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Friday / July 19.
HomemicontactSecond Dose

Second Dose

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Professor Nathan Efron’spersonal journey of retinopexy, cryopexy, vitrectomy and IOL surgery. An unexpected “ink in the sky” moment led to urgent surgery on a symptomatic left eye, with the asymptomatic right eye to follow…

Two days after having my left eye lasered, it was time to do the right eye. After having endured the full surgical routine so recently, I wasn’t really in the mood for a second dose. But I had no choice – there was a large tear in my superior retina that could propagate at any time, and it had to be sealed up without delay.

One hour before arriving at the surgery, I duly instilled a drop of mydriatic into my right eye from the unit dose dispenser I was given when discharged two days previously, following my left eye lasering. I was asked to fill out the same form that I had completed two days earlier, about my past medical history. This seemed a waste of effort, as nothing had changed, or could reasonably be expected to have changed, in the preceding 48 hours. But I guess systems are systems, and I’ll just do what is requested.

Risky Protest

There was an interesting question on the form that assumed increased relevance this time around. It went something like this: “Do you have any concerns about the procedure you are about to have that you would like to tell us about?”, with an open field into which comments could be entered. You may recall that during the first operation, I was disturbed that one of the assisting nurses who was standing next to me was leaning against, and occasionally bumping, the operating table during my operation. So here was a chance to make a definitive statement about this concern. Should I mention this now? Or would it offend my surgeon Bill (not his real name), or his staff? I decided to make a statement, something to the effect of “please instruct assisting theatre staff to avoid bumping the operating table during surgery”. I wondered how the admissions nurse would respond to this when she retrieved my form, but she said nothing.

Bill said he could see a small region of ‘mottling’ (I think that was the term he used) inferiorly, and that he intended lasering that too, for good measure.

Unlike two days before, when the admission room was full of women, most of whom were about to undergo breast augmentation, on the day of my second laser treatment, I was surrounded by generally older patients about to be subjected to various forms of eye surgery. After all, this was an ‘official’ ophthalmic procedures list. So again, on went the dark blue gown, light blue shoe covers and red hair net. Not especially fashionable, but fashion was of no interest here. The attending nurse again took my blood pressure, instilled more mydriatic and marked my forehead – this time above my right eye – and commented how red and angry my left eye looked. I told her that this was due to the operation performed on that eye two days ago.

So, off came my glasses, and I was led through the same blurry corridor to the blurry pre-surgical room where Bill again injected the anaesthetic. Same cold feeling around my eye. Same beanbag placed over my eye and face to spread the anaesthetic. Then I was wheeled into the operating theatre for another round of retinopexy and cryopexy. Just before the procedures began, one of the nurses drew Bill’s attention to my comment about bumping the operating the table. Bill’s immediate response was “Yes, I saw that”, and he then proceeded to briefly relate this concern to the assembled theatre accordingly. So, I was pleased that my concern was taken seriously.

More Surprises in Store

Having had this procedure performed on my left eye two days ago, I knew what to expect in terms of the retinopexy and cryopexy. But there was a surprise in store. Following an initial general inspection of my eye with his head-mounted indirect ophthalmoscope, Bill said he could see a small region of ‘mottling’ (I think that was the term he used) inferiorly, and that he intended lasering that too, for good measure.

Here we go again. Same sensations. Same light show. Same discomfort when cryopexy was performed. And no bumping of the operating table, thank goodness! Bill declared this procedure a success, and I was despatched to the recovery room, where I enjoyed another round of coffee and sandwiches. The same assisting ophthalmologist who saw me post-surgically two days prior was again on hand. He removed my eye patch, had a quick look around, and declared all was well and that I was free to leave.

Off I trotted with a new package of the same pre-prepared medications I received last time – paracetamol/codeine tablets and prednisolone forte eye drops – and another bill from the local pharmacist who prepared and supplied these drugs. I didn’t really need more analgesics, as I had plenty of these left over from two days ago, but it was just easiest to grab them and go. I was now faced with the prospect of instilling the pred forte drops in both eyes every four hours for six weeks or so!

Inserting eye drops four times a day is quite an intrusion into one’s lifestyle! But the intrusion did not stop there. As a bit of a health fanatic, I try and keep fit by eating well and doing a workout every day – in the gym for one hour before work, or a one hour walk along the Surfers Paradise beachfront with my wife Suzanne on Saturdays and Sundays. However, I figured that while beach walks would be OK, strenuous gym training would not be such a good idea following eye surgery, and Bill confirmed this, advising I should ‘take it easy’ for at least the next two weeks. When I did return to the gym two weeks later, I restricted myself to cardiovascular training and avoided the heavy weights for a further fortnight, before gradually getting back into heavy lifting.

Broad Perspective

A few months after this double-dose of eye surgery, I was visiting an ophthalmic trade fair and on display was one of those Optos ultra-widefield retinal imaging machines. There was quite a buzz of activity around this particular display, so I waited on the side for a quiet moment, then introduced myself, explained my recent ophthalmic history, and asked if they could capture images of my eyes. They obliged, and managed to capture two great images in particular – one superiorly and one inferiorly. Fortunately I had my trusty USB thumb drive with me, and we transferred the images onto this. These images are astonishing, with the lasered regions clearly visible. Because the Optos instrument is capable of capturing images across a 200° field, it was possible to image the far lasered regions in the far periphery and my optic disc in a single frame. This is impressive, given that both the superior and inferior lasering were performed about 10 disc diameters away from my optic disc. Such imaging was not possible a decade ago, when fundus cameras were only capable of capturing images across a field of about 30°.

The accompanying figure was constructed by montaging the superior and inferior fundus images into a single picture, using the optic disc as the reference point. This has resulted in an image of the fundus of my right eye that probably spans some 250°. Now I need to declare here that I have no financial interests, shares or consulting arrangements with Optos… but let’s give credit where credit’s due! This amazing technology has allowed me to observe the ambiguity of, on one hand, the beauty and precision of Bill’s lasering technique, and on the other hand, the tragic consequence of being a high myope with retinal tears!

Professor Nathan Efron is a researcher at the Institute of Health and Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology. He is currently president of the Australian College of Optometry and is the only person to have served as president of both the British Contact Lens Association and the Cornea and Contact Lens Society of Australia.