surfer’s eye: a benign imposition

About 12 years-ago surfboard shaper Andy Jordan faced an obscure dilemma. Widely known for his knack of clocking-up numerous hours in the water, Jordan had begun to have issues with an itch and redness developing in his eye after surfing. Upon seeking medical advice he learnt that the benign growth stemming from the nasal side of his eye was in fact ‘surfer’s eye’ or a ‘Pterygium’ as it is labelled in medical realms. “It was a bit like you had sand in it, it’d just hurt,” Jordan says upon the realisation the issue was something more than ordinary. “Mainly when your eyes were tired it’d start to hurt, especially after surfing a lot my eyes would be really sore.” Winding the clocks forward to 2013, Ben Kennings from Surfing New Zealand began to experience a similar issue to that of Jordan. As a young child Kennings had a glass bottle explode into his eye resulting in severe trauma and scar tissue developing. What started out as a scar soon turned into a pterygium although not the kind of abscesses seen with surfer’s eye. “It was a pterygium on the outside of my eye, not the usual one on the inside of the eye that surfers usually get,” Kennings explains. “It was still growing into my eye and was starting to get close to my pupil. I’d been in the salt, sand and sun and stuff – the scar tissue just grew over it to protect it. When I went to go and get my eyes tested they said ‘look that’s slowly going to grow over and one day you’re going to have to get that operated on’ but that was the best part of 25 years ago they were talking about that and I only had it done last year.” Pterygium (tuh-rij-ee-uhm), also known as ‘surfer’s eye’, is a benign growth formed through excessive exposure to the suns harsh ultraviolet rays. Generally speaking it is an overgrowth of the conjunctiva, the membrane/skin that covers the white of the eye. When out in the sunshine for particularly long periods an overgrowth of the conjunctiva can begin to develop. Over a number of years this overgrowth can eventually grow across the eye and, if left untreated, can result in loss of vision. Therefore the risk for surfers is very high. But what really makes matters worse is New Zealand’s geographical location and proximity to the ozone-layer hole, an attribute leading to hundreds of surfers facing treatment for pterygiums each year. New Zealand and Australia have some of the most intense ultra-violet rays on the planet because of their proximity to the ozone-layer hole. This results in higher cases of skin cancers than most countries, especially in older generations. Whilst a pterygium obviously isn’t a cancer, the need for medical consultation is prevalent. Dr Sue Ormonde from Auckland Eye says New Zealanders’ awareness of pterygium is growing. “I came originally from the UK and have only been in New Zealand for 13 years. In the UK we would see very few of them (pterygium) and we may have only operated on two-three a year whereas here in New Zealand we literally do hundreds a year.” Surgical treatment for people with pterygiums has become more attainable in New Zealand as a result of the number of cases growing. The treatment itself involves a brisk 10-15 minute procedure in which the pterygium is literally peeled away whilst the patient is under anaesthesia. The anaesthetics can be given in the form of eye drops, an injection or

both methods combined. During surgery, if the pterygium is peeled off and nothing else is done it will grow back quite rapidly. To counter-act re-growth, a piece of the healthy conjunctiva is taken from the top of the eyeball underneath the eyelid. From here it is then glued into the position where the pterygium was taken away from. Ormonde says advances in the procedure have allowed for a less time consuming operation also allowing for the patient to be more relaxed. “Going back a few years ago when we used to stitch the conjunctiva in place, people were quite uncomfortable with that because they could feel the stitches scratching on the surface. Now we’ve got these special glues that set in a couple of minutes and they’re much more comfortable afterwards.” While this may sound straight-forward enough, the follow-on effects of the operation are what Jordan describes as “probably the worst thing I’ve ever gone through, it’s pretty gnarly! I’ve had the ear (surfer’s ear) operation done and the pterygium was way worse, I don’t want to go through it again.” The initial recovery period after treatment can be devastating depending on the severity and size of the pterygium that was removed. The procedure has come a long way in recent times but the two agonising weeks after surgery are, in Jordan and Kennings opinions, a large hurdle to recovery. Kennings bluntly recalls the aftermath of his surgery as agonising. “You just go in, get the drops, they just sort of cover your face, squeeze shit in your eye and start cutting away at it. My mates who’d had it said you need to take some Panadol in with you and down them as soon as you’re finished which I did - but the doctor said you’ve got to get to the medical centre straight away and get more pain relief. By the time I got to the medical centre and got that, I was pretty much horizontal in the car and in the most pain I’d ever been in.” After all of this, Kennings grovelled his way back home to Whangamata where he rested for two weeks. In a month or two most of the bleeding had gone and his eye has been good ever since. In hindsight, Kennings and Jordan sacrificed only a short period of suffering in the grand scheme of things. Kennings was back in the water after two months and Jordan was back surfing after a month. Both surfers have taken to wearing sunglasses a lot more as their main precautionary measure. Due to Kennings’ childhood scar he had to take steroid drops for three months to help with rehabilitation. Since his surgery he has continued to surf just as much as he used to yet he is aware that a re-growth could spark up with little notice. The re-growth of a pterygium is somewhat of an issue but medical advances have narrowed these recurrences down to a small percentage. Dr Ormonde says “by gluing the piece of healthy conjunctiva, the recurrence rate is very low – probably less than five percent - it’s not impossible, but if they do grow back you can simply repeat the procedure.” However the cost of removal has escalated substantially in the last decade. The price of the procedure varies and is greatly dependent on whether the patient is having one or two pterygia removed. To get one pterygium removed

“It was still growing into my eye and was starting to get close to my pupil. I’d been in the salt, sand and sun and stuff – the scar tissue just grew over it to protect it.”

can cost between $2700-$4100 (NZD) whereas to get two pterygia removed it can be anywhere up to $4500$6100 (NZD). The other variables which constitute price depend on which anaesthetic a patient chooses and whether a glue or stitch method is used. The affordability of treatment has decreased in comparison to 12 years ago when Jordan had his removed. He recalls his pterygium surgery having no monetary value. “I did a deal with the doctor and made him a surfboard so it didn’t actually cost me anything but I think at the time it was about a grand or 900 bucks or something.” Because Kennings’ ptreygium was a ‘trauma pterygium’ he was told there was a 50 percent chance it could grow back in the six months following his surgery. Upon seeing a specialist in the following weeks this was made clear to him, but the doctor said his looked fine and he was given the all clear. “It hasn’t grown back yet, touchwood, which is pretty cool but if it did I don’t know if I’d go through it again,” Kennings says. “It may grow back, and well I guess so be it.” In retrospect, Jordan has had no issues either since his surgery 12 years ago. In this time he has continued to surf in between stints in the shaping bay. But living and surfing in The Mount has meant he has to be weary of the East Coast’s harsh morning ultra-violet rays. Because of this, his days of surfing in the dawn have become less regular. “Unless there’s a really good bank or I’m going to The Island early, I’ll try to go out a bit later.