“All of these cases have really encouraged me to explore hospital optometry as a career”
City, University of London optometry student, Twinkle Bhuva, explains how a trip to India confirmed her interest in hospital optometry as a career
Being a second-year optometry student at City, University of London, I had the opportunity to experience a knowledge-packed hospital placement, at the LV Prasad Eye Institute in Hyderabad, India. It was a two-week hospital placement in December 2019, which we did as a group of four.
The opportunity was presented to us last summer and, without hesitation, I immediately knew that I wanted to do it. It was easily my best experience abroad.
We had to go through an application process that involved filling out an application form, accompanied with a CV and cover letter, followed by an interview. This process was an experience in itself and brought out the confidence in me.
During the two weeks that I was at the LV Prasad Eye Institute, I was assigned to a different clinic each day. The clinics included contact lenses, cornea, cataract, glaucoma, low vision, squint, vision rehabilitation, and oculoplasty and prosthesis. Every patient case was unique and hence the tests carried out were different, thus ensuring that we gained the maximum insight from each experience. We also had the opportunity to observe surgery and I was fortunate enough to be able to witness cataract surgery and an Ahmed glaucoma valve (AGV) implantation, which is used for glaucoma. I found this really interesting.
The hospital was equipped with state-of- the-art facilities, ensuring high quality care for each patient. The optometrists and ophthalmologists worked hand-in-hand and were able to answer any questions I had.
Some of my “wow” moments…
One case that I found really fascinating involved a 12-year-old child, who came to the low vision clinic. This child had coloboma iridis. This is a rare condition, and one that I’m unlikely to see throughout my career as an optometrist in the UK as it affects less than one in every 10,000 childbirths.
The patient was first refracted and the results indicated myopia of -6.25DS but subjectively, she did not accept this. I learnt that the reason why she would not accept this was because retinoscopy was carried out over the coloboma area. The team then set to work to correct her properly using subjective refraction. The patient also experienced glare and discomfort and consequently, tried a selection of tints of different colours and grades to help with her discomfort. It was very satisfying to see how the optometrist managed each of her problems, and I was able to follow the patient journey from management to the dispense.
I really enjoyed my time in the cornea clinic as different conditions could be observed
Another case that I particularly enjoyed seeing also involved a young child. This time the patient was 10 years old.
The girl attended the corneal clinic due to severe photophobia associated with redness and discharge from both eyes. I learnt that her symptoms were caused by looking directly at a welding light and consequently, the patient was unable to open her eyes during the examination. I was previously unaware that looking directly at welding lights could cause such grave damage. The patient also reported a gradual decrease in vision in both eyes. She was diagnosed with keratoconjunctivitis and corneal burn from the welding light at one of the outreach clinics in the village. The optometrist also referred her for a B-Scan (ophthalmic ultrasonography). I really enjoyed my time in the cornea clinic as different conditions could be observed with bare eyes, and I was able to understand the particular condition during the eye examination.
In the prosthetic clinic, I saw the whole process from the lab work to the detailed painting on how a prosthetic eye is custom-made
At the oculoplasty clinic, I observed a patient who had previously undergone surgery for a brain tumour. Unfortunately, the surgery didn’t go as expected and the patient was left with a right facial nerve palsy which resulted in a drooping lower eyelid and exposure keratopathy on the right eye. On slit lamp examination, superficial punctate keratitis (SPK) and arcus senilis were observed. I was allowed to carry out slit lamp on this patient and being able to observe these details for myself was really good: the optometrist would explain the details of what I was looking at to help further my understanding of this condition. I found this really helpful.
In the prosthetic clinic, I saw the whole process from the lab work to the detailed painting on how a prosthetic eye is custom-made and meticulously painted to look exactly the same as the patient’s other eye. It was amazing how they could do this. I also observed a patient removing his old prosthetic eye, which had yellowed over time, and be refitted with a new one. Prosthesis is associated with artistry and it was a real highlight for me to see the skills and expertise shown.
All of these cases have really encouraged me to explore hospital optometry as a career.
Apart from observing at the hospital, we also had time to explore Hyderabad and the culture of India. During this time, the four of us visited the famous Charminar Mosque and a couple of museums in the city. We ventured around on rikshaw rides that took us almost anywhere and everywhere often at high speed. It was great fun as they swerved in and out of the traffic. One of my highlights of the trip was all the delicious food on offer. We absolutely loved the dosas (lentil and rice pancake) and thalis (a plate of food with a variety of side dishes usually including rice, Indian breads and dessert), not forgetting the famous Hyderabad biryani (rice dish) and the masala chai (spice infused tea).
I would like to thank City, University of London and the Hospital Saturday Fund for making this trip possible, and also LV Prasad Eye Institute for making us feel so welcome and letting us observe so many interesting cases. We came back with a whole lot of memories and an experience to be remembered for a lifetime.