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Restored Sight for Bill
RESTORED SIGHT FOR BILL Tui M. Ufenorde, R.N. Bill is a crackerjack airline mechanic. He is twenty-six years old, married, has two little girls. His family enjoys a modern, mortgaged home and a bright future. On weekends Bill and Marian tend their home and lawn in the tradition of families almost everywhere. A certain Sunday afternoon changed the pattern for the Smith family. While running the edger around his neat walks, Bill felt a stinging spray across his face-he had left his protective goggles in the garage since he planned to hurry and finish only the front yard and take the kids to the beach. When he brushed at his eyes, he realized it was more than a little sand to rinse away. Marian drove him to the emergency room where close examination revealed a penetrating laceration of the cornea of his right eye. It would require suturing. In the operating room and under sedation, Bill felt no acute distress. The emergency repair took only a short time and he felt fortunate to have a skilled ophthalmologist available to help. He was fortunate that there was no deeper laceration. His eye lost only the anterior chamber (the fluid in front of the iris), there was no iris incarceration and the lens was not damaged. A few anxious days with systemic antibiotics and they were past the worry of infection. Bill had his repair sutures removed on the eighth day. The closure looked good. There was only one thing-a pale grayish blue scar Tui M. Uffenorde, R.N., graduated from the Jackson Memorial Hospital School of Nursing and is currently a private duty nurse in Savannah, Ga. She was charge nurse, labor, delivery, and nursery, Merced, Calif., and also head nurse, ophthalmology, Jackson Memorial Hospital for nine years. Miss Uffenorde thanks Mrs. Pearl Goldherg, administrative secretary of the Florida Lions Eye Bank for her help with this article.
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directly across the pupil! ! The ophthalmologist was optimistic, however. The tissues might continue to heal and repair themselves to the extent that the scar would diminish and not block the vision. Bill soon returned to work to find he could not perform the intricate details necessary to his job. His right eye had a blur that he could not see around. The follow up with the ophthalmologist revealed the answer. Bill would require a corneal transplant. The ophthalmologist explained the procedure to him: A critical part of the surgery would be the securing of eyes at the time that the surgery would be performed. The need for fresh tissue for corneal transplant procedures far exceeds the supply so there would most likely be a waiting period. Because of this critical need, eye banks throughout the world have been organized to assist in this effort. This is how eye banks originated and work constantly in an effort to educate and expose the public to the need for eye donors. After eyes have been removed by the physician, they are examined under a slit lamp to determine whether or not they are suitable for a corneal transplant. If, after examination, the corneas are found to be suitable for use, the next doctor on a waiting list is called. He must contact his patient, arrange for a hospital bed and operating time. Bill was now on standby to be admitted for a transplant, A week went by before he was called on to come to the hospital-the eyes were available. Bill thought his second visit to surgery was more involved. He remembered some of the events. The operating room was quiet but he could hear the surgeon and nurses. His face was cleansed and covered with sterile drapes. The nurse had arranged oxygen under the drapes to help him breathe more easily.
AORN Journal
Inspection o f donor eye with slit l a m p incorporated w i t h microscope prior to surgery.
Surgeon with operating microscope controlled b y foot.
His arms had been tucked down by his sides
the operating room, Bill was on his way back to his room. He was moved on a Translift and both eyes were covered to keep him from moving them more than necessary that first day. Bill’s recovery was uneventful. The graft “took” well and in a few weeks only a trained observer could see any sign of the graft. Certainly Bill and his family were overjoyed at the surgeon’s success and the return of his priceless eyesight. Even though thousands of people have signed donor forms for the purpose of donating their eyes after death, most are young or middle aged and the immediate needs are not being met. Because of this situation, many families have to be approached immediately following the loss of a loved one. Eyes, if they are to be used for corneal transplant surgery, are to be removed preferably within four to six hours after expiration, and used in surgery within twenty-four hours
and he drifted in and out of sleep. While Bill dozed, the ophthalmic team prepared the donor eye. The surgeon had determined the size needed for the graft. Under a powerful microscope, he removed a tiny circle of the donor cornea using a trephine in much the same way you would cut a round cookie with a cookie cutter. The new disposable trephines are superior to the former reusable instruments. Using the same trephine, he removed a circle of Bill’s cornea and lifted out the offending scar. The graft (or donor cornea) fit into the opening perfectly, and was sutured in place. Bill, of course, could not observe the intricate microscope operated by ‘the surgeon’s feet, the delicate instruments, almost invisible suture with its tiny, microscopically inspected needle, or the nursing team whose training in this specialty made them a valuable asset. In an hour or less from the time he entered
February 1968
61
Trephines with cutting edge exposed.
(Above) New disposable trephine with guard
in place. (Below) Reusable trephine.
after death. Making provision for the donation of eyes in one’s will is ineffective since too much time elapses before the will is read. Donor eyes are available locally or statewide to any ophthalmologist in need of eyes for transplantation. If these needs are fulfilled at the time of donation, then the donor eyes are sent to other cities in need of eyes or, at times, are shipped internationally via the International Eye Bank in Washington, D.C. These efforts are accomplished through the cooperation of the Eye Bank Network, a group of volunteer amateur radio operators who check in every morning and every evening in order to fulfill the emergencies that may arise in eye banks throughout the world. Eyes from a patient who has died in Miami at twelve noon have been in Denver, Colorado, in time for 8:OO P.M. surgery that same evening, or Los Angeles, California; or Tyler, Texas. Hospitals, physicians, funeral homes, highway patrols, the sheriff’s department, police departments, airlines, all assist voluntarily in order that this facility can function successfully. It is important to remember that eyes not suitable for corneal transplant surgery are invaluable for study in the causes and cures of some of our many blinding diseases today. The Florida program encompasses the operation of an eye pathology laboratory for the processing of ocular tissue and specimens. Specimens from all sections of the country are
62
submitted and after microscopic study, reports are sent back to the submitting physician so that he can adequately treat his patient. Every one has the privilege of playing an integral part in this program of sight restoration. The future looks bright for Bill and his family thanks to the gift of an unknown friend. These are some questions asked by persons interested in donating their eyes: 1) My vision is poor. I wear heavy glasses. Can I donate my eyes? Yes. Anyone can donate eyes. 2) I am 77 years old. Am I too old to donate my eyes? No. One is never too young or too old to give this blessed gift. Color of eyes, sex, age or race also does not matter. 3) Can eyes be stored, like blood? No. For best results, doctors prefer to use them within 48 hours after death of donor. In some special cases frozen tissue can be used. 4) Is the appearance disturbed when eyes are removed? No. Morticians use their skill so that the features remain unchanged. 5) Are there any religious objections? No. All major religious faiths approve and endorse this humanitarian program. 6) What is the procedure when a donor dies? The nearest of kin, nurse, funexal director or anyone who is aware of the donor’s wish to leave his eye to the eye bank should phone the nearest eye bank immediately anytime of day or night.
AORN Journal
60
directly across the pupil! ! The ophthalmologist was optimistic, however. The tissues might continue to heal and repair themselves to the extent that the scar would diminish and not block the vision. Bill soon returned to work to find he could not perform the intricate details necessary to his job. His right eye had a blur that he could not see around. The follow up with the ophthalmologist revealed the answer. Bill would require a corneal transplant. The ophthalmologist explained the procedure to him: A critical part of the surgery would be the securing of eyes at the time that the surgery would be performed. The need for fresh tissue for corneal transplant procedures far exceeds the supply so there would most likely be a waiting period. Because of this critical need, eye banks throughout the world have been organized to assist in this effort. This is how eye banks originated and work constantly in an effort to educate and expose the public to the need for eye donors. After eyes have been removed by the physician, they are examined under a slit lamp to determine whether or not they are suitable for a corneal transplant. If, after examination, the corneas are found to be suitable for use, the next doctor on a waiting list is called. He must contact his patient, arrange for a hospital bed and operating time. Bill was now on standby to be admitted for a transplant, A week went by before he was called on to come to the hospital-the eyes were available. Bill thought his second visit to surgery was more involved. He remembered some of the events. The operating room was quiet but he could hear the surgeon and nurses. His face was cleansed and covered with sterile drapes. The nurse had arranged oxygen under the drapes to help him breathe more easily.
AORN Journal
Inspection o f donor eye with slit l a m p incorporated w i t h microscope prior to surgery.
Surgeon with operating microscope controlled b y foot.
His arms had been tucked down by his sides
the operating room, Bill was on his way back to his room. He was moved on a Translift and both eyes were covered to keep him from moving them more than necessary that first day. Bill’s recovery was uneventful. The graft “took” well and in a few weeks only a trained observer could see any sign of the graft. Certainly Bill and his family were overjoyed at the surgeon’s success and the return of his priceless eyesight. Even though thousands of people have signed donor forms for the purpose of donating their eyes after death, most are young or middle aged and the immediate needs are not being met. Because of this situation, many families have to be approached immediately following the loss of a loved one. Eyes, if they are to be used for corneal transplant surgery, are to be removed preferably within four to six hours after expiration, and used in surgery within twenty-four hours
and he drifted in and out of sleep. While Bill dozed, the ophthalmic team prepared the donor eye. The surgeon had determined the size needed for the graft. Under a powerful microscope, he removed a tiny circle of the donor cornea using a trephine in much the same way you would cut a round cookie with a cookie cutter. The new disposable trephines are superior to the former reusable instruments. Using the same trephine, he removed a circle of Bill’s cornea and lifted out the offending scar. The graft (or donor cornea) fit into the opening perfectly, and was sutured in place. Bill, of course, could not observe the intricate microscope operated by ‘the surgeon’s feet, the delicate instruments, almost invisible suture with its tiny, microscopically inspected needle, or the nursing team whose training in this specialty made them a valuable asset. In an hour or less from the time he entered
February 1968
61
Trephines with cutting edge exposed.
(Above) New disposable trephine with guard
in place. (Below) Reusable trephine.
after death. Making provision for the donation of eyes in one’s will is ineffective since too much time elapses before the will is read. Donor eyes are available locally or statewide to any ophthalmologist in need of eyes for transplantation. If these needs are fulfilled at the time of donation, then the donor eyes are sent to other cities in need of eyes or, at times, are shipped internationally via the International Eye Bank in Washington, D.C. These efforts are accomplished through the cooperation of the Eye Bank Network, a group of volunteer amateur radio operators who check in every morning and every evening in order to fulfill the emergencies that may arise in eye banks throughout the world. Eyes from a patient who has died in Miami at twelve noon have been in Denver, Colorado, in time for 8:OO P.M. surgery that same evening, or Los Angeles, California; or Tyler, Texas. Hospitals, physicians, funeral homes, highway patrols, the sheriff’s department, police departments, airlines, all assist voluntarily in order that this facility can function successfully. It is important to remember that eyes not suitable for corneal transplant surgery are invaluable for study in the causes and cures of some of our many blinding diseases today. The Florida program encompasses the operation of an eye pathology laboratory for the processing of ocular tissue and specimens. Specimens from all sections of the country are
62
submitted and after microscopic study, reports are sent back to the submitting physician so that he can adequately treat his patient. Every one has the privilege of playing an integral part in this program of sight restoration. The future looks bright for Bill and his family thanks to the gift of an unknown friend. These are some questions asked by persons interested in donating their eyes: 1) My vision is poor. I wear heavy glasses. Can I donate my eyes? Yes. Anyone can donate eyes. 2) I am 77 years old. Am I too old to donate my eyes? No. One is never too young or too old to give this blessed gift. Color of eyes, sex, age or race also does not matter. 3) Can eyes be stored, like blood? No. For best results, doctors prefer to use them within 48 hours after death of donor. In some special cases frozen tissue can be used. 4) Is the appearance disturbed when eyes are removed? No. Morticians use their skill so that the features remain unchanged. 5) Are there any religious objections? No. All major religious faiths approve and endorse this humanitarian program. 6) What is the procedure when a donor dies? The nearest of kin, nurse, funexal director or anyone who is aware of the donor’s wish to leave his eye to the eye bank should phone the nearest eye bank immediately anytime of day or night.
AORN Journal