5. Day 2 - Ocular Prosthesis

I’ve been in India for a total of 4 days now and still not had to pop open the packet of Imodium – I know, miracles do happen! I think its owed partially to the valuable advice many of you passed on before I travelled abroad, but also my eagerness to avoid any tap-water contaminated food and street vendors. I have to admit, I am a sucker for street food though and there’s no doubt in my mind I will have to try some eventually – saving this for towards the end of my trip so that if there are implications, they’re not too costly on my time here. If you know of anything in particular that I should try please let me know, I’m open to all suggestions. In other news, my biggest expense by far on this trip has been water – and just so you can understand how much cheaper things are here; a 1L bottle is 20 rupees (25p) from the onsite canteen. While we’re on the topic of water, last night actually got pretty wild as I finished my last water bottle and the cafeterias were all closed so I had to venture out to McDonalds and buy 6 bottles for peace of mind that I wouldn’t be left in this unfortunate position again. Just before sitting down to write this blog, I bought a coffee, 2x 1L water bottles and a samosa, which came to the grand total of 70 rupees (90p). In England the coffee itself would be £3, I’m starting to question how they can charge these high prices. Maybe I should move here so I can live the luxury life I try and afford in England on a student budget.

Breakfast! Masala Dosa (30 rupees)

Breakfast was delicious today, masala dosa and some masala tea – really trying to blend in here if you can’t tell already. Many of you may probably already know this, but it seems pretty fashionable to wear socks and sandals in India with over 50% of the staff here choosing to do so, the others opting for the sandals without socks option (eww feet pt2). Males all wear shirts and trousers; however, the majority of female staff wear traditional clothing, which is something I didn’t expect. In other news, it’s incredibly dusty here in Hyderabad, I discovered a terrace on our floor at the accommodation and even though we’re pretty high up you can’t see that far into the distance due to the dust. Surprisingly, the weather app on my iPhone describes the current pollution levels as ‘dangerously high’, supporting the modern and common theory that there’s an app for everything, guess they’re called smartphones for a reason. This probably explains why every morning so far, I’ve woken up with a dry and sore throat, having to guzzle down a bottle of water as soon as I wake up just to find my voice and start the day.

Clinical Room in the
Ocular Prosthesis Department

Today marks Day 2 of my placement at LV Prasad Eye Institute, and probably the 50^th time I have been asked if I speak Hindi based on the melanin in my skin. I feel like every time I say no I watch the staff’s eyebrows raise in shock horror, then I question if they’re asking me so that I can understand the consultation or if it’s so they know they’re safe to talk about me whilst I stand next to them knowing I’d be completely oblivious. I blame my parents personally; my Dad seems pretty clueless when it comes to the mother tongue and my mum mixes both her Hindi and Punjabi, so I don’t really have much to go off here. Anyway, today I was allocated to the ocular prosthesis outpatients department. I spent the morning observing the clinics and labs revolving around the production of a prosthetic eye. This clinical area seemed a lot more laid back in comparison to the hustle and bustle you experience elsewhere in the hospital, with the consultant explaining that she wouldn’t normally see more than 2 patients a day. The reason for this being that each patient would be clinically assessed, have a mould of their eye socket taken, and then be asked to return later that following day for the fitting of their prosthetic eye, rather than asking them to return at a later date. I’m going to explain this process in slightly more detail, as it was pretty interesting to see, and I’ve never come across this field of work before. Interestingly enough, the majority of materials used were all marked with warning signs saying ‘For denture purpose use only’ – so thank you to the dentists for introducing us to your useful supplies and allowing us to advance the field of optometry further. In reflection, ocular prosthesis blends to two worlds of optometry and art together – as part of the process includes such a detailed craft to paint eye and make it have a regular appearance. This is of course important to the patients, who would like to remove the stigma associated with their condition, as this seems the main motivation for their treatment, knowing their vision will remain unaffected.

Wax mould (left), Actual prosthetic eye made from PMMA (right)

One of the two patients that I saw in the ocular prosthesis clinic today was a 51-year-old Male from an area fairly local to Hyderabad, who had lost his eye due to an accident with fireworks during Diwali celebrations about a month ago. He seemed to have a pretty lifted mood, which was not what I was expecting, but incredibly refreshing to see. The patient was clearly appreciative and grateful for the help he was receiving, thanking the optometrist after nearly every comment she made. The patient had lost his left eye, however his right eye maintained incredibly clear and crisp vision – therefore he required no correction. The process of forming a prosthetic eye is fairly straightforward, however involves multiple steps that I’ll detail for you now. Initially, an impression of the eye socket is taken and placed into a mould, creating a gap that is the desired shape of the eye that will be made. Hot wax is melted and poured in to the impression to form a mould. This mould was then taken to the lab, which is conveniently located about 14 steps away from the clinical room. In the lab, a cast was made using dental stone and water – I thought this would be a carefully controlled procedure, however no measurements were taken when making up the cast and the lab technician just continued to add water until the consistency seemed appropriate. After placing the cast mixture into two separate halves of something that I guess I can only describe as sort of a metal cup or clamp, this was then left under a light bulb in a cupboard for about 10-15 minutes, allowing the cast to harden slightly. The wax mould was then placed into the cast, the two halves of the metal cup/clamp where placed together to compress the mould within the cast – this was then placed under hydraulic pressure.

Prosthetic eye after its been painted to have a more natural look

This above process essentially results in the formation of a cast that had an indent of the exact shape that the ocular prosthesis should take. A mixture of PMMA mixed with Trevalon Hi (which I was told is the most dangerous thing in the lab), was made and again placed under a light to slightly thicken. This was then placed into the cast, once again under hydraulic pressure to form what would be used for the prosthetic eye. The end product was then placed into a polymerisation machine to harden further, which was described to me as a pressure cooker. After smoothing down and buffing the surfaces, the patient was then asked to return to the clinic, so the fit could be assessed. The optometrist allowed me to administer both the antibiotic (moxifloxacin) and anaesthetic (proparacaine) eyedrops throughout the consultation, which may sound boring to you, but I was happy at the opportunity to be involved. In the patient I discussed above, regarding the firework incident – his prosthetic eye didn’t fit as well as expected; there was a slight gap temporally and the iris was slightly decentred towards the nose. In order to counteract this issue, the optometrist melted some red wax onto the nasal region of the prosthetic eye, to mimic the slight redness that we have normally. The eye was then painted so that it would match the alternative eye, which requires a great deal of attention to detail, manual dexterity and patience. I was lucky to be given the opportunity to participate in this painting process, I felt an enormous amount of pressure though as this is done in front of the patient.

I loved the patient’s response to his new prosthetic eye, when I found out he’d only recently lost his ocular organ I thought that he’d be pretty downbeat and low in mood. He couldn’t stop thanking the members of the department for their help, explaining that he felt ‘normal’ again. It was a pleasure to work closely with the staff and provide a high quality of care to our patient, and seeing his satisfaction was incredibly rewarding. My appreciation for our sense of sight is increasing more and more with each and every experience. The patient made one final joke before he left the clinic, claiming he no longer needed to rock the Bollywood actor look any longer – referring to the fact he’d been wearing his dark sunglasses each time he left his home, ever since his accident. Another day, and another life positively impacted.

I didn’t actually get a chance to go visit the ocularplasty outpatient department, because I wanted to see the full process involved in how the prosthetic eyes were produced, and this took the whole day. I will make sure I do go visit the ocularplasty department at some point this week for sure (maybe tomorrow?). I’m going to be spending most my time tomorrow observing the squint and strabismus department, which is basically patients with what’s more commonly known as a ‘lazy’ eye.

There’s one more thing I want to share with you guys today, keeping this blog a little shorter than yesterdays (I know it was pretty long). I think out of everything I’ve seen at the hospital so far, this is by far the most humbling. A wall of colourful handprints from children who have survived ocular cancer, such as retinoblastoma, with the pictures of the survivors making up the words ‘we have survived cancer’. This is incredibly inspiring, I wish each and every one of those little fighters a successful future. I think having this in the centre of the hospital provides a scope of hope for the patient’s present who are struggling with their own pathologies.

Once again, thank you for reading and especially to those of you who have been interacting with me through various social media platforms giving me your feedback and suggestions for places to go, things to do and most importantly – food to eat! Keep them coming!