12. Contact Lenses + an Extremely Rare Condition

My final day here at LV Prasad Eye institute has come to an end, marking the end of an incredible and insightful journey across the last fortnight into the world of ocular-related pathologies. What a ride it has been, the clinical exposure has been phenomenal and far better than I had anticipated before I travelled overseas. It’s actually quite sad to think today was the last time I’ll spend running around in a white coat through this incredible centre of excellence. I certainly hope that one day in the not too distant future to return here, once I have enhanced my knowledge in the field of optometry further, and endure a more hands on clinical experience, perhaps seeing patients of my own through another pre-arranged placement. Until then I’m sad to say goodbye, but thankful for the unparalleled opportunity to develop an understanding of many ocular-related conditions that I may never come across again, at least not in the frequency I’ve been exposed to them here.

For my last day of placement, I was posted in the contact lens department, where I was lucky enough to be exposed to one exceptionally rare genetic condition that I will discuss in further information below. The majority of patients I saw today were either being fitted with contact lenses for the first time or attending contact lens after care check-ups. This was fairly similar to that of the contact lens appointments that occur at the optical practice I work at in the UK, with the only exception being that almost every patient was diagnosed with keratoconus. For those of you who know me personally or have read my other blogs – you’ll know I also have been diagnosed with keratoconus, which is a condition that effects the cornea of my eyes. The cornea is the superficial transparent layer that forms the front of the eye, which normally has a rounded shape – however in keratoconus the cornea becomes more ‘cone’ shaped, resulting in non-ideal image formation leading to visual distortion and blurring. Note to all; Please don’t stare keep staring at my eyes every time you see me now, attempting to try and see this ‘cone’ of a cornea yourself – as its not visible with the naked eye, only at a microscopic level or using specific imaging machines designed to map the contours of the cornea.

Most of the consultations I observed today included the fitting or review of rigid gas permeable lenses (RGPs), which are ‘hard’ contact lenses that ultimately apply some pressure to the cornea, essentially forcing it back into a more suitable shape. The use of these lenses results in a much better quality of vision for individuals in general, but especially those with high astigmatism and keratoconus. I was actually amazed how much the visual acuity in these individuals improved with the use of lenses, with some of them not even able to view the test chart without the contact lenses but able to read down to the 6/7.6 or even 6/6 line (bottom line of the normal test chart) with them in. At the moment I currently have no corrective lenses for my own eyes, with my left eye being the only eye that’s really poorly effected as my right eye received treatment at a very early stage. I am however under the care Moorefield’s Eye hospital, where I have a contact lens fit arranged for the end of January, which I am extremely excited for now after my time in the contact lens department today. The idea of being able to regain near enough 6/6 visual acuity in my left eye again is something I desperately long for and can’t wait to hopefully achieve this.

Now, I would like to talk about the amazing and informative experience I had today, simply by being fortunate enough to find myself in the right place at the right time! I was able to sit in on a consultation with an 8-year-old male patient, who had been diagnosed with GAPO syndrome, an extremely rare genetic condition. To put into perspective how rare this condition is, only 38 known cases of GAPO syndrome have been recorded around the world since the year 1947. The abbreviation GAPO;

-       G = Growth Retardation (Patient was 8 years old but appeared to be the height and build of perhaps a 4/5-year-old, with small hands and feet, short limbs)

-       A = Alopecia (Hair loss or baldness – The patient was completely hairless)

-       P = Pseudoanodontia (The clinical absence of teeth, due to failure of eruption)

-       O = Ocular Manifestations (In this specific case, the patient presented with retinal detachment in his right eye at the age of 5, and complete blindness in his left eye)

This patient was actually from Yemen, UAE, and had flown to Hyderabad with the intention of receiving treatment for this disorder. The young boy and his father had been staying in Hyderabad for 6 weeks, as they’d had multiple appointments. He had received retinal reattachment surgery at the point this was diagnosed, around 4 years prior to the appointment today. The consultant explained how the patient had previously only been able to see hand movements, however now was able to see 6/12 with the correct spectacle prescription. I happened to find myself sitting in the penultimate consultation of the patients stay, where the child was given a contact lens purely for the cosmesis of his left eye, which had no vision at all and was completely white with no real distinguishable iris (colourful part of your eye) or pupil. It was incredibly heart-warming to see how fascinated the child was as he looked at himself in the mirror for the first time with a ‘normal’ appearance in his left eye, and the smile on his face was extremely uplifting. The satisfaction of the practitioner himself was incredibly obvious too, as he was genuinely so pleased with the positive response from the patient and his father. The father of the young boy must of taken about 20-30 photos of his son within the first 2 minutes of the contact lens being fitted and had already sent this on an array of WhatsApp groups to family back home in Yemen, including his wife who he kept attempting to video call.

This consultation was the perfect example of why I choose a career in optometry, being able to really make a difference and impact on individuals lives. Although the patient didn’t receive any treatment to give him vision in his left eye, as this is impossible even with the current advancements that we have in this field, the satisfaction he had as he left this consultation room was unbelievable and evident as ever. In general, I think so many of us only really gain an appreciation for the sense of sight when this tends to deteriorate, this is certainly true for myself as I only really valued my vision since developing keratoconus. This is something that so many of us take for granted, and today highlighted that in the most special and unique of ways. I wish the young child and his father a positive future, and I’m glad they received the management they had required, with the help and expertise of the extremely attentive LVPEI staff.

So that’s it! That’s the end of my placement here at this incredibly special centre of excellence, and an experience that I will forever treasure and hold close. I relish the opportunity to return, gain more experience, more exposure of clinical cases, and really go on to add value to and make a difference in the field of optometry. I will do a final blog tomorrow whilst I’m on the flight home, about my reflections on my time here. Until then, it’s time to pack as I’m leaving for the airport at 6am!