Johannes Weigl
With the following report I would like to give a short overview of my last ten days at the Department of Ophthalmology. I just write about my experiences I could gather during that time and make no claims of completeness of content regarding specialist knowledge.
The first two weeks of my medical clerkship at the University Hospital of Tsukuba I spend at the Department of Ophthalmology with Dr. Fukuda as my first person to turn to.
In the afternoon of Monday, 25th February, I had my first contact with the physicians, students and patients at the Ward Building. Each Monday the patients who were operated in the last time or are going to be operated the following days are checked by the professor or his representative. After that procedure all physicians and students usually go to the conference room where the surgeries of the week are discussed and actual examination results are shown to the professor respectively his representative. At the end of the day, the students whose two-weeks practical training is starting should shortly introduce themselves to the attendants. Following, I got a private lecture from Dr. Okamoto about the most common eye diseases in Japan why patients have to be operated in the hospital. For two hours, I was taught many things about cataract, glaucome and retinal detachment, for example the most important risk factors of developing a cataract namely aging, steroids and diabetes mellitus. I also was informed about the differences between monofocal and multifocal lenses as well as the usual surgical techniques at the University Hospital of Tsukuba. All in all, I got well-prepared for the next day on which I could watch a lot of surgeries.
Tuesday and Thursday are always the surgery days in the Department of Ophthalmology. I’m still very glad to had the chance to be present because I got a great impression how the treatment of the patients and the behaviour in the surgery room is managed in Japan in comparison to Germany. After the surgery, the students and I had a lecture about age-related macular degeneration.
On Wednesday, 27th February, we met at the Ward Building to practise how to use a slim light microscope and an indirect ophthalmoscope which is used by the check-ups on Monday and Friday, for example. On this occasion, we students examined one another by looking at the fundus and its vessels after taking some eye-drops for widening the pupil. In the early afternoon we had a lecture about “How to look at the picture of the fundus” and the typical appearances of the fundus by different diseases.
Thursday was completely marked by surgeries including vitrectomies or lense changes. On Friday, 01st March, we had the possibility to practise anamnesis conversations with two patients, a 42-years old woman who suffered from a glaucoma and a 60-years old man who complained of vision disorders and said that if he just looked with his left eye, the centre would appear dark. In the following discussions with the physician, we were taught that according to the patient’s words a macular hole as well as a macular pucker was a possible reason and further examinations had to be done. In the lecture we students also heard something about idiopathic neuritis treatment and the differences between symmetric and non-symmetric defects which might point to a brain tumor or a peripheral located problem like an eye damage. In the afternoon, the first week ended with the same procedure it started on Monday, the check-up of the operated patients and those who are going to undergo surgery next week. At the beginning of the second week I had the pleasure to get to know other Japanese medical students I did practical training the remaining five days with. On Monday, 4th March, we were introduced to the different instruments which are used in Ophthalmology by Professor Oshika himself. It was very interesting, especially because each student was examined by another one and so we got information about the condition of our own eyes and learned how to use the medical equipment as well. For example, our eyes were tested for nearsightedness and longsightedness as well as the axial length. We also got a picture of our own fundus or had the opportunity to look through different formed lenses. That way, we got an impression how a patient with strabism is able to perceive the environment. At last, we also could use the specular microscopy which is an important part of the preoperative evaluation if corneal guttata or other signs of a low endothelial cell count are found. We heard that it must be done before any examination that might roughen or dry the corneal surface. In the early afternoon, we learned something about the detection of perimetric sensity loss and about color vision. For that reason, we tested one of our own eyes with the 24-2 SITA Standard Test Procedure on the Humphrey Field Analyzer which made the topic even more interesting and impressive. Furthermore, now we also know the fundamental differences between pseudoisochromatic plate tests like Ishihara’s test and arrangement tests like the Farnsworth-Munsell 100 Hue-Test as well as the fact that the “gold standard” of the color vision tests, the Rayleigh color match, is performed on the anomaloscope. The very informative day ended like last week’s Monday, so the check-up of the patients and the discussion in the conference room.
On the next day, many cataract surgeries had to be done and one highlight of my time at the Department of Ophthalmology occurred. I had the honor to sit down next to the professor during one cataract surgery and to trace every single step by the microscope. Although the surgery was finished after a few minutes, I’ll never forget that impressive situation.
We students could practise our own skills concerning phaco technique with a pig’s eye on Wednesday, 6th March. It was very fascinating to try out yourself and to get confirmed your premonition how difficult it is to operate on such a small and sensitive area like the eye. We were taught by Dr. Fukuda that this kind of technique is very often used in other Asian countries like India but is not anymore common in Japan because of the excellent equipment most of the hospitals here are fitted with now.
The surgeries at the following day were dominated by cataracts, but macular hole and some emergencies had to be treated, too. At the end of the day, I was a little bit sad because of the fact that I won’t watch any ophthalmologic surgeries for a long time from then.
Then, my last day at the Department of Ophthalmology came up. In the morning we students had the opportunity to anamnesis conversations with two patients once again; one of them was a 79-years old man who suffered from macular degeneration on his right eye. The other 59-years old man talked to us that he went to his physician for check-up and on this occasion, a bleeding behind the cornea of his left eye was found. In the following, we discussed our results with a physician and received important tips how to get as much information as possible from the patient without being too intimate. The topic of my last lecture was diabetic retinopathy. Interesting videos about trabeculectomy or glaucome shunt implantation were shown to us and we learned that 40% of patients with diabetes mellitus would develop diabetic retinopathy as well as 10% of the patients suffering from that would acquire a proliferative diabetic retinopathy. With the meanwhile well-known check-up my great days at the Department of Ophthalmology came to an end, unfortunately.
All in all, I’m very grateful for the last two weeks! I could get so many unforgettable impressions I never dreamed of. And even though I could do my medical clerkship in a country whose health care system seems to be quite similar to the German one there still are many differences which to know is very enriching, in my opinion. I would like to give thanks to all the physicians and students who helped me so much by translating so many times and who brought me wonderful evenings because of joint dinners or even a volleyball match!!!