Dr Nirosha Paramanathan is a comprehensively trained and highly effective Ophthalmologist. Technical expertise, thoroughness, kindness and an instinctive commitment to holistic care, are demonstrated core values in her clinical practice.
We asked her a few questions to get to know her better, and to find out more about our consultant ophthalmic surgeon.
Q1. What are you passionate about in Ophthalmology?
Something I’ve noticed myself becoming increasingly passionate about is cataract cases that have been deemed ’not worth doing’. For example in patients: with dementia, with poor central vision, elderly in age or considered technically too difficult by some and not referred on. Vision, and any improvement in vision, at any stage in life, is valuable. If you feel in your hands or in someone else’s hands, the benefits outweigh the potential risks, and the patient wants the surgery, surgery should be done.
Q2. Tell us about a difficult case.
A recent cataract case was a beautiful example of how all the little things, are not so little when it comes to microsurgery. It was seemingly routine, hence my registrar began operating. Side port was perfect, but then the main wound too long, and too close to the side-port. No big deal, but it meant you didn’t have the best angles when using your instruments through the two wounds. Then the rhexis, about 1 mm too small. Also, no big deal. Central groove sculpted – but nucleus unable to be cracked into two hemispheres. No problem. At this point, due to the main wound being too long and the two wounds being so close together, the central cornea started to get cloudy and the view became poor. I took over. Deepened the groove, hoping to crack the nucleus, no. Now it was unsafe to groove any deeper as the poor view meant no reliable depth perception. I did not want to entertain phacoing through the posterior capsule. I tried to pull the nucleus up as a whole to chop – but rhexis and now also the pupil, being too small, made it difficult to get the nucleus up. I decided to hydro dissect to prolapse the nucleus into the AC – again small pupil and rhexis held the nucleus down in the bag. I injected viscoelastic behind the nucleus in the hope of floating the nucleus up – again small pupil and rhexis were a barrier. In the end, I tentatively chopped the nucleus up piece-meal, until it was small enough to float up and emulsify completely. One or even two of those minor deviations from perfect, and you would have been able to perform the surgery with greater ease. But all minor aberrations stacked together equals a difficult case. Blood, sweat, tears and prolonged time in the eye aside, the patient saw 6/24 the next day and 6/6 at week 1.
Q3. Dr Nirosha, what is something we don’t know about you?
I’m very much a morning person. In a perfect world, I want to be in bed by 9.30pm, up by 4.30 – 5am.
Q4. Patients and referrers are quite surprised to learn that you are also a published author. Please tell us more about your writing?
I consider ophthalmology my profession. A profession I love and feel very privileged to practise. Vocationally, however, I suspect I am a teacher. And presently, writing is the medium through which I teach, both children and adults. Currently, I am head down getting ready for the release of my latest book, “You are Power and Potential”. This book has been a lifetime in developing, and 4 years of stops and starts, in the writing!