Student sets his sights on university following severe brain injury from ski accident

For Johnny Blaxland, from Andover, a long weekend skiing in Switzerland earlier this year was cut short by a traumatic accident resulting in brain injury and loss of vision.

Despite being a very proficient skier, Johnny, age 20, who had been working at a French ski resort during his gap year, fell during a back-flip at a snow park.  He did not clear the jump and landed very heavily on his head.  He was immediately knocked out and remained unconscious for a very long time. Once airlifted to hospital, scans revealed a brain injury so severe that he was put into an induced coma to avoid blood swelling around the brain. On awakening four days later, he not only had great confusion and weakness so was unable to walk without a zimmer frame, but also loss of vision in his left eye.

There were great fears for his wellbeing, potentially putting his imminent launch into university life on hold, but Johnny went on to make a dramatic recovery.

Within a few days of returned to the UK from Switzerland, and three weeks after his accident, Johnny was reviewed by Consultant Ophthalmic Surgeon, Stephen Lash at Optegra Eye Hospital Hampshire.

Mr Lash explains: “When I first met Johnny he could just about see my hand moving in front of his eye.  On examination, he had a bleed inside the eye preventing any view of the back of his eye and so a diagnosis was difficult at this stage. An ultrasound scan of his eye showed a dome on the retina which was very thin walled and vibrating with eye movements. This is so rare, I have never seen anything like it before.

“I knew there were a spectrum of potential causes for this.  It could it be tear in the retina, in which case the retina could potentially detach resulting in loss of sight if left alone; it could be severe injury to the optic nerve so he may never see again; or could it be Terson’s Syndrome where a bleed in the brain or a rapid rise in intracranial pressure, forces blood in to the eye around the optic nerve compressing the main veins from the retina causing the retinal vessels to burst resulting in bleeding within the retina and into the vitreous – if that was the case some people do very well, but many are left with very poor sight after injury.”

Mr Lash explained that as Johnny was young, risks of surgery were in fact increased.  Due to his age the jelly (vitreous) within the eye is very firmly attached, which means an increase in the 2 in 100 risk of retinal detachment quoted for this procedure in much older patients.

Anna Blaxland, Johnny’s mother, explained how they reached the decision to progress with surgery.  She said: “We knew that the procedure was risky, but the greatest risk was that Johnny would have a second fall.  His balance was very poor at this stage as his right side was not working properly. The neurological team explained his biggest problem was if he were to fall over again, it could be catastrophic.  And of course he was more likely to trip or fall with sight in only one eye. Also we were told the longer it was left, the greater the risk of infection.

“In fact he was something of a liability at this point as his confusion meant he still could not understand that he was not fighting fit. And we had been warned a second fall could prove fatal and so we needed to act quickly.”

And so the vitrectomy procedure went ahead within days at Optegra’s Hampshire hospital. The surgery was to remove most of the vitreous from the eye; though in Johnny’s case, until the operation had begun, the surgeon was not entirely sure what he would be dealing with.

Mr. Lash explains: “Johnny was awake throughout as we use local anesthetic with some sedation and a great playlist (in my opinion!) and so I was able to talk to Johnny throughout the procedure. I placed three tiny keyholes in his eye. We used tools the size of needles to cut the jelly – the vitreous – and blood into small pieces and suck them out.  As I started to clear blood in the middle of the eye I could see a dome at back of eye which was bright white. At first I could not see if it was in front of the retina, or under the surface of the retina which could mean risk of damage to the sensitive central part of the retina, the macula.

“I used a very high magnifying lens and began to very carefully peel the surface and a milky substance began to pour out.  It was most likely altered blood, but I had never seen anything as thick or white as that.  Very gradually I began to see the retinal vessels again and the layer I was peeling was the surface layer of the retina the internal limiting membrane. Once I was sure of the anatomy I was able to proceed with confidence and clear the white substance.’ 

In addition to the cyst, which perhaps indicated a Terson’s Syndrome-like pathology, Mr Lash found multiple peripheral retinal tears which were fixed with laser, and the eye was then filled with a gas bubble to allow for healing, and particularly to keep the repaired tears dry whilst the laser burns matured and scarred.  Time would tell whether the procedure had been a success.

After a week of rest, Johnny returned to Optegra for tests which revealed vision of level 0.24, which is around driving standard. At his most recent review at 6 months, it was – 0.04, which is better than 20/20 vision.

Mr Lash said: “I think there was a whole spectrum of potential outcomes, from no vision to perfectly normal.  With Terson’s Syndrome, most outcomes are either ‘okay’ or very poor vision.  But Johnny has done extraordinary well, he has exceeded expectations and I am delighted for him. He has been discharged and advised to see his optometrist for regular check-ups and vision should continue to improve up to a year after his surgery.”

While Johnny himself was not aware that his long term sight was ever at risk, this exceptional outcome has been a great relief, and combined with his general health recovery, means he has just started his first term at Exeter University – something which just months ago appeared to have to be put on hold, potentially indefinitely.

Johnny said: “This whole event has been quite an emotional rollercoaster. I woke up not knowing what was going on, but then as the situation became clearer, the aftermath of being 18 and on a gap year, but with constrictions like avoiding contact sport, watersports and even swimming alone – all the things I enjoy doing.

“But I know things could have turned out a lot worse, and thank God they turned out as they did. I think it has been more tough for the people around me.

“My eyes were messed up for about a month, but I was taking in everything that happened, so I was not worrying about my eyes especially.  I was just relieved to be alive. As I was getting better and becoming more sane, less confused, I still did not realize the impact of it all – I thought it was just a routine op. For the days after the op I was worrying I would never be able to see out of my left eye again. But now, it is pretty much amazing!”

And so, Johnny has now begun life as a university student reading history at Exeter – something his mother was so relieved to see.  Johnny says most of the chat about his future and university was with his parents, he was not aware it was possibly in jeopardy.

He says: “It has been good for mum to see though, as she thought I was not going to make it to uni – for me, I was not told I might not make it as no-one wanted to freak me out.  Personally I would say I am completely back to normal but there are some very minor details like occasionally I struggle to find a word, but it is so minor! I’ve done some reading, but not had to concentrate on lectures yet – I’m sure it will be brilliant!”

Mum Anna says “We thought it was very unlikely he would get to university, he has been incredibly lucky and we are so grateful.”

Terson’s Syndrome is a complication of the visual function that comes from a vitreous hemorrhage and often leads to permanent visual complication. It affects 8-20% of patients with a subarachnoid (brain) hemorrhage and 3% of traumatic brain injuries and it can affect both eyes. In brain hemorrhage, 13% of patients have Terson’s Syndrome which is associated with more severe cases.

Optegra Eye Hospital Hampshire treats the A to Z of all eye health care from vision correction to all medical conditions, and is based in Whiteley.

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