Today was the first day of my work placement at St Thomas’ paediatric ophthalmology unit.I was kindly allowed to observe Mr Amaya at his clinic where he saw to his patients.Due to it being a paeditric’s unit all the patients were very young and so very cute ! The main eye conditions that the patients suffered from was squinting.However,squinting can be a result from many different problems,e.g cataract formation,myopia (short sighted),congenital glaucoma,nanophthalmos etc.
The first patient was 15 years old and had nanophthalmos.This was made evident as when the patient took her glasses off,her eyes were very small,bilateral and symmetrical.Research has been conducted to suggest that a mutation of the MFRP protein can lead to this condition.”This protein can alter eye refraction, or focus.” said Olof Sundin, Ph.D., assistant professor of ophthalmology at the Johns Hopkins School of Medicine in the Wilmer Eye Institute.From genetic mutations, some eyes continue to grow beyond the point at which the retina is the right distance from the lens for proper focus.This is done by a mechanism which uses visual experience to decide this, but this mechanism is yet to be known.The protein stops functioning once mutated and the retina becomes too close to the lens,but the lens and cornea,the eyes outer most later normal sizes and shapes.The patient had her pressure checked and all was fine, and had the routine eye tests to check for ambyopia (lazy eye).
Ambyopia is when a vision in one eye doesn’t develop properly.A lazy eye occurs when the brain connections that are responsible for vision are not made properly.The retina translates an image made up of light that’s passed through the retina in to nerve signals that are sent to the brain. The brain then combines the signals from each eye into a three-dimensional image.The abnormal brain connections can be due to confusion in the eye from two different images being processed from each eye which could be due to a squint as the eyes are not aligned and thus cannot work together.
Mr Amaya interacted very well with the children and I observed a clear difference between non paediatric patients and paediatric ones.He used fun techniques when examining them.One funny one was when shining a light in the children’s eye he attached a monster figure and told them it was freddy the bogey monster and that he was checking them for bogeys to eat.They all laughed.If a child was struggling to open their eyes when the light was flashed in them, he gave eye drops to help dilate the pupils and it would take 20 minutes for them to work.The dilating drops also relaxes the focusing muscles of the eye allows for a better more accurate measure for refractive error (need for glasses).
The most common treatment given to help a squint was to attach an eye patch to the eye that was better than the other,This would force the child to use the weaker eye.The children would object to the eye patch seeing as it uncomfortable to be forced to use the eye they’re not used to using.They would need to wear it for an hour everyday until the eye adjusts.Surgery had been conducted on many of the children to prevent the squint,Strabismus surgery would loosen the eye muscles which changes the alignment of the eyes relative to each other.Muscle recession procedure is used.The extraoccular muscle is cut from the surface of the eye by placing a sutre through the muscle and readjusting it further back from the front of the eye.
I also came across retinopathy of prematurity.This would occur when the child was born very premature (e.g. 27 weeks).Normal blood vessel growth stops in the retina and this abnormal blood vessel growth occuring could spread through the retina causing bleeding and scarring.This could lead to retinal detachment and result in vision loss.Laser surgery is done to correct this to stop the growth of the abnormal blood vessels, ensuring the retina isn’t pulled.My Amaya has performed this many times and prevented many of the patients from blindness which is amazing to hear.
Today was very inSIGHTful and I even go to attend a lecture with consultant ophthalmologists and speacialists in opthalmology on the different types of cataracts and the cases some doctors came across which was very interesting as I was oblivious to the many different types of infantile cataracts and the many genes that could possible be responsible for them.I will discuss this in my next blog.I am glad I got to learn a lot of new useful information as I had previously never really discovered the realms of opthalmology but it is truly fascinating!
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