BLOG: The patient who inspired me most
When I first met 14-year-old Ani in Armenia, I was taken by her name, which matched the first name of my 3-year-old daughter.
Also like my daughter, she had beautiful almond-shaped eyes, but this Ani’s eyes were blind, opacified and vascularized by a chemical injury that occurred when she was 3 years old — the same age as my daughter. She had found a bottle of bleach under the kitchen sink and tried to take a drink. Recognizing the bleach was foul, she spit it out and dropped the bottle. It splashed heavily in both of her eyes, and her life was changed forever.
Ani grew up poor and blind in a developing country in the former Soviet Union. She never went to school because it could not accommodate her visual disability. She was completely dependent upon her parents. Twice she underwent corneal transplants that were rejected quickly because her corneas were so vascularized but gave hope that the child had not developed dense amblyopia.
At the time I first met Ani, Tony Aldave from UCLA and I were teaching Armenian cornea specialists how to use keratoprostheses, which are artificial corneas made of acrylic materials that are well suited to patients whose traditional corneal transplants have been repeatedly rejected. The Boston type 1 keratoprosthesis (KPro) uses a piece of acrylic plastic attached to a human corneal rim and sutured in like a traditional corneal transplant. Because of the clear plastic central optic, patients can potentially see right away after surgery.
There in the clinic on the first postoperative day, we were surrounded by Ani’s parents and extended family from her village. As we took the bandages off her eye, she blinked twice, looked up at her mother’s face and said in Armenian, “Mama, you’re so beautiful!”
Everyone wept and hugged. Forever I will carry with me that moment of pure joy.
In the years after her surgeries, Ani went to school to learn to read and do math. She learned to sew and began to make a living. She began to cook for her parents. She met a boy and is now engaged to be married.
Ani continued to have difficulties, however. As sometimes occurs with keratoprostheses, she developed corneal melting around the acrylic material and lost one eye to infectious endophthalmitis. In her other eye, the KPro had begun to extrude and was removed and replaced with a tectonic corneal graft, taking away her precious vision. More recently, Anna Hovakimyan, the outstanding surgeon in Armenia who takes primary care of Ani, performed a living related conjunctival limbal allograft to set the stage for a future penetrating keratoplasty, which is much more likely to succeed than previous attempts at a transplant alone. This technique was taught to her by Ed Holland, whose Holland Foundation supports ocular surface transplants in many centers of excellence around the world — one of them being in Armenia.
While Ani still has troubles, she has hope, as does her village, as does her region. Hers is just one story among thousands of patients the Armenian EyeCare Project has had the privilege to help in the Caucasus region over 32 years. Her story, and that of many others, is told in a short video at https://eyecareproject.com/videos/.
Many of us physicians have one or more patients who inspire us most, and if we’re lucky, we get to see them repeatedly throughout our careers. They remind us that, no matter what happens in health care, we’ve been given a privilege afforded to few — profoundly to lift the lives of the vulnerable. To help them see the beauty that was once dark.
Follow @DrHovanesian on X, formerly known as Twitter, and Instagram.
For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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