One on One Teenage blindness helped inspire me to become ophthalmologist, says Dr. Jarka Heissigerová
Jarka Heissigerová is an internationally recognised expert on uveitis, a rare, hard to diagnose and potentially blinding eye condition. The doctor, who spent a number of years studying and working in Scotland, switched her focus to the disease after previously specialising in the incredibly complex procedure of corneal transplantation. Our conversation took in those fields – and eye-care in general – but I first asked Dr. Heissigerová what had inspired her to become an ophthalmologist.
“Because when I was 16 I actually lost the vision in one eye and for several months I couldn’t see with one eye at all.
“But then suddenly the vision came back and since I see very well.
“So when I started to study medicine, this might have been the original reason why.
“When in the fifth year the very first day we studied ophthalmology I fell in love with it. And I’ve never fallen out of love with it.
“Ophthalmology is a fantastic field which covers everything in medicine. It covers inflammation, surgery, plastic things like skin procedures, tumours – everything, simply.
“Anything you like you find in ophthalmology. It’s so delicate. Just a fantastic field.”
Before we move on I have to ask you, what actually happened to you? How did you go blind? Do you know what happened?
“There is a very specific disease. It’s a disease of the yellow spot, which is the major part of the retina with which you see.
“And in young women, this actually sometimes happens. Why has not been explained at all, but it occurs.
“It doesn’t leave anything in your eye, but for a certain period of time – for weeks or months – you lose your centre of vision and it comes back.
“And nobody can explain it.”
We had a professor at university who claimed – I don’t know if this is true – that Charles Darwin said that the eye could not have evolved because it’s so perfect. Whether that’s true or not, the eye is an incredibly complex organ. Is it the most complex, would you say?
“When I was 16 I actually lost the vision in one eye and for several months I couldn’t see with it at all.”
“It might be. But actually our eye is maybe not as well-developed as some scientists say, because the light in our eye actually has to go through the retina to touch the sensitive parts, and then goes back through the nerves and to the brain.
“Some people say that our brain evolved so well just because we needed some good ‘computer’ to process the not so good signal that it gets.
“So our brain probably evolved just because of our not so ingeniously designed eye.”
You went for some years to Scotland, Jarka. What brought you to Scotland? And what did you do there?
“I was sent there, originally. I had started my PhD studies at Charles University’s Ophthalmology Department and I was sent there for one year to get international experience.
“Actually at that time I was doing a very, very difficult surgical procedure, which was corneal transplantation in an experimental model.
“The cornea was only two millimetres in diameter and I was putting 12 stitches around it, under the microscope.
“At that time very few people around the world knew that technique.
“So I was sent to the department in Scotland, in Aberdeen, to continue with my research there. Because they needed somebody who would be able to do this surgical technique.
“I did a PhD there for about a year. I stayed slightly longer. I met a professor there who led me in my PhD – Professor Forester at the University of Aberdeen – and from corneal transplantation he showed me another fascinating field: the field of uveitis.
“It’s a very special intraocular inflammation – very damaging but quite fascinating. And he is a world expert in uveitis.
“So I came back to finish my PhD at Charles University and, two years later, I was called back to Aberdeen to spend another two years on clinical and basic research in another field: the field of uveitis.”
Getting back briefly to corneal transplantation, when you speak about the tiny scale – what kind of instruments are you using?
“We use very special ophthalmic instruments for ophthalmic surgery. Incredibly tiny instruments have been developed.
“For this corneal transplantation the tiniest are used. Also the tiniest stitches. It was in microns, really, the thickness of the thread and the needle.”
But are you doing it yourself in a hands-on way, or are you directing some machine?
“No, no, it was my hands that did it. And under the operating microscope it didn’t look so tiny.
“Under the microscope when you finally got the coordination right you could do that.”
Your specialisation is, as you say, uveitis, which is an inflammation of the uvea, the layer between the retina and the outer layer of the eye. How common is uveitis? And how does it manifest itself?
“For corneal transplantation the tiniest instruments are used. The thickness was in microns.”
“Luckily it’s very rare. In half of the patients it’s in the iris. It’s called anterior uveitis or iritis.
“This type of uveitis is very painful and, luckily, brings the patient to the doctor immediately and it’s very nicely cured with eye drops.
“So this is sort of the better type, even though the patient suffers at the very beginning. The pain itself is actually an advantage.
“Because there is another half of cases where it can be not painful at all. It can very gradually and insidiously lose the vision of the patient.
“Therefore these cases can very often be sight-threatening and need systemic treatment.
“The difficulty with uveitis is that we almost never on first sight are sure if it is infectious – if it’s a virus, bacteria or mycosis that’s causing it – or if it is autoimmune.
“If it’s autoimmune, you have to use immunosuppressive treatment – to suppress the immune system of the patient.
“However, if it’s infectious, you need to use specialised anti-biotics or virostatics.
“And these two treatments actually go against each other.
“So if you do not make a correct diagnosis you immunosuppress a patient who’s got a virus in his body and you actually suppress the last immunity he’s got and he needs to fight the virus.
“It’s quite a serious thing to make a correct diagnosis. And as it is quite rare there are not many doctors who are experienced enough with this disease.
“There are just a very few centres in this country who concentrate on this disease, as it is rare.
“I can for sure say that the biggest centre is at our hospital at Charles University. We’ve got five specialised doctors and I can vouch for them that they will see the patient and really, most of the time, make the correct diagnosis.”
If we could speak more generally about eye care, is there anything that people typically do wrong when it comes to looking after their eyes?
“Taking care of the eyes is actually the same as taking care of the whole of the body.
“You should eat well enough to have vitamins, anti-oxidants and minerals.
“All these are like little stones which build good vision, because they help the mechanism of the retina simply to work well enough.
“Next to good food, good lifestyle is also very important. You need to be active to have healthy eyes.
“Just a few years ago, there was a large study which showed that two hours spent outside is a great prevention of myopia, short-sightedness, in children.
“This is a big problem in places like China, Singapore – children are getting very myopic very early in their lives and nobody knew what was causing it.
“It’s probably not so closely linked to tablets and PDAs and mobile phones as it is thought, but more people spending more time inside than outside.”
So they don’t see long distances?
“Exactly. The eye [in such cases] is actually trained just for middle and short sight. The retina gets the signal, Yeah, we need this short sight, let’s make it better.
“Two hours spent outside is a great prevention of short-sightedness in children.”
“So the eye is very clever, nature is very clever: We need this, let’s get it to the eye.
“But it’s actually damaging for children. For everybody.
“So even for adults, they should take care not to… I wouldn’t say not to read too much, but to take care to look to the distance. Outside. Out of the window. And to swop between short and long distances.”
This leads to my next question. I remember, I don’t know, 10 or 15 years ago when everyone started using computers all time we got this advice, Take a break, look away for five minutes, leave your screen. But nobody says that anymore – am I right?
“You are right. And it’s actually even more important now, as it has become a lifestyle to look to your smartphone. If you look on public transport, everybody is looking at their mobile phones or tablets.
“People are therefore changing their vision. And they’re changing it for the future – it’s like Darwin’s theory!
“People in general will need only short sight so, Let’s change it! Nature is very clever and will give it back to us, if we want it.”
I feel like I’m abusing you with very general questions now. But one question I have about eyes is: Are cheap sunglasses dangerous?
“Many of those sold are dangerous, because there are many sunglasses which are only dark and do not have the specific UV filters they should have.
“There should always be a UV sign, a UV certificate.
“So to be honest you shouldn’t use very cheap sunglasses which you don’t know where they come from – and if they are really protective, or only sort of ‘browned’.”