Lightning strikes twice

About a year ago I saw a 59 year old gentleman for a routine sight test, in fact it was his first proper sight test. Unsurprisingly he needed a pair of glasses to help with close work, whilst his distance was pretty good - just a little bit of astigmatism in one eye. What was more remarkable was a longstanding retinal detachment in his right eye inferiorly, it had sealed pigmented edges and was out in periphery so wasn't affecting his vision or likely to but in need of a referral. So after checking what I was seeing was what I thought I was seeing with a colleague I called the on-call ophthalmologist at the local hospital eye casualty and arranged an appointment to check it in a few days.

Fast forward a year and the gentleman comes back in noticing a line like floater in his vision in the right eye, no shadow or cobweb over vision and no flashes. The referral from last test had resulted in a check and a lot of cancelled follow-ups but no treatment. Having a check undilated I noted a Weiss ring showing a posterior vitreous detachment but also a faint silver line temporally so dilation was definitely indicated (I'd have dilated even without this just to check periphery). After a brief wait (and seeing another patient in mean time) I called patient back in to have a look. Most of the periphery was flat and normal, previous scar present and unchanged and then the silver line was a horseshoe shaped tear in temporal peripheral retina. So it was onto the phone to chat with the on-call ophthalmologist and explain the situation before writing a letter and sending the patient on their way to the hospital, after answering the obligatory "is this serious?" question. Answer - where it is currently no, but if it spreads and your macula comes off then yes, very.

So my total for retinal tears/detachments moves onto 2 in  almost 3 years of practice so I'm slightly ahead of the average 1 every 16 months, although not sure if 2 in the same eye of the same patient should count as 1 or 2. Either way proof that lightning can unfortunately strike twice.

(For reference having a retinal detachment in the eye does make you more likely to have another one in same eye and the other eye).

Vision overseas

In the UK we are lucky enough to have a very good eye care system with a vast array of multiple and independent optometrists who offer private sight tests for a range of fees and NHS sight tests for those with entitlement, including under 16s, over 60s, certain income related benefits and those deemed to be at risk (or everyone in Scotland). There are enhanced optical services, chargeable in some parts of England, free in Wales and Scotland, for acute eye problems and further investigations to aid referrals to the hospital eye service. The NHS hospital eye service provides treatment free at point of use for all manner of eye conditions from routine procedures such as cataracts (although maybe not within correct timescale) to emergency appointments for uveitis, foreign bodies or papilloedema. There is also private hospital eye service for people with insurance providing extra cover for orthoptics, cataracts and other routine procedures. However the same is not the same worldwide, even in America you need insurance to cover the cost of the sight test and any prescription glasses you might need - myopes really have it tough; and that's another first world country, it's much worse in the developing world.

A few days ago I saw an article from the New York Times (high brow I know) about eye care in the developing world, in particular India. This section really struck me:

More than a billion people around the world need eyeglasses but don’t have them, researchers say, an affliction long overlooked on lists of public health priorities. Some estimates put that figure closer to 2.5 billion people. They include thousands of nearsighted Nigerian truck drivers who strain to see pedestrians darting across the road and middle-aged coffee farmers in Bolivia whose inability to see objects up close makes it hard to spot ripe beans for harvest.

 It seems such a simple thing but even according to the World Health Organisation up to 75% of blindness in the world could have been avoided. 60% of the the cases of blindness in 1996 were due to either cataract or refractive error. This could be prevented or cured with a simple 30 minute operation or a pair of glasses but isn't due to lack of care or money.

Even before I qualified I wanted to help give back to the world with my new skills, helping patients in the UK is great but with the exception of some emergency health appointments you are rarely making a significant difference to someone's life that they wouldn't be able to get elsewhere. Some of friends have helped out in Moldova, Romania, Uganda and elsewhere. For me the Caribbean has always had a special place in my heart, after I got married in Jamaica in 2006. Whilst there is some eye care available in the bigger towns and cities, if you have insurance, there is very little in rural parts with only 2 public health eye care providers for every 500,000 Jamaicans and no public health optometrists. 43% of Jamaicans have never seen or been treated for eye health problems in their lifetime! Because of this I am volunteering to help with Great Shape Inc on their iCare initiative in Jamaica this October. I will be doing some fundraising later on and will do my best to keep you updated on progress and what happens when I'm over there.