Tuesday, 31 March 2015

Bristol eye hospital

Hello once again,

After handing in my dissertation a week ago - freedom! Last week it was my turn to head off to Bristol Eye hospital to have a look at what happens when we refer a patient and how they are managed under the hospital eye service.

Of course this means having to get up rather early to get to the hospital for 9 am, leaving Cardiff at 7:30 am. I hate early mornings!

The first morning I was in optometry, which for the most part consisted of refraction with a bit of slit lamp funduscopy. Some features of our typical routine seem to go out the window, so no history and symptoms (or fairly minimal), no binocular vision, no motility etc. I suppose a lot of those have been done elsewhere or before so will only be done if needed. In this clinic I got the chance to see some keratoconic patients and see just how the condition affects their vision, recurrent erosion syndrome and an endothelial graft after Fuch's endothelial dystrophy. It was good to see some of these rarer conditions and to see the type of patients that are managed under the hospital.

The afternoon was spent in surgery. After dressing up in some very attractive raspberry scrubs and stylish orange crocs, it was time to go and watch some operations. The first two were fairly simple cataract phacoemulsifications and IOL insertions or in simple terms cataract removal. The last operation was a little bit trickier, the removal of an IOL that had become opacified, so needed to be removed and replaced. This was really interesting to watch to see how the surgeon adapted the procedure. The first two were good to watch to better understand what we would be referred patients with cataracts would undergo, the final operation was just intriguing. You can see what is involved in a cataract operation on the video below (not if you're slightly squeamish).

After another early start on Tuesday, it was a trip to outpatients - in particular medical retina. This clinic featured patients who were being monitored for follow up after treatment at the hospital, but also an inpatient who the doctor had seen earlier in the day. These patients had often been referred from the diabetic screening service (a must for any diabetic patient), but also included branch and central retinal vein occlusions, uveitis and adult vitelliform dystrophy.

The afternoon was spent in a shared care clinic focusing on glaucoma, although neither of the patients we saw in our time there had glaucoma. Instead they had ocular hypertension and were borderline, hence why they were being monitored under the hospital.

The final morning saw a trip to casualty, as an observer not as a patient. This was split into two parts, one watching the optometrist in the eye casualty, the other in the triage station with the nurses. Before we saw any patients I had a chat with the optom and learnt how they got into hospital placement (via independent prescriber is the answer). Then it got interesting - a patient with a large patch of their corneal epithelium missing after being poked in the eye by their 14 month old son, suspected uveitis and then a retinal detachment complete with tobacco dust. With the nurses I got to see how they triage patients; check vision, quick slit lamp exam and what they are able to do - remove small foreign bodies, give out drugs, refer to different departments as necessary. Patient wise I saw some interesting cases, 5 corneal ulcers on same eye (!), a foreign body due to a granule from an exfoliating facewash and chemosis (which looks worse than it is).

Overall I really enjoyed my time at the hospital (despite the early starts) and it's made me think a little more about what I want to do after I qualify. I would like to thank all the staff at the hospital for putting up with all us students asking stupid questions and getting in the way and the patients for letting us have a look at their eyes despite some serious conditions.

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