Caitlyn, a Western University Veterinary Student, got to intern for both Dr. Esson and Dr. Calavarese over the last month! Each week she wrote her educated experiences while observing multiple ophthalmic cases.
Extern Diary - Week 1: “Hi everyone! My name is Caitlyn, I am a 4th year veterinary student from Western University of Health Sciences. I am wrapping up my first week on rotation with the kind and talented team here at VOC. From day one I was able to see a wide variety of cases including exams with diagnostic procedures, surgery and medical management. So far I have learned so much about evaluating eyes and I have seen a plethora problems including eyelid masses, corneal degeneration, ulcers, dry eye, glaucoma, uveitis, ocular tumors, and the list goes on.
This week, I had the pleasure of learning about a diagnostic test called an electroretinogram (ERG). The ERG is a test that allows us to measure the electrical activity of photoreceptors within the retina. This test is not painful or traumatic for the pet in any way, the data is collected much like an EKG measures the electrical activity of the heart. There are many reasons to perform an ERG but the first patient scheduled for this diagnostic test was a non-visual dog with cataracts. Measuring the retinal activity is important in order to determine if the patient is a good candidate for phacoemulsification (cataract surgery). We always want to make sure that the primary cause of the loss of vision is due to the cataracts and not retinal damage.
I also got to watch Dr. Esson in his surgeries, especially with this cute bulldog, Abby, who was a very good patient!”
Extern Diary - Week 2: “As a veterinary student, it’s always fun to learn about rare cases- like the patient who came to us with a deep corneal abscess in one eye and uveitis in both eyes- BUT the goal in veterinary medicine is to maximize the quality of life for our patients. So, I thought of the best example of how Dr. Esson and his team have been improving the quality of life for VOC patients this week.
As I took my time reading from Dr. Esson’s textbook I was struck by the impact glaucoma can have on the quality of life if left unmanaged. Glaucoma is a condition where the pressure inside the eye, the intraocular pressure (IOP), is above normal and symptoms arise. Glaucoma can lead many changes including ocular discomfort and loss of vision. There are many causes for this condition, some breeds just have more of a chance genetically, it can result from past trauma, and sometimes the increased IOP is secondary to systemic disease like diabetes.
I could only imagine the discomfort this condition inflicts, and how it would interfere with daily activities. I made it a goal for this week to learn how Dr. Esson manages glaucoma with medicine and/or the many options for surgery! This week reminded me that great quality of life does not hinge solely on achieving a visual eye. Our pets are incredible at adapting to their environment.
My favorite tip that Dr. Esson shared with me this week was how to help a dog adapt to vision loss. **A non-visual dog will lean on a friend for support if your dog is an “only child” think about introducing another dog to help navigate, play and enjoy a great quality of life using every other sense!” 👩🏼⚕️
Extern Diary - Week 3: “It has been another busy week at VOC as Dr. Esson prepared to fly to a conference in Dublin, Ireland. I was elated to have the opportunity to visit the Upland clinic and learn from Dr. Calvarese (Dr. Esson’s wife). Not many veterinary students have the chance to observe the styles of two different ophthalmologists!
This week I dove into the topic of ocular emergencies. One emergency that caught my eye was luxation of the lens as my own dogs happen to be predisposed to this condition. Small Terrier breed dogs, Cattle dogs, poodles, and Shar-Pei are commonly affected.
I have learned that a lens can luxate (shift around) after the ciliary zonules fail. These little collagen fibers normally hold the lens in place behind the pupil and without them the lens is free to move around the globe and cause many problems. If the lens moves to the front of the eye (anterior luxation) it can block the flow of fluid through the pupil causing increased pressure inside the eye.
The lens can luxate early in life if the zonules do not form properly or they can rupture in middle age (typically at 5-6 years of age). Signs that a pet is experiencing lens instability include squinting, a cloudy eye, and signs of pain due to increased eye pressure. Lens luxation is diagnosed easily by looking into the pet’s eyes with a light source. The veterinarian may even see the lens in front of the iris.
Moving forward with surgery as quickly as possible is essential if the pet’s vision can be preserved. The surgical removal of the lens is called intracapsular lens extraction (ICLE). The removal of the lens is a microscopic procedure where the surgeon makes an incision into the globe and carefully removes the lens and the capsule. With any procedure there is a chance for complications but the capsule is not opened during this procedure and the post-op inflammation is minimal. “Willy” was adopted with only one eye so her only chance for vision preservation was the ICLE procedure. Her surgery was a success and we expect a smooth recovery!”
Extern Diary - Week 4: “I can't believe it has come to the end of my Ophthalmology rotation already! In just four short weeks I have had the opportunity to see some very interesting cases with Dr. Esson and his incredible team at VOC. I have been armed with resources I need to continue my education and inspired to utilize them with each opportunity. This week we had many cases that lead me to focus on the structures surrounding the eye. As an Ophthalmologist, Dr. Esson is not just responsible for the eyeball. The exam includes the orbit and globe of course but the eyelids (all three!), conjunctiva, nerves, and lacrimal (tear production) system are equally important. There could not have been a better demonstration of the intricacies of the profession than the afternoon that we saw two sweet dogs each presented to VOC with a growth on the eye. Dr. Esson reviewed the chart for the first pet and had a chat with the referring veterinarian before going into the exam. We learned that this dog has had a history of Onchocerciasis an infection of a worm that infects a ligament in the horse's neck! This case is a very rare presentation of a parasite that can bury itself in the tissues surrounding the eye. As the worms grow stronger and multiply the tissue becomes irritated and attempts to "wall it off" with something called a granuloma (that's the growth of tissue we can see!). The parasite and the granuloma can cause harmful inflammation and trauma to the eye over time. Luckily with the careful consideration of the pet's history, a thorough exam, and some diagnostic testing, this pet has an excellent prognosis with surgical removal of the growth and systemic treatment to ward off any parasites hiding away. My last day here at VOC was so much better than I could have imagined! I had the opportunity to work with a preceptor who inspired me to work with exotic species in my third year of vet school (Dr. Weldy) and he brought some beautiful birds for us!” 🦅
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