Last month I tested a lovely man in his 70s (Mr C) who had recently been discharged from HES.  He had been attending for wet AMD in his left eye.  The hospital had ceased treatment in July and told him that there was nothing else that could be done.  He was 6/120 in that eye and on Volk, there was the horrible grey membrane across his macula that sometimes results from wet AMD.  His other eye was 6/10 corrected, with a little touch of cataract and some drusen.  Thankfully, the macula of the right eye looked reasonably flat and was intact.

Mr C was having difficulty with glare and I remembered reading that a tint can help patients with AMD.  I consulted one of my colleagues who then promptly Googled it (your phone is your friend in these situations).  It turns out that red, yellow, orange or brown tints are beneficial so I asked the DO to dispense Mr C with a brown tint and left them to work out the depth of the tint required.  Mr C left us with two pairs of tinted specs, a Macular Society AMD leaflet, an Amsler grid and my usual “If you notice any changes in your vision, or any holes or distortion on that grid, come back straight away.”

Anyway, I didn’t really think about Mr C again until a few days ago.  He called to make an appointment because he couldn’t see with his glasses.  This could’ve been a simple recheck but then he told the receptionist that they had been fine until 4 days ago when suddenly, he couldn’t see with them and the day before, he’d been to Mass and he couldn’t see the priest’s face but he could see his body and everything around him.

He was booked into my clinic, in the last slot of the day.  From what he’d said on the phone, I had a sinking feeling that he’d developed a central scotoma.  Perhaps wet AMD, perhaps a macular hole.  Anyway, the day rushed by and suddenly, I was calling Mr C into my test room.  He told me he’d first noticed the change on Thursday and how, as well as not being able to see people’s faces, lines looked “wiggly” to him.  I asked him if he’d checked the Amsler chart I’d given him and he confirmed that he couldn’t see the central spot and the lines that he could see were bowed outwards.

Like many from his generation, Mr C didn’t want to be a bother or a nuisance.  He apologised to me for coming back.

I checked his vision, which was down to 6/15 in his right eye.  On dilated fundoscopy, I saw his macula was raised.  I told Mr C that it was wet AMD and I would refer him through the fast track.  I asked one of optical assistants to do post-dilation pressures and take a photo while I filled out the fast track form.  Mr C then left to walk home.

As I was ticking boxes on the wet AMD form, I started really thinking about the situation and decided to call the hospital instead.  I’d referred a lovely lady (in fact, she’s appeared in this blog) through the fast track recently and they took 6 weeks to see her (her vision in the affected ete has gone from 6/20 when I referred her to 6/120 last week, the hospital have postponed treating her due to an eye infection apparently).

Mr C needed to be seen as soon as possible.  He could be blind in 6 weeks.  It was now after 6pm and it took ten minutes for me to get through to the hospital switchboard but after that initial wait, I was put through to the on-call ophthalmologist straight away.  By a stroke of luck, the lady ophthalmologist I spoke to was the same doctor who had been looking after Mr C’s left eye.  She reassured me that I’d done the right thing calling rather than referring through the wet AMD pathway.  Luckily she had an AMD clinic the next morning and would fit Mr C in.  All I needed to do was give him a referral letter and tell him to go up to the hospital for 9.15am.

Now, I only had a home phone number for Mr C.  I called but he was obviously still on his way home.  I left a ridiculously long message on his voicemail (it actually cut me off) asking him to come to the store the next morning at 8am and pick up the referral letter then head to HES.  As I was packing up, I started worrying that he wouldn’t get my voicemail and that it might be too much for him to make his way to us then to the hospital.

I printed out two copies of the referral and left one at reception.  I looked up Mr C’s address on my phone and discovered he lived 5 mins drive away from the store.  I decided to go to his house and give him the referral letter.  It was in a part of town I wasn’t familiar with so it was a bit of an adventure.  Where would we be without sat nav on our phones?

Anyway, I took ages to find his flat, which was tucked away behind the road.  I rang the doorbell fully expecting no answer (I’d written a little note to go with the letter so I could just post it through his letter box) but Mr C answered.  I explained what had happened and gave him the referral letter to take with him the next day.  He was very touched that I’d went out of my way to help him.  I was just happy that he’ll be seen as soon as possible and I hope they can save his vision in that eye.

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