Can we really save Moses from going blind?

Last week Moses Africanus appealed to Dr. Ben to save him from blindness. Why? He had been having severe itching in both eyes for quite a while. Following intense rubbing, his eyes were always red and he experienced a gritty sensation as if there were sand particles in the eyes.

It had become unbearable to leave his eyes open for more than a few seconds without blinking and his red eyes had become an embarrassment to him because friends and family thought he was on hard drugs. Moses had tried several medications with little success until a pharmacy attendant recommended a wonder eye preparation which contained both antibiotics and steroids.

Relief was instantaneous and sustained. The itching and redness disappeared. For the first time in several years, his eyes were comfortable. He wondered why this simple and very cheap eye drops had been denied him by those who had attended to him before. He had never really consulted an eye doctor – he couldn’t afford the cost. It wasn’t necessary again, he had thought. But now there was a problem – as long as he used the eye drops he was okay but whenever he missed a dose, the intense itching and redness returned with vengeance. So he continued using it without fail.

After over one year on the drops, for the first time, he decided to read the accompanying leaflet containing instructions for use. He was alarmed by what he read and decided to contact Dr. Ben to prescribe safer eye drops for him. Dr. Ben, in turn, reprimanded him for putting his Master’s education in his pocket and reading the instructions long after he had been using the eye drops.

He described his behaviour as, “Medicine after death” and asked him to consult an ophthalmologist immediately for a full eye examination and report back with the findings. I had promised to share it with you. Here is the relevant part!

“I saw Mr. Moses Africanus yesterday. He was very anxious about his eyes, having used eye drops containing antibiotics and steroids for about one year four months. His distance visual acuity was moderately compromised in both eyes. This, I established, was due to a combination of an error of refraction and an unusual type of cataract still in its early stages.

This type of cataract is often associated with prolonged use of steroids. In addition, when I examined the inside of Moses’ eyes, I saw evidence of structural damage to the nerves at the back of his eyes (the optic nerves). We call this cupping of the discs and it’s suggestive of glaucoma when the ratio of the cup to the disc is equal to or greater than 0.50.

Surprisingly, when I measured his intraocular pressures, they were within normal limits. Glaucoma is usually associated with elevated intraocular pressure. I cannot say, specifically, the damage was caused by the use of the eye drops – it could have been present before he started using the drops and made worse by it!

“Moses requires further tests – Pachymetry, to measure the thickness of the cornea to see if the prolonged use of steroids had caused thinning of the tissues of the eyes. This may be the reason why the eye pressures readings were falsely low. He must also have a Central Visual Field (CVF) study to determine, first, if there is any functional damage to his optic nerves in keeping with glaucoma and if this functional loss shows a relationship with the physical damage identified when I examined his eyes.

“Unfortunately, Moses said he had no money to pay for the tests. In the absence of these tests, which should help me confirm the diagnosis of glaucoma, I am considering commencing him on treatment. Even here, the major challenge is money. In addition to medicines that will relieve the itching, he would need glaucoma medications. They don’t come cheap! If care is not taken, Moses is on his way to blindness.

“There is one thing, I have left to the last but which may even destroy Moses sight faster than glaucoma. He is already developing dry eyes. This means the surface of his eyes which should be always wet and well-oiled is dry. Dryness of the eyes may lead to blindness. He must jettison cheap but dangerous steroids for more expensive, less effective but certainly safer medications.”

Next week we shall discuss in a little more detail, some of the issues raised by the ophthalmologist. Suffice it to say that Moses is in a real big mess.