Nawab Ali, 57, couldn't conceal his excitement. He was jubilant and sported a broad smile as he strutted through the doors of the Imperial Healthcare Institute at Dubai Healthcare City for a subsequent check-up, less than 24 hours after his orbital implantation surgery.
He had undergone surgery to remove a cataract in his right eye and now the vision in his right eye was perfect. What's more, his visually dysfunctional left eye, which had been giving him problems for more than seven years, had recently been replaced with an ocular prosthesis (an artificial eye).
His joy knew no bounds. He could now see the world clearly and he was keen to thank all those who helped him see again.
Loss of vision
Ali, a Pakistani expat, remembers the night almost a year ago when his life changed dramatically. It was Eid Al Adha and the hospitable Ali, a transport manager at Zener Electronic Services, was busy attending to guests who had dropped by at his house. When the last guest left, he retired for the night only to wake up a few hours later due to severe discomfort in his left eye.
He waited for a few minutes sure the pain would subside but when it did not he decided to head to the washroom to rinse his eye. However, when he looked into the mirror, he got a shock when he saw the condition of his eye.
It was bloodshot and itchy. Also, my vision was affected because everything in the washroom appeared hazy and distorted, he recalls.
The next morning he rushed to an ophthalmologist who, after an initial consultation, diagnosed his condition as ocular bleeding in the left eye.
A diabetic, Ali's condition was attributed to diabetic retinopathy, a complication that occurs as a result of damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).
Ali was given oral medication and eye drops with a strong recommendation to further pursue treatment. Ali began the course but decided to return to his home country and seek a second opinion.
Failed surgeries
Back home, he headed to a family-recommended ophthalmologist who, after examining him, conducted a laser surgery on both eyes to curb the effect and damage of diabetic retinopathy. But there was no significant improvement. Although I was taking the prescribed medicines my vision was still not good, he recalls. The doctor conducted another series of tests and concluded that Ali would need another surgery.
It was a two-hour procedure, says Ali, after which I was assured that the intense retinal bleed would be cleaned up and my vision will improve.
Two days later, Ali returned for a check up and to have the bandage removed. His vision though cloudy was relatively better and as days progressed, his sight cleared.
A happy Ali returned to Dubai and reported to work. However, his happiness was short-lived as a few weeks later his nightmare returned - vision in his left eye was affected again.
"I returned [home] the following day and consulted my ophthalmologist but on receiving no supportive response was taken to another ocular physician.
"On detailed check-ups, the ophthalmologist cited dense cataract and damage to the retinal area and suggested an immediate operation to stop the intense retinal bleeding.''
Ali hoped that the three-hour procedure would be the last he would require for his eyes, but he was in for a shock. The next morning, he found that he had lost complete sight in his left eye.
To add to his woes, his right eye too began to exhibit signs of vision loss. A distraught Ali - refusing to undergo any further treatment - returned to Dubai and shared his spate of misfortunes with his manager who suggested he visit the local diabetes centre where he was enrolled to stabilise his fluctuating blood sugar levels.
Once that was brought under control, he, on the recommendation of his manager, approached Dr Vinod Gauba - a British trained ophthalmologist and Lasik-Laser eye specialist at the Imperial Healthcare Institute in Dubai Healthcare City.
I had given up all hope to resurrect the lost vision but on the insistence by my manager, I met Dr Gauba and agreed to proceed with his treatment plan, he says.
Says Dr Gauba: "The patient was suffering from severe diabetic retinopathy, resulting in active blood vessel proliferation. His left eye, on which multiple surgeries had been done, was visually dysfunctional as he could not see, even perceive, light. His right eye had dense cataract which had been allowed to progress to a stage where it was visually disabling him.
"He could only see broad hand movements, leaving him unable to read the vision chart, even the large top letter."
The treatment plan began with the coordinated aim of controlling diabetic retinopathy and returning functional vision to his right eye. However, the biggest challenge remained salvaging the patient's only functional eye.
Dr Gauba elaborates, "We conducted a five-minute procedure whereby an agent was injected to completely stop the recurrent bleed in his right eye, without having to perform any surgery."
Through subsequent check-ups and close monitoring, and once it was confirmed that his right eye had stabilised, Dr Gauba continued with the treatment to remove the cataract.
"Performing cataract surgery on a patient who has a single functional eye involves extensive consideration and care; basically [it has to be] a flawless surgery."
Cataract myths
Dr Gauba also helped clear myths surrounding cataracts. "Cataract is a treatable source of visual disability. Unfortunately, it's a common myth that a cataract has to mature to a certain level before it is considered safe for surgery. With that misconception, in the past, people have waited too long before opting for surgery leaving them visually impaired.
"Today, cataract removal is a highly safe surgical procedure which lasts 10 to 15 minutes.
"We use only eye drop anaesthetics with minimally invasive techniques using the latest ultrasound technology to remove the cataract, hence no stitches or bandages are required and the patient can return home within an hour after surgery. Most of our patients are back to work within two to three days."
Step-by-step restoring of vision
For Ali, it was a dream come true, as he emerged from his cataract surgery with good vision. He could see his friends and family without the aid of spectacles. So great was his elation that it didn't wear off even when Dr Gauba unfolded the grim news to Ali that he was in need of an orbital implantation surgery as his left eye had succumbed to diabetes and was functionally dead.
Ali bore the news in his stride and agreed to the treatment plan. Soon after, Dr Gauba conducted orbital implantation surgery to replace the redundant left eye with an ocular prosthesis (artificial eye).
"Orbital Implantation is basically a volume replacement procedure. It is a process whereby an abnormal, painful or pathological eye which has no functional sight whatsoever is removed and replaced by an artificially implanted eye."
When is such a surgery required? According to Dr Gauba, "Perception of light is the least form of vision; it's important for regulating the body's hormonal cycle and letting the body know when it's light or dark. When that potential is lost and there is no way to resurrect it and the eye is painful or unsightly, then an orbital implantation surgery is mandated.''
The surgery requires using a particular implant in the affected eye.
"There are various kinds, but the one we use integrates well in the body enabling the blood vessels to grow in the implant. The muscles and the original ball cavity, however, are retained to allow natural eye movement.
Lastly, a customised cosmetic shell is manufactured and placed in front of the eye for the individual to feel and the eye to behave much as a normal eye, in terms of movement, aesthetics and comfort," he says.
The need for eye prosthesis
Dr Gauba has teamed up with Dr Hassan Awada, a renowned ocularist to manufacture ocular prosthesis in-house. State-of-the-art equipment and technology is available at the clinic to create ‘the perfect eye prosthesis'. The process entails a lot of craftsmanship as the entire ocular prosthesis is handmade. The ocular prosthesis is manufactured based on the size of the eye, colour, shape, volume, contour and the amount of lid opening.
Dr Gauba strongly feels the need to acknowledge and celebrate medical achievements in Dubai and the UAE.
"The UAE has come a long way in terms of medical advancements and technology. Today, such options for treatment exist which were unthinkable a decade ago.
"However, education and awareness is of essence; my recommendation is: stay informed!"
Today, Ali is an independent man and is grateful to his company for the financial and emotional support it extended to him.
Ali also holds Dr Gauba in high regard and appreciates the help of the entire medical team that worked on his eye.
He feels he owes them his vision and a lot more.
"Please take extra care of your eyes, especially if you are a diabetic patient,'' he says. "There is no greater asset than a pair of fully functional eyes. Consult an experienced ophthalmologist and get your eyes checked every six months, if not earlier, to detect and cure any ailment at an early stage.''
Diabetic Retinopathy at a glance
Symptoms
The symptoms may not be apparent in the initial stages. The most common ones are:
- Blurred vision
- Poor night vision
- Vision loss
- Dark streaks
- Vision distorted by a red film
High risk factors
- High blood pressure
- Pregnancy
- High cholesterol levels
- Smoking
- Uncontrolled blood sugar
Prevention tips
- Close monitoring of blood sugar levels
- Keeping cholesterol in check
- Quitting smoking
- Paying attention to vision alterations
Zainab Mansoor is a Dubai-based freelance writer.
