Ophthalmology at Toronto Western Hospital

Hello everyone! The countdown has begun for my New Year’s Eve departure to Accra, Ghana. I printed out all of my tickets and program materials today, and it just hit me that I’m really going to Africa! With just under two weeks to go, things are going to be super busy around here! 

I spent this past week shadowing two incredible ophthalmologists, Dr. Buys and Dr. Drori, at Toronto Western Hospital. Dr. Buys is a professor at the University of Toronto, Department of Ophthalmology and Visual Sciences, the Co-Director of the Glaucoma Unit at the University Health Network, and an amazing physician! Dr. Drori is a Glaucoma Fellow here for one year from Israel (she isn't looking forward to the Canadian winter!). I spent the first day in the operating room with Dr. Buys, Dr. Drori, and the ophthalmic nurses. Since Dr. Buys specializes in glaucoma, I observed mostly glaucoma treatments, with a few cataract surgeries as well.

Glaucoma is an eye condition caused by increased pressure in the eye often due to improper drainage of eye fluid. The increased pressure causes irreversible damage to the optic nerve, and results in progressive loss of peripheral vision, eventually causing blindness in the eye. Glaucoma is a disease of aging, common in people over the age of 60. Glaucoma is also more common in persons of African descent and people with a family history of glaucoma.

If detected and treated early, permanent damage can be minimized or even avoided. However, once damage occurs, it cannot be reversed. Pressure-lowering eye drops serve as the first line of treatment for glaucoma. However, once the eye drops become ineffective, patients may require more drastic treatment, including operation.

The first procedure that I observed was a trabeculectomy. A trabeculectomy is a common glaucoma procedure used to relieve eye pressure. Surgeons remove part of the eye’s meshwork so that the fluid can drain normally, and the pressure can be lowered. I also observed a laser trabeculoplasty. In this procedure, a laser machine created small holes for the eye fluid to drain.

Last but not least, I observed a procedure where the doctors performed a combined cataract/glaucoma surgery. The doctors made a small incision to remove the cataract (opaque lens in the eye) from the patient’s eye, followed by a trabeculectomy.

I was amazed at how small and precise the eye incisions were, and how the doctors worked so efficiently. The turnover time for each patient was just roughly 10 minutes! Each procedure was very quick, clean, and efficient.

I spent the next two days in the glaucoma clinic observing the doctors following-up with patients, and diagnosing new patients. Follow-up is an extremely important part of the post-surgical healing process, as the eye needs to be closely monitored to ensure that infection does not occur, and that a lower eye pressure is maintained. The follow-up includes many visits to clinic. During the visits, the doctors observe the drainage in the eye, and measure the pressure. I was very excited when the doctors allowed me to look through the microscope and observe the patients eyes. Some of the things I saw included a “bleb” (a small bump that forms on the upper eye post-surgery, signifying proper drainage of the eye), cataracts, and calcium deposits in the eye. I also observed visual acuity screenings pre and post-surgery. It was amazing to see how the patients’ vision changed, especially after removal of cataracts!

Perhaps one of my favourite moments during the shadowing experience was when I met an elderly woman who came in for her 6 month post-surgery follow-up. She was very nervous, and sat uncomfortably in the examination chair. After thorough examination, Dr. Buys told her that everything looked great, and that she had nothing to worry about. The woman’s face immediately lit up, and I could even see tears of joy forming in her eyes. As I helped her up from the chair, she said to me, “This is my Christmas present…or should I say, Diwali present!” I was touched by how grateful each patient was. It just goes to show just how important your sight is, and how improving someone’s vision can make a world of difference in their lives. 


Things will likely be different in the OR and clinic in Ghana. But it was great to get some experience in ophthalmology here. I definitely now have a much greater appreciation for the field!