EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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by Maxine Lipner EyeWorld Senior Contributing Writer Operating under duress is the most active area for earth- quakes in the world." The New Zealand fault line in q uestion went through the middle of the country, not particularly close to Christchurch. However, that nighttime episode began a pattern of earthquakes in Christchurch that has occurred for some time, includ- ing three other major quakes, ac- cording to Dr. Kent. It turned out that there was a fault line right u nder the city. It was something that was totally unknown, agreed James Borthwick, MD, of Christchurch. "We often felt a little tremor that had been going on for years, but not something that would actually affect us," Dr. Borthwick said. "Christchurch didn't know that we were sitting on a fault line until September 2010." Since then, he said, there have been more than 10,000 earthquakes in the city. On the laser track Dr. Kent said that despite this, life for ophthalmologists goes on here. He noted there is usually some fore- warning for the bigger earthquakes. "If you're operating and there's about to be a good-sized earthquake, you hear it before everything starts shaking," he said. "You know it is coming—it's a deep rumbling." As- suming that the practitioner is confi- dent that the building is earthquake safe, having survived prior quakes, and that the equipment will not malfunction, it typically becomes a EW International 78 February 2014 waiting game with the practitioner removing instruments from the eye until the shaking has passed. This may, however, depend upon the type of ophthalmic sur- g ery that the patient is undergoing. Dr. Kent recounted one case of LASIK that he was performing on his own office manager. "I could feel there was an earthquake happening and I was in the middle of doing the laser treatment," he recalled. "I locked down the microscope and I thought, 'Do I take my foot off the p edal and stop the excimer laser, or do I carry on?" It then occurred to him that the eye tracker on the ex- cimer laser was designed to cope with movement and in fact would stop if it was too great. "In fact, the amount of movement caused by a moderate earthquake is less than the amount that people move anyway— it's not as fast as eye movement," he said. "Certainly you can carry on operating because there's no point in stopping if it means that you're going to have the flap up for longer and it's going to dry out." It's a different situation in in- stances where someone may be hit by an earthquake for the first time or is in an unfamiliar area. "They're going to be worried that the build- ing will collapse or that the laser is going to stop working," he said, adding that in Christchurch every- thing that was likely to fall had already done so. M any of us have never felt an earth- q uake, much less considered how to safely handle this should one occur during surgery. David Kent, MD, and James Borthwick, MD, of Christchurch, New Zealand, have had considerable experience with this natural phenomena. Their city has registered more than 10,000 minor quakes since 2010. So it makes sense that they should be prepared as well a s know how to proceed when the world is moving underneath them. We hope you enjoy EyeWorld's account of two remarkable ophthalmologists and the unique challenges they face. John A. Vukich, MD, international editor Ophthalmic surgery in the "Shaky Isles" I t happened without warning in the middle of the night, David G. Kent, MD, Christchurch, New Zealand, recalled. "We were asleep in bed and then all of a sudden we heard this tremendous noise that woke us up. My first thought was t hat there was a very strong wind coming. It probably took only frac- tions of seconds to realize that wasn't right when things started to shake—that in fact it was an earth- quake." What Dr. Kent also didn't realize was that this was the start of a pattern that would affect the peo- ple of Christchurch, as well as its practitioners, for many months to come. The fact that New Zealand in earthquake prone is well known. "New Zealand had been nicknamed the 'Shaky Isles,'" Dr. Kent said. "We're sitting on a fault line that is part of the Pacific Rim of Fire." The Pacific, he explained, is like a big ring of fault lines going all around the area. This includes the U.S. San Andreas Fault, the fault line off the coast of Chile, which once gener- ated a record-shattering 9.5 earth- quake, and extends further north and goes up the coastline of Japan, where there was a massive earth- quake and tsunami in 2010. "The Pacific Plate is the center," Dr. Kent said, observing, "Where the Pacific Plate meets the surrounding plates International outlook The Christchurch Cathedral after a 2010 earthquake. The building is soon to be demolished. Source: James Borthwick, MD Since 2010 there have been more than 10,000 earthquakes in Christchurch, ravaging buildings and disrupting lives. Source: Dr. Mark Jeffery, University of Otago 78-81 International_EW February 2014-DL3_Layout 1 1/30/14 11:08 AM Page 78