Keratoconus: The Evil Eye of the Sun

The Evil Eye of the Sun
Ramesh Avadhani, our chief Indian correspondant, is back with a story about the effects of a solar eclipse...
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I am well versed with his routine because I can see directly across my window into his house. At 8.30 in the morning he is off to work on his two-wheeler. By 6.30 he is back home, has a bath, and settles down to watch TV.  Often I see him engrossed for hours in a movie or soap serial, or a cricket match between India and say, West Indies. Then dinner, and finally the lights in his house go off by 10. All quite predictable you could say.


But all this changed recently. I saw him and his wife leaving the house hurriedly at all kinds of odd hours, and even skipping work. The couple looked uncharacteristically disturbed. The second or third time they were preparing to ride off, I couldn’t restrain myself. “What was the matter?” I asked. Kattimani, my neighbor, just shook his head. “My eyes, they are gone,” he said. “I have to get them operated. I need to shell out 40,000 rupees.”


Forty thousand, almost a thousand dollars, is a substantial sum for an Indian middle class family; two or three months’ salary. What sort of eye trouble was it that required so much money? The most I was aware of was Rs 20,000, charged for laser operative procedures to correct short or long sightedness. Must be all that TV watching, I thought. I’d observed that he sat pretty close to the box.


“That’s because I can’t see properly,” he said. “The thing is in childhood, I stared at the sun with my naked eyes. There was this solar eclipse in my native town of Dharwar. Most people were looking at the moon crossing the sun, using dark or smoked glasses and other safe methods. But I thought, what the hell, what can happen if I look with my naked eyes?”


This happened in 1987 when he was studying in pre-university. The time was around noon, he recalls. He was with some of his friends, all boys. Initially the eclipse was hidden by a large cloud. “My friends, being from conservative families, didn’t look at the eclipse. As you know a lot of Hindus are like that.”


“But I was the most progressive minded of my friends,” said Kattimani. “I kept looking up, waiting to see the sun. The cloud broke and there it was, an utterly dazzling spectacle. I stared transfixed. Just a few seconds, maybe four or five, passed, and then I could no longer look.”


He didn’t suffer any ill effects. Not right away. Not until a few weeks later, when he was strolling down the main road of the town and glancing, as was his habit, at the prominent clock tower there. Amongst all his friends he was always the first to read the time from a distance. But this time the hands of the clock were blurred. “I was a little perplexed but didn’t take it seriously. I thought it was a momentary phase.”


The trouble deepened in the next two years, when as a student of B.A. he was unable to read the writing on the blackboard. “Again I didn’t make much of it, just carried on, copying notes from the boy sitting next to me.” Some weeks later, when he found that irksome, he went to the district hospital and got his eyes checked. Dr Mitara there prescribed lenses for short sightedness. “The power was negligible, minus 0.1. So I was lulled into thinking that there was nothing seriously wrong with my eyes.”


In 2002, he married Uma and since then she had been pestering him to get his eyes checked by a specialist. It took him four years to relent; he met with a doctor. “He was the first doctor to tell me that the ‘axis’ and ‘spherical power’ required for my glasses were changing rapidly, that my eyes were deteriorating. That was true; even with powered glasses I had to look sideways to see an object properly. Yet, this doctor only prescribed some eye drops and tablets, and didn’t explain what was wrong with my eyes. All he said was that an operation could be risky, that I ought to manage with whatever sight I had.


Then I got another pair of spectacles with power of minus 8.75 for working at the computer, thinking that would solve the problem. But I used to get headaches. So I stopped wearing those spectacles.”


In May 2009, the same doctor prescribed some eye cream with a steroid content when Kattimani told him he was experiencing pain and irritation. Kattimani applied the cream at night and immediately screamed. His eyes turned red and he rushed to the bathroom to wash them. “I told the doctor about it and he just said, stop using the cream. It’s only last month I learnt that I am severely allergic to steroids in any form.”


In September this year, when the refractory power of his glasses crossed -10, Kattimani finally heeded Uma’s advice. The couple went to the famed Netradhama Eye Hospital. Dr Sagar S. Kharosekar there did a thorough check up and gave the alarming verdict: Kattimani’s eyes had deteriorated badly over the years due to his boyhood defiance of the sun. Corrective operation was absolutely necessary. Else he would be blinded irreversibly.


“I was suffering from a rare degenerative disease called Keratoconus. About one in a thousand have it. The condition could be prevented from deteriorating further by an operation called C3R—Corneal Collagen Cross-linking with Riboflavin.”


(Briefly, Keratoconus is a condition where the front transparent portion of the cornea bulges out a little like a cone and so loses its gradual curve. That plays havoc with focusing of images on the retina.)

“Shapes of images tended to vary, and there was a blurry effect, I found myself waiting for at least a minute to recognize what or who I was looking at. I couldn’t recognize my own wife if she were standing at a provision store or walking by on the street! At night the condition was worse. I couldn’t drive safely because the lights were scattered.”


Kattimani remembers the doctors cleaning up his eyes thoroughly and administering anesthesia. Then the delicate procedure started—applying the Riboflavin medicine every five minutes and exposing the cornea to calibrated UV-A light for half an hour or so.


“They kept asking me at regular intervals, how I was feeling, whether I was experiencing pain. When I said, yes, they anesthetized me some more.”  Outside, Uma kept asking the nurses how her husband was faring. The operation lasted two hours.


“A success,” the doctors declared. Uma breathed a sigh of relief and Kattimani thought that was the end of his problems. That wasn’t to be.


The  doctors gave him two types of eye drops. One of them unfortunately contained a steroid.


Kattimani experienced severe pain the first night but stoically bore it. The doctors had warned him about it, that he should manage the pain without painkillers else he would have to be dependent on them for a long time. But worse things followed. “Everything appeared foggy. I even asked Uma whether she had mistakenly left something to burn in the kitchen. The tube lights radiated several colors, not just white. And there was a lot of pressure inside my eyes. I had to exert myself to focus on even nearby objects. I couldn’t go to office. I suffered like this for a fortnight. I thought my eyes were finished, the doctors had botched up the operation.”


It was only after consultation with the doctors that the criminal was found—the steroid in one of the eye drops. “The doctor advised me to discontinue it immediately and replaced it with another steroid free medicine. They said if I had delayed coming to them I would have lost vision permanently.” In future, Kattimani has to be extremely careful not to apply or take anything that has steroid in it—shaving creams, perfumes, deodorants, skin creams, soaps, and of course medicines.


"What next?" I asked.


“We have to wait for six months to see if this operation has halted the deterioration in my eyes. Then the doctors want to perform another surgery called ICL whereby I wouldn’t have to use spectacles at all. The cost is 150,000. I don’t think I can afford it. Even this 40,000 that I have spent, I can't afford it. I do have insurance but it does not cover degenerative diseases. I will pull on with my minus 10 glasses. After all there is no urgent need for perfect vision. I am already approaching 40, two thirds of my lifespan is over. What is there to achieve now? I have a family, a job, that’s enough!”


I expressed surprise at his statement. He laughed and said, “See, I must be grateful for what I have. Just yesterday, a colleague of mine passed away due to heart attack. He was only 49.”


Any concluding thoughts?


“Yes,” he said. “I should have stayed home during that damn eclipse.”

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