Last week, on a day when our entire diary was full, my first patient reported a “curtain across her vision”.  Her vision was R 6/6 N5 L 6/10 N14, with the left eye being the one with the “curtain”.  The “curtain” didn’t move with eye movements and there were no flashing lights or floaters but, given the asymptomatic nature of the last detachment I’d seen, I was still on edge.  The patient had a cortical cataract in that eye, one that swept across her visual axis with a little PCO thrown in for good measure.  Once the TRO1.0 kicked in, I did Volk twice in both eyes. I couldn’t see anything to explain her symptoms except that left cataract.  I asked one of my colleagues to double check the left eye and he agreed that there were no tears or breaks, no Schaeffer’s sign.

My thoroughness had held up my clinic by fifteen minutes.  One of my colleagues was dealing with an emergency (a young woman with diabetes, dense cataract in one eye and a CRAO in the other who had went from 6/10 in her “good” eye to hand movements) which had knocked his clinic behind as well.  The third optometrist had picked up the slack but we were running behind by 30 mins for most of the morning.  This stresses me out because I, myself, hate waiting.  I could only apologize when taking in my patients and told them that an emergency first thing in the morning had set us back.  It was sod’s law that everyone booked in that morning actually turned up – usually we get a couple of no-shows but not that day.

I had a couple of routine eye tests then a patient with severe anxiety.  As we entered the test room, she confided that she’d been up all night, unable to sleep, worried about this eye test.  This patient, J, had been coming to our practice for several years before she moved up North for work.  Her first test in her new opticians had resulted in a referral for papilloedema.  Now, I’ve seen papilloedema and I’ve seen myelin around the disc, optic disc drusen and pseudopapilloedema.  Her discs looked fine.  She had no symptoms – no headaches, VA 6/5 in each eye.  Yes, the discs were slightly less well defined in the inferior aspect and were minutely raised in that same region but it had been noted before and the photos were pretty much the same for the last 6 years.

Anyway, as someone who suffers from anxiety, the referral really worried J.  She went home and googled swollen discs and convinced herself she had a brain tumour.  It was made worse by the fact the ophthalmologist did not want to see her as she had no symptoms (and it was an electronic referral so the fundus photos would have been attached as well). J chased the optician about the referral but, ultimately, it was left unresolved and she moved back to us.  She had been up all night worried that I would see something at the back of her eyes.

During the entire test, I had to reassure J that everything was fine.  She wanted to know if the IOPs were okay, before we even sat down in the room, and if she passed the autorefractor (which I explained isn’t something you can “pass”).  J asked questions about every part of the test and, at the end, when I showed her a photo of the back of her eyes and told her that everything looked healthy, she burst into tears.  She was so relieved and kept thanking me.

As the optometrist she had seen was working for the same company as I am, I wondered why they hadn’t called us and asked for her records to be faxed to them before referring her.  Something as simple as that could’ve saved this young woman a lot of stress and worry.

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