After enjoying a well-deserved day off, which I used as an
opportunity to venture out, explore the city and some local tourist attractions
– I found myself once again waking up early in the morning on the most dreaded
day of the week. Monday 17th December, the start of our second and
last week here at LVPEI. I continued with my normal morning routine; turning
off my alarm, closing my eyes again, enduring a 5-minute mental battle where I
try to convince myself to get out of bed, and eventually make my way into the
shower whilst playing some music to change my mood. I’m the certain type of
individual that needs a shower every morning to start my day, often stumbling
into the shower in a zombie-like manner and strolling back out a new and
refreshed man, ready to face any challenges the day may provide.
Every morning my colleagues and I have enjoyed our first
meal of the day at the on-site staff canteen, sampling a range of Indian
breakfasts during our stay. Before travelling to India, I had the somewhat
naïve belief that I would lose a lot of weight due to the strict vegetarian
policy employed at the institute, but this doesn’t seem to be the case. I only
have the flavoursome and inexpensive meals to blame, paired with my eagerness
to indulge every time I find myself in the cafeteria. I’m probably being
dramatic, and realistically don’t think I’ve put any weight on, but I’ll wait
for my family to let me know when I get back – which I’m sure they’ll have no
reservations in doing. Today I was placed in the retina department where I
spread my time between both the clinics and the diagnostic rooms, which
included a series of detailed imaging machines.
The first patient of the day was a 61-year-old female who
was accompanied by her concerned daughter. As the patient walked into the room what
was most apparent was the extreme thickness of her lenses, which stuck out from
the side of the frame. Retinoscopy revealed the patient had extremely high
myopia (‘short-sightedness’), with one of the main causes of this being a
‘long’ eyeball, with increased axial length. An extensive history and symptoms revealed
the patient had suffered from a motorcycle accident 4 years ago, subsequently
suffering from 15 days of vomiting and was on bed-rest for 3 months following
an operation to remove a blood clot on the brain. Since this incident, the
patient had reported floaters, which are little black specs that appear in your
vision, however these had not increased in size, number or frequency until the
last 3 days. The patient explained that she was now experiencing flashing
lights, developed photophobia and had stubbed her toe over the last few days on
multiple occasions because she was unable to see the steps. Retinal detachment
was the immediate diagnosis that both me and the optometrist on duty jumped
too, and the patient was given some eyedrops and sent to the waiting room for
40minutes as we waited for their eyes to dilate. As the patient returned to the
room indirect ophthalmoscopy was conducted, revealing a superior retinal
detachment – explaining all the symptoms the patient was experiencing,
including the lower visual field loss responsible for the patient stubbing
their toe and having frequent trips and falls. Patients with high myopia (a
high negative prescription) are far more likely to develop retinal detachment,
to explain; this can be thought of as the retina being ‘stretched’ as the
eyeball is longer, and therefore more likely to separate from the surface its
bound to.
Patient number 2 I’m going to discuss was a 51-year-old
male, who had developed a fistula in the brain that was compressing his optic
nerve and had led to sudden but painless vision loss. Concerns were first
reported round 3.5 years ago, when he first noticed a rapid deterioration in
his vision that has continued to progress. The patient was a known diabetic,
initially being diagnosed with type 2 diabetes 12 years ago and had received
medical care elsewhere. The previous medical history accompanied with the
relevant documents explained that he was suffering from optic nerve atrophy as
a result of the fistula in his brain tissue. I’m not sure of the exact science
behind this and how the fistula leads to wasting away of the optic nerve, this
is something I’ll need to look into further. On examination the patient had
extremely poor vision, unable to see hand movements from as close as 10cm from
this face. The patient did have perception to light, though he was unable to
accurately describe the direction that light was coming from. Interestingly,
the patient had developed a constant nystagmus, which is best described as
rapid and involuntary movements of the eyes. This made it impossible for the
optometrist to carry out a number of tests, including tonometry and
ophthalmoscopy.
The 3rd and final patient I’m going to mention
was a young 10-year-old male, who had attended over 30 appointments across the
last 2 months. He had been previously diagnosed with endogenous
endophthalmitis. This is a very rare and potentially blinding ocular infection,
which results from a spread of bacteria from a remote primary source. The
prognosis of this condition is reliant on an early diagnosis and the immediate
administration of treatment to obtain the best visual outcome. In ideal cases,
the causative bacteria would be identified and managed, though in this case it
hadn’t yet been discovered, which isn’t uncommon. The patient was on numerous
antibiotic eyedrops, the majority of which were wide spectrum with the aim of
destroying the present bacteria and resolving the symptoms as best as possible.
The optometrist explained that a vitreous fluid biopsy had been taken and was
hopeful the exact infective microorganism would be discovered.
Spending a short amount of time in the retina diagnostic
room enabled me to view some state-of-the-art machines and understand how they
work and allow us to diagnose conditions with high sensitivity and accuracy. Of
specific mention are the ocular ultrasound and Topcon DRI OCT Triton, which
contains a number of different imaging settings allowing you to view different
structures of the eye using varied contrasts to allow the tissues to be viewed
in more detail. I haven’t ever seen an imaging system like this and the quality
of the images produced were extremely crisp and clear. During my time using
this machine I was able to see some retinal angiography images, as well as a
case of retinitis.
This day was quite interesting due to the complexity of the
cases I encountered, however it was not as hands on as some of the other
clinics have been. I spent pretty much all of my time in observation, which is
the reason I’m here, but after a while this can get tedious as I prefer a more
involved approach. Tomorrow I’m lucky enough to be posted in the operating
theatre where I’ll witness some routine surgeries, and then will spend my
afternoon in the glaucoma clinic.
I’d like to thank you all that are still following my
journey, and I’m grateful for the support that has seen me receive over 1550
views on my page so far across the last week! I’ll be back with you again,
around the same time tomorrow J
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