Thursday, 21 April 2016


Yes, I have finally returned to blogging after a long hiatus. Pre-reg is a busy year and it has been hard to balance work, study, trying to relax and writing this blog. The good news is that I have now passed Stage 2 of the year so it is coming to an end (at last). Just the OSCEs left in a few months, but that's a subject for another day.

This blog however is about a lovely lady Mrs D who came in to see me a few weeks ago. She had last been to the practice over 2 years ago when we had spotted she had some small haemorrhages from the blood vessels below the retina at the back of her eye and referred her off to the hospital to be treated. She came back in on a Saturday afternoon with no problems but wanted some new varifocals as current ones were a bit old and she felt vision wasn't as good as it had been. However she wasn't complaining of any of the typical wet AMD symptoms of loss of central vision or distortion. She was still under the hospital, having been seen 10 days before her sight test, although she had not had an injection on the last visit. To make things a bit more complicated she was amblyopic in her right eye, BCVA of 6/45, so her left eye was very important to her.

I had run through history and symptoms, no major problems reported and checked vision with current glasses, 6/120 with balance lens in right, 6/9 in the left. No major BV problems and given that she had IOLs in both eyes I was pretty confident that a lens opacity wasn't the problem. Being optomistic I expected a small refractive change and to send her on her way with a new set of varifocals. So I moved onto the slit lamp examination to check everything. Right eye was fine, some drusen at the macula but nothing too bad and no problems with the retina, so onto to the left. Anterior eye, fine; lens capsule, clear IOL with no posterior opacification; disc, healthy; macula... Hang on what have we here, a few small haemorrhages. The macula appeared flat but subjective showed a little hyperopic shift implying some oedema. After having my supervisor double check we agreed that she should be referred back to the HES to be seen as soon as possible so I filled in the referral form and faxed it over. However it was a Saturday so I wasn't expecting anything to be picked up and dealt with until Monday.

A few days later I had a phone call from one of the ophthalmic secretaries saying they had picked up the referral and wanted to know how soon I thought they should be seen. They were thinking of a few weeks, whilst I thought it should be sooner as existing patient, vision was reasonably unaffected at the time so a better chance of a good outcome and due to the poor vision in the other eye. After pushing back she was booked in for just over a week later.

Fast forward to last week and I see her name in my diary booked in to see me to check refraction before looking at new varifocals. She had been off to the clinic for another Lucentis injection and had noticed the improvement in her vision. I had a quick look at the fundus and although there were still lots of drusen (they aren't going to go) there was no sign of any haemorrhages. Refraction showed she had basically gone back to her old prescription. As she left the test room she thanked me for looking after her, and I advised her to return if anything felt a bit different or to call the HES to get appointment moved up.

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