Monday, 28 August 2017

Time flies

Thanks to the joys of Facebook memories the anniversary of 2 major milestones happened this past few weeks - starting my pre-reg and passing my OSCEs and becoming fully qualified.

First up was 2 years since I started my pre-reg. Looking back at my records, confidence and test times it is easy to see that I have progressed a lot. When I started I was getting everything checked, wanted to dilate every older patient with smaller pupils, was making big unnecessary changes to prescriptions resulting in retests and remakes and taking up to an hour to test patients. It has taken a lot of practice, over 1000 patients during pre-reg alone and a lot of extra work outside of the store to keep knowledge up to date. In a timely reminder of when I started our new pre-reg has just started her optometry career after working with us for the last 2 summers on summer placements. It'll be interesting and exciting to see how she progresses and I will do my best to pass on knowledge from my experience and any tips on how to get through it.

(Edit due to delay in posting I've also had the memory that I'd had visit 1)

Secondly, and possibly more importantly, was the notification that I'd passed my OSCEs and was now fully qualified. I still remember not being able to sleep properly the night before and being awake well before the expected time of 9am for the results to be posted online. Thankfully they were up before then and I had passed. The other thing about that day was that I was off on holiday 2 days later, and so had to get all paperwork sorted and sent off to ensure it was all sorted by the time I got back. So whilst on holiday I was constantly checking my email for updates whether I had my GOC number and then getting my NHS number sorted before I got back so I could get straight back to testing upon return. Luckily mine all got sorted whilst I was away, and so unlike some friends in England waiting on Capita, I was able to carry on testing almost every patient without any problem.

Whilst I learnt a lot through pre-reg and it helped build my confidence in testing I know I still have an awful lot to learn. It is also not an experience I would want to repeat anytime soon. A lot of what is holding me back from quicker, more efficient testing is just having confidence in my own abilities and knowledge. That is one of my personal downsides that I need to keep working on but it's coming (slowly).

Sunday, 23 July 2017

An interesting cataract story

It appears my posting on here is getting less and less frequent but that is mostly due to being busier and busier at work. However there is one story that I felt needs to be told.

Cataracts are clouding of the lens in your eye that sits just behind your pupil and enables you to change the focal length of your eye so you can see things close up and far away. Most commonly they are caused by age but can be congenital, brought on by diabetes or steroid use, electric shocks and trauma.

In this case Mrs A, a lady in her mid 40s came in for a routine check as she felt the vision in her left eye was getting worse and seemed blurrier than her right eye. Now initially I thought this might just be a slight difference in prescription but said it had been getting noticeably worse over the past couple of weeks. Finished off history and symptoms (one point of note but that's the spoiler) and moved onto checking visions - R 6/6 unaided L HM?! Ok so this was looking a little bit more than just a slight change in prescription. Cover test fine, pupils reacted normally but whilst looking at the pupil reactions got first clue as to what the problem was.
So onto slit lamp examination, the right eye was fine, all looking healthy with no problems at all. Anterior segment of left eye, fine; onto the lens and there was a really dense cataract filling the entire lens. It was so dense that even with dilation I still couldn't get a view of the retina. Normally with that dense a cataract I would expect it to be congenital and patient to have no usable vision in that eye but the patient reported that had been fine previously (no previous record at the practice).

It's now time for the kicker - how it happened. The patient reported that a few weeks ago they had been boxing training and doing some pad work on uppercuts. The patient said they had thrown an uppercut but the pad had moved so instead of hitting a nice soft pad and stopping the punch continued and they had hit themself in the eye, which appeared to have caused a traumatic cataract to form over the space of past 3 weeks. Quite how they had failed to notice that vision was more than "a little blurry" I will never know.

Due to the history of trauma and the fact that I had no view of the retina I called the on-call ophthalmologist at the local hospital and described the situation. For normal cataract referrals we dilate and then send a letter to hospital and they are seen after a few weeks and placed on the list. For this patient I felt an assessment sooner rather than later was the best course of action and the ophthalmologist agreed to see them the following day at the eye casualty department. Unfortunately I haven't heard anything back from the hospital or patient to find out how they got on and what end result was.