February 11, 2013
An Inspiration and a Beginning
Hello!! Welcome to my blog. This is the first time I write a blog and it is not common for physicians to have a blog on their professional websites. I hope to use this forum to educate the public and my patients about eyes and vision through my own lens. The opinions expressed in this blog are solely my own personal experiences and perspectives on eye care. They have not been peer reviewed in scientific journals or tested in a laboratory. They are simply my take on things from the latest advances in ophthalmology to the day-to-day practice of medicine. They do offer you, the reader, a glimpse of who I am as a physician and to garner your trust in me as your Eye M.D. Let’s begin our journey.
This past Wednesday evening, I had the pleasure of entertaining Dr. G and his wife at my home. Dr. G is a retired ophthalmologist and emeritus professor from the Chicago area. He sought me out to be his cataract surgeon several years ago after he moved to Bainbridge Island. It was a real honor for me to be his doctor and his surgery went perfectly. We kept in touch over the years and he enthusiastically shared with me his eye mission trips to Burma each time he came in for his follow up visits. My staff would save up expired medications and supplies for him to take on his trips and he is always very appreciative of them. Dr. G’s wife came in couple of weeks ago for her eye check and told me about his most recent trip to Burma in December. Since my wife Danielle and I have been talking about traveling to Burma in the near future, we decided to invite them over for dinner.
For the dinner, I prepared a salad with lotus root, Napa cabbage and chili-lime vinaigrette, a steamed Chilean Sea Bass, a stir fry baby bok choy and shitake mushrooms and some steamed Bhutanese red rice. I thought I did a pretty good job on the food but Dr. G’s slide show of his Burma mission trips was truly the highlight of the evening.
Burma, also known as Myanmar, is a Southeast Asian country with a population of 60 million. It has been under military rule since the early 60’s but democratic reforms have been forthcoming since 2008, allowing foreigners like Dr. G better access into the country. While the country is rich in precious stone, oil and gas, the per capita health expenditure is less than US $2.50. Needless to say, eye care is scarce and a group of Australian ophthalmologists developed an eye hospital there with the mission of treating reversible blindness. Dr. G was one of the volunteer surgeons who traveled there to provide expert eye care for free.
Cataract is by far the most common cause of reversible blindness in the developing world. A cataract is the clouding of the crystalline lens in the eye. The most common type of cataract is called Nuclear Sclerosis and is related to aging. In this type of cataract, the center of the lens turns yellow to brown, blocking light from entering the eye, causing diminution of vision. The picture below showed a very advanced cataract that Dr. G saw in Burma. Cataracts rarely progressed to this stage in the United States because of good access to quality eye care and eye surgeons in our country. However, just because you have been diagnosed with a cataract does not mean that you have to have it removed right away. For seniors with MILD nuclear sclerosis cataracts, a change of your glasses prescriptions may be all that is necessary. Wearing sunglasses to protect the eye’s lens from harmful UV light exposure may also slow down the progression of cataracts. Medications, supplements or eye exercises cannot prevent or cure cataracts. When your vision is so poor that it can no longer be improved with glasses AND your daily activities are affected, that is the time to consider cataract surgery.
Back to Dr. G. In the two weeks that he was there, his waiting room looked like this each morning. He would then operate for hours to accommodate all the patients that traveled for miles to see him. The equipment available to him was poor and he had to create a large incision (13mm) to extract the entire cataract lens in one piece in a technique known as extracapsular cataract extraction. The most advanced technique in cataract surgery that I practiced involved making a 2.65 mm incision that requires no suture. The cataract is then broken down into pieces using an ultrasound, the pieces are removed by suction, and a folded implant is then inserted and unfolded inside the eye. This technique, small-incisional phacoemulsification with new technology intraocular lens, allows for much faster restoration of the vision. It is, however, much more costly and not practicable in a setting like Burma.
While the full recovery of Dr. G’s Burmese patients might take some time, he was gratified by the stun
ned and joyous expression of each of his patient’s face on the day after the surgery. He felt privileged to have made a significant positive impact on
their lives and these trips have brought meaning to his life’s work. My wife (an ER doctor) and I long to join Dr. G on one of his mission trips but we might have to wait a year or two because of our young children.
The morning after my dinner with Dr. G, I operated on six patients with visually significant cataracts. I reflected on our discussions about the different techniques and approaches to cataract surgery and I was inspired by the common mission of our work. Restoring sight is a noble cause. While operating in the US might be less “exotic” than in Burma, and we are constantly burdened by insurance companies and government regulatory restrictions; the end effect to me as a surgeon is still the same: it is truly a privilege to bring vision back for my patients. The following day, I was equally gratified by the joyous expression of my patients face when I removed their eye patches and they read 20/25 to 20/20 without glasses. Patients often thank me for the miraculous gift of restoring their sight. The truth is, they have given me a gift that is equally miraculous: a sense of purpose and meaning in my work.