Lest We For­get

The Oban Times - - Leisure - with John Wal­lace

In this Re­mem­brance Week, thoughts turn to the horrors of war. Man’s in­hu­man­ity to his fel­low men knows no bound­aries. Yet, de­spite all the carnage, or more prob­a­bly be­cause of all the carnage, ma­jor tech­no­log­i­cal and med­i­cal ad­vances hap­pen in times of con­flict.

In the Great War knowl­edge of neuro-anatomy and brain func­tion in­creased ex­po­nen­tially fol­low­ing on from the huge num­bers of head wounds. In the Sec­ond World War plas­tic and re­con­struc­tive surgery took gi­ant strides for­ward. More re­cently, ma­jor ad­vances in the re­ha­bil­i­ta­tion of brain in­jured ser­vice per­son­nel have oc­curred. The foun­da­tion of our knowl­edge of vis­ual func­tion is based on stud­ies of th­ese badly in­jured ser­vice men and women.

Hav­ing the op­tics of our eyes fully func­tion­ing is a pre­req­ui­site of an ef­fi­cient vis­ual sys­tem. But vi­sion is not just the abil­ity to see clearly. It is how our brains process and in­ter­pret the in­for­ma­tion fall­ing on our reti­nas. One of the great­est re­cent ad­vances in knowl­edge of brain func­tion is the con­cept of “neuro-plas­tic­ity”. When I trained many years ago we were in­doc­tri­nated with the idea that the vis­ual sys­tem stopped de­vel­op­ing at around the age of six years. Hence lit­tle ef­fort was made to help older chil­dren and adults with squints and am­bly­opic “lazy” eyes. Fol­low­ing on from treat­ing brain in­jured war vet­er­ans we now know the brain never ceases to adapt. The con­cept of “plas­tic­ity” of the vis­ual sys­tem has en­abled treat­ment regimes for pa­tients with long­stand­ing squints and “lazy” eyes to be de­vel­oped. It is now pos­si­ble for older pa­tients with no depth per­cep­tion to de­velop stere­op­sis (3D vi­sion). It is even pos­si­ble to train pa­tients with squints to vol­un­tar­ily straighten their eyes with­out the need for surgery. We are truly liv­ing in ex­cit­ing times. Our debt to our ser­vice per­son­nel is huge.

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