Eye doctors give patients new outlook

  • Published
  • By Staff Sgt. Mareshah Haynes
  • 332nd Air Expeditionary Wing Public Affairs
JOINT BASE BALAD, Iraq (AFPN) --  Eye doctors deployed to the Air Force Theater Hospital in Iraq see more than twice as many eye traumas than they encounter at their homestations. Among their patients are Iraqis and American servicemembers who have suffered eyesight-threatening injuries.
Ophthalmologists can't always save their patients' sight, but they work hard to give patients a new outlook. They use their skills to reconstruct patients' eye sockets and prepare them for prosthetic eyes, said Col. (Dr.) Randall Beatty, an ophthalmologist assigned to the 332nd Expeditionary Medical Operations Squadron here.

"The worst cases have been the ones where both eyes have been destroyed, and these people who are blinded have to deal with living in this culture," said Doctor Beatty, a reservist who is deployed here from Wilford Hall Medical Center at Lackland Air Force Base, Texas. "This is a harder life. They don't have the social services like we have back home."

Injuries frequently result from improvised explosive device blasts and gunshot wounds to the face. According to the Military Combat Eye Protection Program, eye injuries account for more than 10 percent of combat-related injuries, more than half of which are the results of IED blasts. The MCEPP was initiated with the objective of making eye armor universal during field operations.

"A lot of these [injuries] are preventable by the eye protection that our troops have," Doctor Beatty said. "Iraqis don't have the goggles and things that we have. We see many more eye injuries in the Iraqi army, Iraqi security forces and civilians that we're not seeing in the American [servicemembers]."

Eye doctors here primarily treat traumas to the eyelid, eye socket and eyeball, Doctor Beatty said.

"Most ophthalmologists back home perform cataract surgery or refraction surgery to correct nearsightedness or farsightedness. Here we're dealing with traumas taking out eyes and [eye] reconstruction," Doctor Beatty said.

At homestation, ophthalmologists typically see penetrating trauma with one point of entry, which makes it easier to save the eye. Here, however, eye injuries usually involve several foreign bodies such as rocks, shrapnel and concrete, said Maj. (Dr.) Robert Lyons, an ophthalmologist deployed to the 332nd EMDOS from Lackland Air Force Base, Texas.

Because injuries in the combat zone are so severe, doctors can't always save patients' eyes. The doctors instead perform enucleations, wherein they remove the eye altogether and prepare the patient's eye socket for a prosthetic.

"We do the surgery so that there's a pocket there that's safe and smooth -- like the inside of your lip -- to hold the artificial eye so that it'll move," Doctor Beatty said. "We attach the eye muscles to the implant so they have movement when the artificial eye is in place."

Doctors typically use a ball implant for patients, but many of the patients at the Air Force Theater Hospital have compromised immune systems from other injuries, and patients' bodies are more likely to reject the implant. The doctors had to develop an alternative surgical method.

"We take about a quarter-sized piece of skin from their abdomen -- it's called a dermal fat graft -- and we rub off the top layer of skin. Then we put that fat and dermis into the eye socket and attach the eye muscle to it and that'll serve as the implant," Doctor Beatty said. "That way it has more surface to hold the prosthesis and there's no risk of it being extruded or exposed like the hard ball [implant]."

The enucleation procedure takes a few hours, and patients have to wait six to eight weeks for the swelling to subside before they can be fitted with a color prosthesis. Afterward, they see an ocularist, who fashions artificial eyes from the same materials used to make hard contact lenses and teaches patients how to care for their prosthetics.

In the meantime, Doctor Beatty said the doctors at the Air Force Theater Hospital fit enucleation patients with conformers, devices similar to the artificial eyes they'll receive later in their treatment. The conformer is like a large clear hard contact lens that fits over the entire eye.

The prosthetic eyes give patients a renewed sense of self-confidence, Doctor Beatty said.

"If we can give an Iraqi patient an artificial eye, it looks just like a real eye," he added. "A real artificial eye costs $3,500 in the United States, but we can get them something that works well enough, and it doesn't cost them a thing."

The eye may be free, but its value to a patient -- a new outlook on life -- is priceless.

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