Eyeballing It

Luckily my experiences of A+E departments are limited, although I’ve spent plenty of time cycling across Cambridge to Addenbrooke’s Hospital in the interests of research.  The site is expanding rapidly, with new buildings for different aspects of biomedical research springing up, including the new LMB (Laboratory for Molecular Biology) which was opened recently, situated astonishingly close – to my mind – to the main railway line. The Rosie Hospital, the maternity unit, so new and impressive when I had occasion to use it all those years ago, is now obscured by larger, newer buildings.

However, as I discovered last week through painful personal experience, the A+E unit is still where it always was, although it appears to have had a makeover in the not too distant past. I had plenty of time, as I sat there, to scrutinise its décor, to try to interpret the dress codes of different grades of staff and to attempt to unravel the code for the keypad entry to the staff office by watching many fingers make swift work of entry. I have no complaint of the staff I met that afternoon, but 3 hours can feel like a very long time when waiting to discover how serious one’s condition is (spoiler: it wasn’t in the end serious at all, but more of that later on). 3 hours of trying not to think that perhaps one might lose the sight of one’s eye – or alternatively trying not to think ‘why am I still sitting here when the place is pretty empty and nothing much seems to be going on?’

Like a swan swimming, I’m sure a lot was going on behind closed doors (or screens), but it wasn’t like Casualty with paramedics rushing in with stretchered patients on drips pouring blood against a backdrop of constant wails of agony and hushed mutterings from the medical staff. It was calm, silent apart from tapping feet walking sedately backwards and forwards – and infinitely boring as I sat there. Why is it that a clear stretch of time like that prevents clear thought and the hastily gathered novel turns to metaphorical dust in one’s hands?

What brought me to this situation was what I can only describe as ‘visual disturbances’, although Googling that term hadn’t done me much good. It started off with the appearance of a peripheral black ring when I moved my head, followed by a general sensation of things lurking in my vision that had no business to be there just as I blinked. By the time, several hours later, that I had a strong sensation of walking through a swarm of flies – again all located in my peripheral vision – I felt I could no longer pretend this wasn’t happening. I had convinced myself it was no mere visual aura of a migraine and the only thing that approximately fitted my symptoms was a detaching retina (something I knew a family member had nearly lost their sight over). A phone call to my optician consolidated my decision: time to head off to A+E.

So several hours later, the doctor had established I was not having a TIA, which seemed to be what worried her if not me, and she had talked to a consultant ophthalmologist to book me in for an emergency appointment the next morning; I was all set to have a wearing evening and night continuing to fret. What made it all the worse, bizarrely, was by the time I got home the symptoms had significantly receded. Still flocks of insects out of the corner of my eye but the initial peripheral ring had vanished, so additionally I started fretting I was mad, a hypochondriac and wasting everyone’s time. A helpful notice I had read many times while waiting at the hospital had pointed out each visit to A+E by someone who needed no further treatment or could have been treated elsewhere cost the NHS £124. Was I causing over a hundred pounds of taxpayers’ money to be thrown away simply by being neurotic?

Anyone who has had hospital eye examinations will know that eye-drops to dilate the pupil are required. So the next morning I sat around for a further hour or so with pupils as big as millwheels and sans contact lenses so pretty blind and unable to read any interesting notices in the Eye Clinic. But when I finally saw the specialist the whole conversation was immensely reassuring. I had a condition known as a detached vitreous which apparently – for all I’d never heard of it before and nor has anyone to whom I’ve mentioned it – is very common.

Apparently a large number of people of my age and more have it, but for most it happens to them unaware. It can, however, lead to tears in the retina (which it hasn’t, at least so far, in my case) and should be checked out. If it doesn’t damage the retina itself, nevertheless the debris of the vitreous will continue to float around and may or may not go on annoying me (those swarms of insects that I had seen can still be spotted from time to time). The dried up gunge that is the vitreous will never go away but it should cause no additional problems.  So I was despatched home to spend the next 12 hours still pretty blind and miserable until my pupils returned to their normal size. No opportunity to work on my department’s REF Environment Template, which continues to plague me, nor read the thesis I need shortly to examine. With eyes like that there was little I could usefully do except continue to fret. I am not a good patient!

The motivation of this post is that I find it troubling this condition, that is apparently so common, had completely passed me and all my friends and relatives by. Had I known – had Google even hinted at this – I could have spared myself much grief, or at least some of it. The symptoms are close enough to those of a detaching retina that I was right to go to A+E to get myself into the ophthalmology system. But it would also have been reassuring to know that there were conditions whose symptoms would be transient and that therefore, as they faded, it did not prove I was going mad in thinking they were ever there at all, or that I was a hypochondriac for getting worked up about symptoms that passed. Maybe I just didn’t read far enough done the Google list to spot this condition, but fail to find it I did, although now I’ve located this very helpful write-up from the RNIB.

Since I am a soft matter physicist I’d also like to point out that there is some interesting polymer physics to be learnt from the eyeball. Some years ago I had tried, through a brief and ultimately unsuccessful collaboration with an Ophthalmology Department, to study eyeballs in the Environmental Scanning Electron Microscope. This was done with a view to studying the rather mysterious affliction keratoconus, in which the cornea changes shape and distorts vision over time and which often also causes much pain . Our aspiration was to be able to study the arrangement of the collagen fibres in healthy and diseased eyes, one hypothesis at the time being that the collagen network was labile and possibly less well crosslinked or well-oriented in the diseased eye and as a consequence couldn’t retain its shape well. I don’t remember by now quite what didn’t work, but certainly we could learn nothing from the preliminary images and the project ceased before it had ever really got going.

Like the cornea, the vitreous humour (to give it its full title) is largely a collagen gel. As in the development of wrinkles in skin and ageing in other parts of our collagen-rich bodies, collagen tends to form crosslinks (i.e. form bonds between neighbouring molecules) as we age, a phenomenon I first learned about when reading about morphology in rat tail tendon. In skin this means the elasticity decreases and wrinkles are the consequence.  I assume the increasing strength and connectivity of the age-prompted developing crosslinked network in the vitreous means that it develops an internal tension that causes it to shrink and ultimately pull away and detach from the retina.  So, it is indeed a natural part of ageing that polymer physics can rationalise. Surprisingly enough, though, that wasn’t what I was thinking about while I was sitting in A+E, or maybe I could have diagnosed my own problems and walked away.