Sunday, November 16, 2008

SOSH Mission Trip to Cap Haitien, Haiti

Student Optometric Services to Humanity (SOSH) is a non-profit organization, established in 1968, dedicated to providing eye care and vision services to those living in poverty and without access to local eye care. Often, the services that SOSH delivers in these regions are the only means, for some, of receiving proper eye care. The original purpose of the organization was to provide eye care and spectacles to the people of Haiti, but due to the escalating political turmoil and unrest in Haiti in 1986, SOSH no longer felt they would be able to carry out their mission safely. Instead, SOSH PCO extended its services to other countries in need of care such as Guatemala and Mexico and had not returned back to Haiti since. This year, 22 years after the last time SOSH was in Haiti, our group returned back to where it all began...

Our trip was scheduled for Sept 19 2008 to Sept 29 2008 and although Tropical storm Fay, and Hurricane Gustav, Hanna, and Ike were all unpredictably destructive and devastating for Haiti, and the possibility of abandoning our mission trip was imminent at that time, we hesitantly continued on with our operation (and thankfully so since the Haitians really needed our help). Twenty student doctors (me included, of course) and 2 doctor preceptors organized into 2 groups and went to 2 different sites everyday; one group went to Living Hope Mission and the other group would go to a site that Justinien hospital set up but ALL of us were responsible for providing the most effective and compassionate eye and vision care service possible. At both sites, a comprehensive history was taken by one of the translators, or nurse, and then we were responsible for measuring the patients' visual acuity, which was followed by lens rack-retinoscopy to get an approximate idea of the patients' refractive error. This was then later followed by an anterior view of the eye and posterior view of the fundus with the direct opthalmoscope. If the patients best corrected visual acuity was worse than 20/400 in the better seeing eye then we would refer the patient to the doctor preceptor. Referrals for cataract surgery, pterygium removal and glaucoma surgery were the most prevalent reasons we recommended surgery. If no referrals we required, patients would conclude their ocular health evaluation at the 'optical center' where all patients were provided with a pair of glasses to help neutralize their refractive error (if needed), a pair of sunglasses, and candy! By the end the trip, we helped approximately 2400 patients and improved the vision of hundreds of people.

This trip was both academically and personally fulfilling. This trip was sooooooo much more than I ever expected and I was soooooo lucky I got to go. The gracious people we met on our trip, to the beautiful, breathe-taking scenery and the little unspoken moments I got the privilege of experiencing, have all been embedded, and cherished, in my memory. We were able to improve the lives of so many people but this trip has also changed my outlook on life. The poverty and desperation that I witnessed, contrasted with the fierce spirit and courage demonstrated by the Haitians, was inspiring and humbling. I got to see the most raw strength of human nature which, for that reason alone, made this trip so overwhelming and unforgettable.

The whole group @ Living Hope

Hundreds of people waiting outside to get an eye exam @ one of the Justinien Sites

SOSH Members measuring Visual Acuity

Looking at the fundus using Direct Opthalmoscope

J performing lens rack-ret on a patient

Our mode of transportation to and from mission sites

Playing 'Mafia,' at the hotel, after a long, hard day of work

Thursday, June 5, 2008

The Case of the LAZY Eye

Okay! its a new semester, with a new clinic rotation, and my first pt 8:30 on a hot Monday morning comes in...

48-yr old black female presents with a chief complaint of blurry vision @ distance and near. She reported that she experienced this ocular complaint before, but did not seek help or treatment in the last 20 yrs. (Thats right! She hasnt seen an eye doctor in T-W-E-N-T-Y yrs!!!). Her systemic history included hypertension and anemia, for which she is properly treated for.

Diagnostic Data
Her best-corrected visual acuity measured 20/80 OD and 20/20 OS. External examination was normal, and there was no evidence of afferent pupillary defect. Biomicroscopy was unremarkable. Intraocular pressure measured at 20 mm Hg OU. Dilated funduscopy found quiet posterior poles with no peripheral pathology except for two retinal holes at the ora serrata OD (I KNOW, RIGHT? Can you believe I got out THAT far...Whoop! Whoop!=P)

Diagnosis and Management
The diagnosis in this case is refractive amblyopia, aka lazy eye, which is defined as poor vision due to lack of development of the visual system to the brain but the eye structure and function is normal. Treatment included prescribing the patient's refractive error. Since she hasnt worn glasses in over 20yrs and, therefore adapted to the poor vision in her right eye anyway, I cut the prescription of her right eye in half to minimize lense thickness. More importantly, I cut her Rx in half to prevent anisokonia, a difference of image size on the retina of each eye due to anisometropia, a difference of refractive error of two eyes, which would lead to more ocular complaints.

Lesson Learned
She was completely aware of her 'challenged' eye since she was a child but chose not to particatpate in patching therapy and chose not to ever wear glasses. And to make matters worse, annual eye exams were a foreign concept to her. A twenty yr grace period is waaaaaaay too long to wait before getting another eye exam. The lesson learned simply put...DON'T BE LAZY!

until next time...