What you might not realise is that for every blog post that you see, there’s a couple of failed ones.  Ones that I start and then I run out of steam or time.  Sometimes these posts sit in my “drafts” folder for years.  This is such a post, where I was originally going to tell the story about two patients that were very different in age and lifetyle, both affected by vision loss.  What happened was that I’d gotten half way through, saved the draft and promptly forgotten about it so here it is, edited because I can’t remember the rest of it.

At the beginning of the month, I saw B.  He is a 25 year old guy whose first words to me were: “I’m going blind.”

He said it in a different way from the usual overly-dramatic patients (the ones who are -0.50DS and declare that they are blind without their specs).  His tone was flat, serious.

“What’s causing it?” I asked, setting up the autorefractor.

“Diabetes.” And that was it, no further information.  I nodded.

During my pre-reg, I had seen a young woman with diabetic maculopathy.  It had left one eye 6/60 and the other with exudates very close to the fovea.  I was reminded of her optimism that her bad eye would somehow heal over time and how I had to break the news that, after so long, her vision was not going to improve.  B didn’t sound optimistic – he’d already had that talk with someone.

So we go through to the test room and we chat about life.

At his first eye test (in July last year), my colleague took one look in his eyes and called HES.  B was seen the same day and that was the start of a very difficult 9 months for him.

He’s lost his job as a forklift driver because he doesn’t meet the visual requirements.  He’s now on Job Seekers’ Allowance.  As B struggles to control his diabetes (he was diagnosed as Type 1 when he was in nursery), he is struggling to find a job that would accommodate his unpredictable healthcare needs.  He had been in and out of hospital several times since the New Year and, in fact, the next day he had an appointment with an ophthalmologist.

B’s a smart guy.  He’s read up on his condition and he realises how close he is to losing his sight.  He knows that the ophthalmologist might laser his peripheral retina to save the macula.  B asks a few questions about the procedure: how does it work? Will it hurt? Will he be able to drive?

He had a small minus prescription but felt that there was a change in his vision.  I refracted him and found him a little more myopic, which could be normal progression or may be the result of better diabetic control.  As he was seeing the ophthalmologist the next day, I had his specs glazed for him straight away and gave him a copy of his prescription with VAs on it for the ophthalmologist to see.

I’m always surprised when we see patients with diabetes who don’t attend their retinal screening and/or get regular eye examinations.  It’s especially strange since those with diabetes are entitled to a “free” eye test* every year.  I wonder if it’s denial, lack of education, lack of understanding or a combination of many things.

* Paid for by the NHS so free at point of delivery.

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