It’s become a bit of a running joke that I rarely get a lunch break. For some reason, people wait until around lunch time to seek help for problems that develop early in the morning/the night before/6 months ago. I’ve seen more emergencies around 12.30pm than any other time (excepting 9pm, the favourite time for problems during my pre-reg, but that’s only because I now work 9 to 5).

So, on Friday, I’d forgotten my sandwiches. I left one practice a little early, planning to drop my things in the other then head out to pick up lunch. As I walked towards the shop, I realised there were two people sitting in the waiting area. It was 55 mins until my first appointment of the afternoon.

When I got in, C explained that the older gentleman, Mr D, had been sent down by his doctor as the GP suspected a retinal detachment. The lady with him was his daughter.

Now, Mr D has dementia and mobility issues so I had to streamline my examination of him to limit the amount of moving around. I did non-contact tonometry (R 14 L 18mmHg) and brought him through to the test room. I explained about the eye drops and popped them in. After I’d done that, I moved onto history and symptoms.

Mr D had been looking at the TV that morning and said to his daughter that his right eye was “kaput”. 

Thinking this was a sudden loss of vision, she’d made an appointment with the GP who had a look with the direct ophthalmoscope. The GP had then referred them to us, telling the daughter that it sounded like a retinal detachment. Except, of course, there were no symptoms or signs consistent with a detachment.

On questioning, Mr D said that his eye had been blurry for a while, although he was unable to give an estimate of duration except for stating it was more than a week.

He was new to our practice so I had no access to his previous records. Indeed, they weren’t sure where he’d been tested last. All I knew was the prescription from his current specs and the fact his vision in his right eye was CF (counting fingers). Also, Mr D was attending the eye clinic every three months but both he and his daughter were unsure as to which clinic it was.

By this time, the TRO 1% had kicked in so I had a good look in both eyes, using my 90D superfield then my 78D to look at the disc and macula. Apart from some background diabetic retinopathy and a moderate cataract, I couldn’t see any issues. There was no tobacco dust and the only alarm bell was the pressure difference between the two eyes.

I explained my findings and decided to call the hospital. After summarising the situation, I explained to the nurse that Mr D was attending HES every three months and that I had no previous recorded vision. I also told the nurse that Mr D had dementia and was unsure of the duration of this blurred vision.

The nurse checked on the system and discovered Mr D’s right eye VA had been CF for some time. He was also due back at HES in two weeks. The nurse said that it was difficult for dementia patients with visual loss because they often forget they have an issue. Luckily, Mr D didn’t seem upset, just a little bemused at what was going on. His daughter, quite rightly, had wanted to get everything checked so was the driving force (figuratively and literally) behind his visit.

After thanking the nurse, I hung up and went into the waiting area. I told Mr D and his daughter that Mr D’s vision was the same as when he was last at the eye clinic and that he would be receiving an appointment soon. They were both quite pleased with the result.

As they left, my first appointment of the afternoon arrived…