10. Surgery and Glaucoma

I woke up this morning to number of thoughts circulating around my mind, with the first being I can’t believe it’s only a week until Christmas. It feels like only a few weeks ago I was celebrating New Year’s Eve and welcoming 2018, yet here we are already on the final stretch with less than 2 weeks left as the year draws to an end. I can certainly say my time and experience at LVPEI will be one of many personal highlights from this calendar year. It’s getting increasingly difficult to wake up as the days go by, with the cumulative effect of fatigue taking its toll on my body, however I was extremely excited this morning as I had the opportunity to visit the operating theatres and witness surgeries. As I showered and got ready for my day, I felt my mind was distracted by a wave of anxiety that was battling with my excitement, as I couldn’t help but feel nervous for my placement today. I think there are many factors that contributed to this, with the main one being horror stories I’ve heard over the years of people passing out whilst observing operations. One of my best friend’s passed out unexpectedly whilst witnessing a surgical extraction not long ago, and he has quite a high tolerance for these sort of things – so I was worried and concerned that I might wake up to see all these bodies leaning over me as I regain consciousness. Stories my mum had told me about the number of times she’d passed out following injections or the sight of blood, as she suffers from a phobia of both needles and blood, were consuming my mind also. Determined to not let it affect me and prove my self-doubts wrong, I made my way to the operating rooms (somewhat hesitantly).

Upon my arrival I was directed to the changing rooms, where I was able to change into some scrubs. If you haven’t worn scrubs before, they are definitely one of the most comfortable things you will ever come across in my own opinion. They’re incredibly light and don’t restrict your movement at all, it almost feels like you’re naked, except for the fact that you’re not. I reported to the administrative staff sitting behind the first desk I saw, and explained I was a student from London here for an observational placement – they kindly asked me to take a seat in the room next door where patients were being prepared for surgery and to wait for a surgeon to arrive. It was quite surreal watching patients being guided into the room and directed to a hospital bed where many important measurements such as their blood pressure and oxygen saturations were taken prior to their surgery. This was also an opportunity for the medical staff to administer some injections and eyedrops as necessary, dependant on the treatment they were set to receive, and answer any queries or concerns the patient presented with. Some patients seemed far more concerned than others, shaking nervously or asking lots of questions, with others just lying on their bed and waiting for calmly to undergo their procedure. I was lucky to witness a number of surgeries including retinal re-attachments, routine cataracts and corneal cross-linking to stop the progression of keratoconus. It was so strange when watching the cross-linking surgery as I’d undergone this procedure twice before, which isn’t so invasive compared to the others – but was just weird being on the other side of the table, seeing this from the view of the practitioner rather than the patient.

It was amazing to see how the members of the team work in harmony with a great understanding throughout, to ensure the operation progresses smoothly and to allow the best possible outcome for the patient. All the professionals on duty maintained a calm and collected approach, and the level of fine intricate movements was exceptional, as a display of remarkable manual dexterity was on show for me to observe. During a retinal tear operation, I witnessed the use of an endoscopic laser that is used to make small burns around the retinal tear. The result of this is development of scar tissue, which sufficiently seals the retina to the underlying tissue, helping to prevent retinal detachment. In other surgeries where the retina had already been detached, I was intrigued about the prognosis of the patients. The ophthalmologist explained that the outcome of the treatment is dependent on the severity of the case, with a better outlook favouring those who have received surgery quickly following the detachment, as the photoreceptors responsible for our vision are more likely to be maintained. Other factors contribute significantly to the prognosis, with there normally being a poorer outcome for patients with macula-involvement as part of their detachment, as this is the part of our retina responsible for central and detailed vision. Spending time in the operating rooms was a valuable learning experience, having only previously seen this through YouTube and various healthcare related drama’s on tv.

I spent the afternoon in a glaucoma outpatient clinic, sitting in on a number of consultations. Glaucoma is the second leading cause of blindness, in which there is often increased ocular pressure resulting in damage to the optic nerve; the nerve that is responsible for carrying information from your eye to the brain. The early stages of glaucoma are often asymptomatic, which is dangerous as it means that when you actually notice issues with your vision, chances are the disease has progressed to a point where vision loss is irreversible. Typically, glaucoma effects the peripheral vision first and patient’s can present complaining of a reduced field of view or the sides of their view appearing blurry, this can often be referred to or thought of as ‘tunnel-vision’. Glaucoma can be either referred to as open-angle, where the normal meshwork that allows aqueous drainage from your eye seems normal in size and appearance, or closed-angle, where the drainage angle is reduced, and this obstruction leads to inadequate drainage and therefore increased intraocular pressure.

In all honesty, I didn’t see anything that particularly stood out in the glaucoma clinic today, probably due to the fact I only spent a short period of time in this clinic as surgery occupied the majority of my day. The consultations were pretty routine and similar to one another, with gonioscopy being the only new thing I was really exposed to. The gonioscope is a small type of lens used in conjunction with the slit lamp to allow a more detailed view of the internal drainage system within the ocular tissue. This is particularly important in glaucoma as it allows the practitioner to classify and differentiate the type of glaucoma, and state whether this is open angle or closed angle type.

At the end of the day I was asked to participate in a trial for a study on colour vision, in which one of the academic staff members at the hospital was working on in partnership with a professor from my University. I was fascinated to understand how these tests worked and quantified an individual’s level of colour vision and contrast sensitivity. It’s great to see that research within this field is being conducted on a global scale, and I’m interested to know what this partnership will go on to achieve and if similar results will be obtained both here in Hyderabad, and in the UK.

Only 3 more days to go – As expected time has flown by considerably fast.