Moorfields Eye Hospital consultant ophthalmologist Kamran Saha has carried out a complex eye procedure to give back to a patient with Motor Neurone Disease her means of communication.
Pam Franklin has had Motor Neurone Disease (MND) for 35 years, has tetraplegia and now uses a device that tracks her eye movements and turns these into commands for a tablet, including her ‘voice’. As such, it has become a cornerstone of her communication.
Her communication device works by monitoring reflections from her pupils. Recently, though, she has developed cataracts that have clouded these reflections, as well as restricting her vision – cataracts being the clouding or opacity of the lens inside the eye. The treatment for these is to replace the natural lens with a clear artificial one, restoring the clarity.
The surgery was considerably more complex than most cataract operations, with Pam needing extra care. The eye tests to calculate the best replacement lens to use had to be done while she was lying down, rather than sitting up, due to her quadriplegia. Because of her difficulties in communicating without her tablet, her daughter came into the theatre with her to assist during the procedure. Her surgery was bilateral, meaning the lenses were replaced in both eyes at the same time, to help her recover more quickly and to avoid multiple appointments. This was done with sedation because of her anxiety over the procedure.
Pam said: “Over 35 years, my MND has reduced my independence considerably, to where I am no longer able to do anything for myself, not even speak. But I can use my eyes.
“I was so looking forward to this surgery, though I was really apprehensive too. I’ve found it harder to communicate with people, and I’ve struggled with emails and shopping online. When I’ve gone out, it’s been getting more difficult to see films or follow shows at the theatre, both of which are great loves of mine. I’m hoping to see Hamilton for Christmas.
“Every day since the operation, my vision has improved, and I am still amazed as I notice things in sharper contrast. I can now see that the wool of my new cover is in two shades of green! I have already been out to the cinema and, now I have my voice back, I can live my life to the full again! The more I think about it, the more grateful I get. It truly is remarkable.”
Kamran added: “At Moorfields, we restore the sight of more cataract patients than anyone else in London. Very few other hospitals can offer anaesthetic cover, sedation and allow family members or carers in to support patients, allowing us to treat more complex patients. We bring all of this expertise and back-up to more routine cataract patients too, all NHS-funded. It is a privilege to help restore Pamela’s communication, as well as her sight.”
Pam’s full story – in her own words
“Over 35 years, my MND has reduced my independence considerably, to where I am no longer able to do anything for myself, not even speak. But I can use my eyes.
“I first approached Moorfields ten years ago about having laser treatment on my eyes to provide monovision [where the replacement lens in one eye is optimised for distance reading, the lens in the other eye for close-up] so that I didn't have to keep asking carers to put my reading glasses on. They were usually dislodged by the headrest on the wheelchair anyway, I could not replace them and I found it so difficult to use my Eyegaze system without them, something that had made my condition much more bearable. It speaks for me, enables me to communicate with the world by email, Zoom, video calls, I would be lost without it. My independence is very, very important to me.
“Moorfields was initially reluctant to do laser treatment because of the difficulty of getting accurate measurements of my eyes and the importance of my sight, but they let me try wearing one lens for reading, leaving my right eye, which is naturally long sighted, as it was. It worked! I used the lens for many years until I began getting a lot of infections, when I agreed to stop using it.
“In Autumn 2023, I had a mini stroke. In the days afterwards, I noticed that my vision was suddenly worse, my eyelids had also dropped. I didn't tell anyone because I feared being hospitalised and I just continued until a few months ago I asked my GP to refer me to Moorfields, who confirmed I had cataracts.
“The rest is now history. Kamran Saha and I discussed the possibility of him creating monovision again when he removed the cataracts. “During the weeks following, I was quite doubtful about this because of the difficulty of measuring my eyes and I also had some anxiety about having any treatment at all. As my eyesight worsened, I had to make the print on my device larger and I also had to spend less time on the device too. I decided that I had to have the operation done, regardless of the fact that I might have to wear glasses after the surgery.
“The day arrived and I had asked my GP for a small supply of Valium to calm my anxiety and prevent the potential rise in my blood pressure (which had happened in a previous operation).
“I was treated by the whole team as if I was royalty. I had put some phrases on the device before I left home and the team gave me plenty of time to write new ones. I felt listened to.
“The anaesthetist came to discuss sedation and other options for numbing my eyes and he mentioned that I had very small and difficult veins to get access to so he would continue with using drops to numb my eyes. It was honestly absolutely, totally pain free.
“During my weeks running up to the procedure, I kept trying to imagine whether I would be able to watch or feel what was being done. The answer is no feeling or pain, my daughter was by my side, holding my hand and it was over in an hour, much easier than I ever imagined possible!!
“I was sent home wearing two eye shields, sleeping most of the way home. We swapped these for extra dark sunglasses, which I wore night and day for two or three days, and then changed to lighter one.
“I did try the Eyegaze for an hour afterwards on the third day and it was OK, it worked with these beautiful new eyes! Every day my vision improved, and I am still amazed every day as I notice things in sharper contrast. My new woollen cover is green, but now I can see that the wool is in two shades of green!
“This monovision that I had hardly thought possible. My vision is absolutely amazing! Even the device is sharper, the screen on the wheelchair is clear too. It's much better than I ever imagined.
“Thank you, Moorfields, the more I think about it, the more grateful I get. It truly is remarkable - please thank the team for me.”
20 December 2024