The last two months have raced by, probably because I’m happier at work.  It’s nice to have one clinic to manage, rather than be handed one patient after another in a seemingly endless stream.  When I’m not testing eyes, I’m dispensing and problem solving.  I’m answering phones and booking appointments.  Best of all, I’m seeing people from last week come in to collect their new specs so I’m involved with the full patient journey.  I love seeing someone happy with their vision, knowing that I’ve gotten it right.  At the moment, I’m learning how to glaze (it looks so easy and fast when I see someone do it but then, when left to my own devices, I can’t find the “on” switch for the machine).

Today, I had a busy morning then a really quiet afternoon.  Only two patients were booked in between 1pm and 5pm so I decided to help organise the frames in the down time.  Of course, as soon as I started moving things around, it started to get busy.  Then, at four, we had a phone call from one of our other practices asking that I see someone urgently.

The patient, Mrs A, had been referred to us from her GP.  She had a brain tumour and was 5 months into her last 16.  Her vision had deteriorated over the last few days and that’s why the GP wanted Mrs A seen – she believed that the brain tumour was causing visual problems.

When Mrs A arrived, I did the pre-screen and led her into the test room.  She said she was struggling to focus with her current glasses.  She was diabetic and had only recently gotten her blood sugar under control.  She was taking a cocktail of medications, including steroids.

Mrs A had recently been through a very invasive surgery during which doctors managed to remove 75% of the tumour, extending her life expectancy from 6 to 16 months.  She was very calm, almost detached, when she told me.  Like most of my patients, she just wanted to be able to read and watch TV.

On refraction, I found a large myopic shift.  I managed to get her vision down to 6/9 in the good eye (the other, a lazy eye, had not responded to patching as a child).  Her discs looked a little pale but there was no papilloedema.  Pupils, motility and visual fields were normal but her tear film was in a terrible state: frothy and greasy.  Vision was variable: 6/9 one minute and 6/18 the next.

I explained that the change was probably a combination of things: there was a nuclear cataract; her blood sugar was not under control at the time of her last eye test so this could’ve caused a hyperopic shift that had now resolved; and the lack of stability of her tear film wouldn’t be helping matters.  The brain tumour, the most serious of all pathologies, was not the culprit.

As well as updating the glasses, I gave her some eye drops to try (Hycosan) and told her to return if there were any changes to her vision.  Fingers crossed that these improve her vision and that all her conditions remain stable.

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