I think I mentioned before that I work in the East End of Glasgow. Now, I’m from this part of Glasgow, having grown up about 2 miles from where I currently work.  I know the people, I know the streets and I know the challenges that people face here.  In 2008, the average life expectancy for men in this part of Glasgow was 54 (worse than many war zones).

We are traditionally quite a poor area and we have a terrible diet.  To give an example, we are partial to a deep fried pizza now and again and some amazing, terrible person recently invented the “pizza crunch” which is a battered, deep fried pizza.  It is both delicious and disgusting.  Anyway, as you can imagine, we have lots of problems with heart attacks (just thinking about a battered, deep fried pizza is enough to make a non-Scot’s heart have a little flutter), strokes and diabetes.

Diabetes is very common here.  Many of our patients live with diabetes and, in this blog, I want to talk about the different attitudes I’ve found in my diabetic patients.

First of all, there is one type of patient with diabetes that I love.  This patient has good control over their condition, goes to their retinal screening appointments and is generally well informed and positive about what they are doing to help minimise their condition’s impact on their lives.  I met one gentleman who said that being diagnosed with diabetes signalled a new start for him – he’d been taking care of his family but not himself for years and when he was diagnosed with Type II diabetes, he turned his life around.  He lost a lot of weight, started exercising (this is something else we tend to do badly in Glasgow) and eating healthily and so avoided needing metformin tablets, controlling his condition through diet alone.

Unfortunately, not all of our patients are as motivated as his man.  I had a lady come in a few months ago complaining that her glasses “weren’t strong enough”.  She was around +2.00DS in each eye but over the last month, she was struggling to read with her glasses on.  During my history and symptoms, she told me she was diabetic (Type II).  She had been diagnosed 18 months ago and she wasn’t on tablets.  She said she was “diet controlled” but then went on to boast that “I don’t even watch what I eat, I’ve never have any problems and I certainly don’t need to go to the retinal screening”.  When I refracted her, I found a significant hyperopic shift (from +2.00 DS to +3.50DS in each eye) so I explained that her blood sugar was affecting the lens in her eye and that she should go back to her GP to see if he was happy with her current control.  I wrote a quick note to the GP advising him what I’d found.  Trying to explain that her diabetes wasn’t under control was difficult – she kept repeating the same thing over and over, that she never had any problems and that she didn’t even need to watch what she ate.  I urged her to go to her GP and told her that I’d sent him a letter.  I saw this woman a couple of weeks ago and she hadn’t gone to her GP.  She told me that she didn’t need to go, that she wanted new glasses instead.  When I refracted her again, she was +2.75DS.  I tried to explain that new glasses weren’t going to do her much good until she got her blood sugar under control but she was, again, adamant that her diabetes was well controlled.

So she was a recently diagnosed diabetic in denial.  I’ve also seen long term diabetics who lost control.  One lady, a Type I diabetic, came in for an eye test just before Christmas.  She had been diagnosed as a teenager and had been on insulin for over 20 years.  During her early twenties, she stopped looking after herself.  She smoked, drank, ate badly and went through two pregnancies without really paying attention to her blood sugar.  She still took insulin but not as regularly as she should have – she even skipped some injections to help her lose weight after her second child.  She wanted me to have all this information because she was worried about her eyes.  Two years ago, she had had a CRVO in one eye and the other had extensive scarring, some of it very close to the macula.  Now, I’m sure you’ve all had a patient who says “this is my bad eye” and then goes on to read 6/4.5 with both eyes, well, she told me that her left eye was her bad eye.  When I refracted her, I found her visual acuities were 6/4.5 and 6/45.  No increase on pinhole.  When I had a look at the back of her left eye, my heart sank.  She had proliferative diabetic retinopathy as well as the CRVO.  Her macula was completely covered in exudates.  The right eye had that worrying scar near the macula.  It was difficult to tell this lady, who was still hopeful that her left eye would get better, that this was it – it was better.

I think one of the worst things about being an optometrist is when you have to give bad news.  It could be something simple like telling an amblyope that laser eye surgery won’t help him see better than 6/18 in that eye* or carefully explaining to an 80 year old that macular translocation is not really a viable option at the moment, despite what they had read on the internet.

*Just as an aside, this lovely man in his early twenties had anisometropic amblyopia and no stereopsis.  When doing the TNO stereo test, he mentioned that the red/green glasses I asked him to put on were like the old style 3D glasses.  He then said 3D movies were rubbish – they looked the same to him, if a little fuzzy – but he wanted to buy a 3D TV to watch football on.  At that point, I had to explain about stereopsis and amblyopia and why he really shouldn’t spent £3k on a 3D TV.

Anyway, my approach to bad news is to be as straightforward as possible.  With the Type I diabetic, I told her that, given the fact that it had been two years, her vision in that eye was probably as good as it would get.  The main thing was to ensure that it didn’t get any worse and that her right eye was well looked after.  “So, make sure you come to us every year, that you keep attending the hospital and if you feel that there’s any change in your vision, that you come straight to us”.  I also congratulated her on giving up smoking and her drive to “get healthier”, stressing that these can make a big difference to her eye health in the future.  She thanked me for being honest.

So, to end on a nice, happy note:

I’m going to the Nederlands Contact Lens Conference in 2 weeks time.  I’ll try to update between now and then but, if I don’t, be prepared to be bombarded with information on contact lenses.  I’m also booked into some workshops about Meibomian glands and technology and other really interesting stuff.

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