of the post-op consultations I observed was 72-year-old gentleman who was able to conversate in English extremely well, which made my understanding of the appointment a lot more comprehensive. He had recently received surgical treatment for his cataract, with the exact name of the procedure being phacoemulsification with the insertion of a foldable intraocular lens. From my understanding, this refers to the fact that the ‘cloudy’ lens was emulsified using an ultrasonic handpiece and aspirated from the eye. The fluid which has been removed is then replaced with a balanced salt solution to maintain the anterior chamber of the eye. During this procedure a foldable intraocular lens was placed to replace the faulty lens, which would allow a level of vision to be restored in the patient. The lens of our eye typically helps contribute significantly to ensuring light rays that enter our pupil are focused on the retina, to allow an image to be formed that resembles the object we’re looking at. The issue in cataracts is that the cloudy lens can obscure the light rays or cause them to reach the retina in a way that is undesirable – resulting in a blurred image. In this patient, the surgery was a success and he now had relatively good vision without the aid of his spectacles. On examination, the use of spectacle lenses of correct prescription did improve his vision further, allowing him to read what we describe as 6/6 or 20/20. The patient expressed his concerns that his current glasses that were prescribed over 2 years ago no longer really helped him, and he found vision was somewhat blurrier with them on. The optometrist explained this is completely normal following surgery, and a new prescription was issued – the patient was referred to the dispensing optician to choose new frames and have his new prescriptive lenses fitted.

Each of the cataract consultations were fairly similar, and in all honesty there’s not really too much more to write about. The only other thing that’s worth a mention is that I was lucky to have the opportunity to view some patients under the slit lamp myself, which was a valuable learning experience as I was able to see how a cataract appeared. The reason this was beneficial is because at University we currently only practice on each other, so although we gain theory of common eye conditions, we don’t actually get to physically see them. The consultant I was with today took aa particular interest in the fact I was an optometry student from London, and he took time to explain a number of things to me about each patient which enhanced my learning and understanding.

The highlight of my day was probably visiting the innovation centre. I can’t say too much about it, as I am sworn to secrecy having signed a form stating that I will not share any of the information I witnessed today. Some of the products that had been designed by the engineers to tackle common issues faced in optometry, were phenomenal and effective at performing the desired tasks. I would absolutely love the opportunity to re-visit LVPEI and spend a large proportion of time working in this department, helping develop current ideas further or even working on any ideas that I may be able to propose myself.