The List

She was a 29-year-old female who did not speak a word of English (but only her local tribal tongue).  She was reserved, shy, and barely uttered a word during the whole clinic visit.  Slightly overweight and with a moon-shaped face, she was not the most attractive young woman.  Her vision was counting fingers at 1 meter in the right eye and counting fingers at 6 inches in the left eye.  Her “sister,” who spoke perfect English, was much more self-confident and served as the patient’s spokesperson.  

The story unfolded.  They were both orphans.  Since the age of two, the patient had started to have difficulty with vision.  In grade school, she could not see the chalkboard at the front of the class.  Even over the last few years, the vision had declined.  Last year, the patient got married.  However, “because of the issue of the vision, she was chased by her husband,” recalled the sister.  Three years ago, the patient came to Lusaka Eye Hospital for an examination.  She was told that she needed to go to South Africa to find glasses that fit her prescription (likely because of high astigmatism).  She had no money for the glasses, so she remained as she was – living life in a blur, without any semblance of clarity.  When I examined her, the eyes were completely normal except for her corneas – steep cone-like protrusions with apical scarring typical of severe keratoconus.  The sister begged me to help the patient.  All I could offer was some advice (no eye rubbing), and placement of the patient name on the Corneal Transplant List.  Options are limited here.  Hopefully I can find a way to obtain corneal tissue in the near future.  

Another patient, a 5-month-old infant, was brought in by his parents.  He had apparently had corneal opacities in both eyes from birth.  The white opacities had gotten more and more dense over the last few months.  Surprisingly, the patient did not have nystagmus, but the intraocular pressure seemed high by palpation.  Peripherally only in the left eye, one could observe a formed anterior chamber and flat iris.  Like a knee-jerk reflex, my mind categorized all the possible causes of white corneas in infants (STUMPED: sclerocornea, tears in Descemet’s, ulcers, metabolic/mucopolysaccharidosis, Peter’s anomaly, edema from glaucoma or CHED, dermoid).  The cornea didn’t look characteristic of the corneal edema from congenital glaucoma that is so common in Zambia.  It seemed to be more of a congenital metabolic process.  I scheduled him for an exam under anesthesia.  After that, he may need to be placed on the ever-growing List.  

As the only full time practicing corneal specialist in the entire country of Zambia – a country with 13 million people and only 22 ophthalmologists – I’m quickly realizing that I need corneal donor tissue, and I need it fast.