Craig Blackwell, MD
Ophthalmology

Santa Cruz, CA
Diplomate: American Board of Ophthalmology
Fellow: American Academy of Ophthalmology

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An Ophthalmology Practice in Santa Cruz, CA

Guatemala Clinic Intro Part Five

April 22nd, 2008

We do a fairly thorough eye exam including pressure check and dilation. There is a supply of glasses, mostly readers, to give out. It doesn’t matter where you live the need for reading glasses occurs at the same age and progresses at the same rate.

Quartet of women waiting in the hallway. Their matching dresses suggest they are from the same village. Sr. Mary says you can judge a person’s financial status by their footwear or absence thereof.


Examining a patient in the clinic.

We see a lot of people with eye irritation from the smoke from the cooking fires in their open air homes. Exposure to sun and wind means frequent pterygia, the membranous growth over the cornea. If it is near the central cornea, likely to block vision we surgically remove that.

Trachoma is an eye infection we don’t have in the US. It’s spread is facilitated by close quarters and poor hygiene. It starts as conjunctivitis, but with time it scars the inside of the eyelid causing it to rotate inward so the lashes rub on the cornea. That leads to pain, corneal scarring and vision loss. If caught in the early stage the treatment is antibiotics (oral, drops or ointment). Once the lid is scarred inward then a surgery can be done to rotate it outward, to the great relief of the patient. Having only read about trachoma before coming here, I got an education on how to recognize the early signs from Chepe, one of the clinic’s medical technicians who travels to outlying villages to screen and treat.

Cataract is a problem that so far has only one solution, surgical removal of the clouded lens and replacement with an artificial lens. In the beginning of the week when the surgical schedule is open we will operate on patients who have a dense cataract in one eye. By midweek as the schedule fills we only operate on people who have dense cataracts in both eyes. Specifically, we do one eye so they can be functional. Consider that people who are bilaterally blind require the nearly full attention of a family member, who is freed of that responsibility if vision is restored.

Patient with cataracts getting ready for surgery. Note the pupils are white.

A large percentage of patients have pseudoexfoliation, an eye condition with extra deposits inside the eye associated with an increased chance of glaucoma and a weakened lens capsule.

Dr. Hsei performing cataract surgery, with nurses Pat McVeigh scrubbed in and Denise Weybright circulating. Shelf on the left holds sutures, lens implants and other supplies.

The main operation is for cataract. We have a simple operating microscope. There is no complicated phaco surgery here, only the older, but much simpler extracapsular technique. It requires a large incision and sutures to close, but the equipment is simple, and manually operated.
Eight to ten cataracts can be performed per day with an occasional pterygium removal, lid repair or glaucoma surgery. One of Dr. McKenzie’s goals is to include a local ophthalmology resident in training for surgical experience to which they have limited exposure.

Dr. Adams and local ophthalmology resident are examining a postop patient. Dr. Adams is retired from his practice in Santa Cruz, now living in San Diego.

Rosie Camp, one of our translators, explaining postop drops to patients and their families. If they live in the vicinity they will have one followup visit a week later with the ophthalmology resident.