This is my day off so I’m catching up with some paperwork.

I am in the process of registering with a selection of NHS Health Boards and filling out my OSCE application.  The OSCE application is done, I just need to find a couple of passport sized photos and then get them signed by my supervisor.  The health board application is a bit cryptic and didn’t come with the usual 20 page document telling you how to fill it out (unlike the Disclosure or PVG, which also has to be done today).

I have had an interesting week.  Paperwork-wise, I had my pre-reg to newly qualified review, which decides whether or not I have a job at the end of my pre-reg.  I would ideally like to stay with the company I currently work for but they have only a couple of jobs and there are 6 of us pre-regs in the West of Scotland.  The review was like a competency based interview but on paper.  I’ll find out about the job next month but I feel a bit sick thinking about it.

I finally got a hold of the lady with the retinal hole and bleed that I saw last week.  She was still remarkably calm and untouched by everything that had happened.  She told me that when she got to the hospital, they took her blood pressure and her systolic BP was over 200.  “That’s a bit high, isn’t it?” she asked me.  I just agreed, not wanting to say “that’s malignant hypertension, if it continued, you could’ve died”.  She was being seen again at the HES in 6 weeks but her GP is monitoring her to get her blood pressure under control.  She thanked me for referring her to the hospital last week and apologised for being a bother.

On the same day as I caught up with this lady, I also had a phone call from a woman (B) I’d seen in January.  She had been referred by one of my colleagues last June for amaurosis fugax but she had not attended the appointment.  When I saw B, she had been having some disturbing symptoms.  I saw her on a Saturday.  On the Thursday, she had a “splitting headache” then she felt as if she was “looking through binoculars”, the headache went away quite quickly but her vision took a few minutes to return.  On the Friday, the same thing happened – she was watching TV when suddenly this severe headache came on and she couldn’t see the right hand side of the TV screen.  Her daughter had practically forced B to come to the opticians, she was very dismissive of the whole thing, thinking that, because her symptoms had resolved, there was no point in her bothering us.

There were no issues at the back of her eyes and her visual fields were normal but I was concerned that these symptoms, coupled with the previous amaurosis fugax could be signs of a TIA or stroke.  Now, at this point, I asked if I could bring her daughter into the room to explain the situation.  So, with her (concerned) daughter present, I went through why I was referring and explained that these symptoms could be warning signs of a more serious problem.  Again, B protested that she was sure everything was fine and that she was just being silly, we didn’t need to take up the doctor’s time at the hospital.  At this point, her daughter jumped in: “Look, if you don’t get this seen to and something serious happens, what will I tell [my children]? That it was too much bother for you to get yourself checked out at the hospital? If these things were happening to me, you’d be the first to tell me to go to the hospital.  I’ll take you there myself.”

Then she turned to me and said, “I’ll make sure she goes.”

Anyway, apparently B did indeed go to the hospital and they did a battery of tests.  Apparently she had suffered two small strokes (I was hearing this from B so I’m not sure if they were strokes or TIAs, I assume the latter because her visual fields were back to normal by the time I saw her that Saturday).  She was calling to update me on her treatment and to thank me for referring her.

It’s amazing when, in the middle of a pretty rubbish week, a couple of phone calls like that can really boost your mood.

I had a patient in a few days ago who had been to another opticians and had an eye test around 2 weeks ago.  He had bought some new varifocals but wasn’t getting on with them.  He just happened to be passing so decided to ask us to recheck his prescription.  No problem, I thought.  Then I spent 30 mins refracting him.  His answers were variable and I was pretty much at my wit’s end (he’d been slotted in as a “quick” refraction check).  I asked him to come back the next day so I could have a look at the back of his eyes (I also told him to bring a friend or family member to drive him home as he had very small pupils and I was going to dilate).  He was quite happy and came back, got the drops in and wandered around the store for ten mins while the TRO 1.0 kicked in.

Now, this gent’s VA the last time we saw him in our store was 6/5 R&L (albeit 6 years ago).  His current VA was R 6/9 and L 6/15.  The optometrist had asked if his left eye had always been lazy (which confused the px so much he mentioned it to me).  He also mentioned that, on the way to our store that evening, he saw the road lines split in two out of the corner of his eye.

Anyway, the first part of my SL routine is a sweep of the lids and lashes.  I wasn’t even looking at the lens and I could see the massive cortical cataracts in both eyes.  They looked like a child’s drawing of the sun (a central circle with “rays” coming out in all directions).  On closer inspection is was a mixed cataract, part posterior subcapsular and part cortical.  Everything at the back of the eyes was fine.  The cataract explained his ghosting and the reduced vision at both distance and near.

The px was really happy to find out that he wasn’t going mad (his words) and I have referred him in for cataract surgery.  Even the fundus photo had that blurriness that comes from a dense cataract so it was pretty hard to miss.  I asked the px if he wanted to see a pic of his cataracts and he was so impressed that he asked me to text the photo to him so he could show his wife.  Here’s the pic (I’m using retroillumination, the pics using direct weren’t very good):

Mixed cortical/posterior subcapsular cataract

Mixed cortical/posterior subcapsular cataract

So, that’s my exciting week.

Now, back to my paperwork.

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