“Doctor, I missed my bus on two consecutive occasions because I didn’t see the bus number in good time to flag it down as it approached me!” said the young lady with anguish. She was one of the first patients I saw on arrival at the Bristol Eye Hospital, Bristol.

If I hadn’t stayed in London for two weeks before then the significance of her experience would have been lost.

City buses are numbered and each bus has its designated mandatory stops along its route. They must stop to discharge and pick up passengers at these stops even if none is waiting. In addition to these mandatory bus stops, there are also a few request bus stops.  A bus would only stop at these stations if a passenger gives notice of his intention to alight from the bus or a waiting passenger flags down the bus in good time to enable the bus driver stop at this optional bus stop.

The young lady’s inability to identify the bus at the usual distance and flag it down led to the bus passing bye without stopping causing her to report late for work. For a society which counts on punctuality, it was obviously distressing for her. The first day it happened, she attributed it to lack of concentration. However when it happened the second time she felt quite rightly that something must have been wrong with her eyes and therefore sought immediate attention. In my many years of eye care work in Nigeria it is unusual to find such early presentation at the eye clinic.

The reasons are familiar to all of us. First, our surroundings are not visually challenging or sophisticated to make us aware of any mild changes in our vision. We don’t have long streets; there are hardly any designated bus-stops and buses don’t have clearly marked routes. The bus conductor compensates by shouting the route in familiar musical notes. Secondly, street signs or signposts are few and far between and where available are weather-beaten and incapable of leading us to our destination without asking for directions.

Finally, there are inherent cultural factors which make it impossible for many to accept any new development or change without thinking of a spiritual or mystical dimension. It is often “rejected” and wished away until the disease becomes firmly established.

“Members of the United for Vision Club, how can we recognize early warning signs of eye problems and do something about them before they become complicated?” I asked in order to ensure their alertness.

Boro raised up his hand. “You may speak,” I told him. “What early warning signs are we talking about sir,” he asked intelligently in return. I threw the question back at him. “I have mentioned at least one. What are the other two equally important ones?” He was definitely attentive. “The first is a change in the ability to see what we used to see before; the second one is pain and the third is a change in the quality or scope (field) of our vision.”

I was impressed and couldn’t hide it. Boro is only 15 and wants to be a medical doctor. He is clearly on the path to being one. “How come you know the answer? I had expected that you would have some difficulty with the other two.” His reply was even more stunning.

“Sir, you once said one could assess how well an eye is functioning in three ways; testing ability to see called visual acuity and ability to appreciate the full scope or field of vision. Pain, I know, is an important sign or symptom of disease in any part of the body. There are many more signs but you have only asked for three.”

I was momentarily lost in thought. This 15year old young lecturer has a bright future ahead of him. An inquisitive mind is an early positive sign of a great researcher and physician. “Am I wrong sir?” he asked jolting me back from my trance to reality. “You are dead accurate. The first is indeed loss, reduction or blurring of vision.

The second is a change in Visual Field or scope of vision and the third is pain. Next week, you will tell us how a change in vision can be an early warning sign of an eye problem.”

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