Ophthalmic Training charity Orbis Carries Out Work With Local Eye-Care Teams In Peru

Eye Surgery ... on an Airplane

What it looks like when a "flying eye hospital" comes to town.

Some 80 percent of the world's avoidable blindness occurs in developing nations. But most doctors and nurses in the developing world lack the means to travel to the U.S. or Europe, for example, to learn about cutting-edge treatments for eye ailments. In the 1970s, American ophthalmologist Dr. David Paton posited an audacious solution: equip an airplane with surgical facilities and, in effect, fly a teaching hospital to where it's needed most. And with that, Orbis International was born. In April 2018, photographer Leon Neal went to Peru to document Orbis doctors, nurses, and trainees in action on the latest "Flying Eye Hospital," a converted jet donated by FedEx. Neal came away with astonishing pictures — and told FOTO he was awestruck by the dedication and skill of the team he saw working surgical wonders aboard an airplane.

Note: This story includes photos of medical procedures that might disturb some readers. (Above, a man holds an artificial retina on board the Flying Eye Hospital, April 2018.)

Eye on the Ground Leon Neal/Getty Images Eye on the Ground "No doubt, the Flying Eye is an impressive plane, and it's been converted into an even more impressive medical facility," Neal told FOTO. "But I realized early on that it would distract from the work that the Orbis people do if I fixated too much on the plane itself. I wanted to focus on what the team members do for their patients, and the energy and compassion they bring to the job." Diana Leon Neal/Getty Images Diana Seventeen-year-old Diana sits with her mother, Rosa, at home in Trujillo, Peru. Diana suffers from Reis-Buckler corneal dystrophy, a rare genetic condition that causes a critical layer of the eye to disintegrate. Rosa has Reis-Buckler, as well, and has struggled with sight loss since she was nine years old. "The problems with Diana's sight eroded her self-confidence," Neal says, "to the point where she wasn't comfortable leaving the house and was going to drop out of school." Diana was one of several people in and around Trujillo selected for surgery aboard the Flying Eye in April. No Turning Back Leon Neal/Getty Images No Turning Back Diana is wheeled into surgery aboard the Flying Eye Hospital on April 20, 2018. Dr. Paton founded Orbis as a medical charity in the 1970s, but it wasn't until 1982 that the original Flying Eye Hospital (a DC-8 jet, donated by United Airlines) flew its maiden mission. The larger second-generation Flying Eye, a DC-10, covered the globe for two decades, starting in the early 1990s. Today's remarkable plane, a McDonnell Douglas MD-10, requires just two pilots — not three, as the previous aircraft did — and can fly nearly twice as far without refueling. Raw Material Leon Neal/Getty Images Raw Material A doctor holds four donor corneas prior to surgery aboard the Orbis Flying Eye Hospital. Since its founding, the U.S.-based non-profit has trained tens of thousands of doctors and nurses, conducted millions of eyes exams, and performed hundreds of thousands of eye surgeries — many of them on board the Flying Eye, but the majority in hospitals in developing countries. Orbis medical teams often stay in one location for weeks or even months, training colleagues in the latest methods for treating eye ailments. Watching, Learning Leon Neal/Getty Images Watching, Learning Local doctors and nurses on board the Flying Eye Hospital watch a live, 3-D video of Diana's operation. "What struck me right away about the plane," Neal says, "is how much state-of-the-art equipment there is, and how efficiently and thoughtfully it's been installed. They don't waste an inch of space. This picture gives a sense, I hope, of how tight the accommodations really are. And yet here are quite a few people comfortably watching a live stream of an incredibly delicate eye operation as it's happening, literally feet from where they're sitting. It's a two-way feed, so they not only hear the surgeon's commentary as he operates, but can also ask questions at any point in the surgery, and he'll respond. Just amazing." Attention Must Be Paid Leon Neal/Getty Images Attention Must Be Paid A surgeon works on Diana's eye. For Leon Neal, the respect and sense of wonder he felt at witnessing the Orbis team ply its extraordinary trade was, occasionally, overwhelmed by the physical reality of what he was documenting. "There were definitely times when I grew squeamish," he says. "Most of the time I was focusing on getting good pictures, and marveling, really, at the skill of the doctors. But then I'd see something especially gruesome and think, 'I can't look at that.' I would step away for a moment, just to kind of re-calibrate my brain. And then it was back to watching retinas being sliced open." Through a Glass, Darkly Leon Neal/Getty Images Through a Glass, Darkly A surgeon lifts a donor cornea from its carrying case before the Orbis team transplants it into Diana's eye. "This photo has a dark, vignette-like effect around the edge," Neal says, "because I was shooting through glass, and through the gap in someone's elbow as they stood with their hands on their hips." Tight Fit Leon Neal/Getty Images Tight Fit Surgeon James Brandt, Professor of Ophthalmology and Vision Science at UC Davis, operates on Diana aboard the Flying Eye, April 20, 2018. "I wasn't allowed in the Flying Eye operating room, because it's simply too small," Neal says. "But I wanted to take some pictures from outside the room, and capture the shape of the airplane windows reflected in the glass that separated the surgery from where I was standing. Everyone knows what airplane windows look like, so with this picture — even if you know nothing about Orbis — you immediately grasp that this is happening on a plane."
Shock of the New Leon Neal/Getty Images Shock of the New As seen on the screen in the viewing area of the Flying Eye's cabin, a surgeon stitches up the new cornea that's been placed in Diana's eye. "I've been thinking quite a bit about the psychological effects of organ transplants," Neal says. "I think most of us can handle the idea of someone else's kidneys, for example, being placed in our bodies, to keep us alive. But knowing that another's heart is keeping you alive, or that you're looking through someone else's eyes — those are two things that, I think, must have an effect on your life afterwards."
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Light in the Eye Leon Neal/Getty Images Light in the Eye Not all of the Orbis team's training sessions take place aboard the Flying Eye Hospital. In fact, the team undertakes procedures in local hospitals, as well, familiarizing doctors and nurses with techniques they can employ long after the Orbis surgeons have left. Here, a beam of light illuminates the left eye of a cataract patient, 60-year-old Obdulia, during surgery at the IRO (Regional Institute for Ophthalmology) in Trujillo, Peru, on April 20, 2018.
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Center of Attention Leon Neal/Getty Images Center of Attention With Dr. Mark Mannis (UC Davis's Chair of the Department of Ophthalmology & Vision Science) at the helm, an 87-year-old patient named Jose undergoes a penetrating keratoplasty, or cornea transplant, in Trujillo, Peru. The Healing Has Begun Leon Neal/Getty Images The Healing Has Begun Jose undergoes post-operative tests the day after a team of Orbis doctors and nurses replaced one of his corneas during an April 2018 surgical training session. Model Patient Leon Neal/Getty Images Model Patient A Peruvian doctor works on an "EyeSi" virtual reality training simulator on board the Orbis Flying Eye Hospital, April 2018. The Little Things Leon Neal/Getty Images The Little Things Diana jokes with her friend, Erika, a few days after her surgery. "Right after the operation," Neal recalls, "Diana was in discomfort, and unhappy. But when I went to see her a few days later, the transformation was striking. She was laughing and joking with her friend — giggling about a crush she had on one of the translators, for example." But the reality of Diana's situation is bittersweet. There is no cure for Reis-Buckler; doctors are not even sure what causes it. The likelihood of Diana requiring another cornea transplant, perhaps within just a few years, is great. In the meantime, Neal told FOTO, "she can see, and she seems like a normal, happy teenager." For now, that small but stirring victory will have to do.

Visit Orbis.org.