“I feel very fortunate”

What led you to have an eye test? Before you went for a sight test, had you experienced any symptoms and how had this affected you in day-to-day life?

Keith Turbutt (KT), 75-year-old patient: I have enjoyed good health most of my life. I did not have to take any regular medication until 2008 when I had a transient ischaemic attack (TIA). Coincidentally, this manifested itself in my left eye, where I completely lost vision, but thankfully only for a few minutes. It was a very strange and frightening experience. Some time later, it was found that I had atrial fibrillation.

A few years later, I received a diagnosis of chronic sleep apnoea. I was provided a Resmed air pump, which feeds air to me through a mask that I wear every night. On the lead up to the sight test, the mask had been leaking due to the cushion becoming detached. I had tried my own repairs without much success but delayed getting a replacement, consequently, I was not receiving the full benefit of wearing the mask.

On the morning in question, I woke up at 5.30am. I thought I needed the toilet, but when I got out of bed I was very confused and couldn’t find my way. The feeling eventually passed, but as the day grew lighter, I realised that my vision wasn’t right, although I couldn’t be more specific about what was wrong. As I was well overdue for my annual eye test, I thought I had better get tested. Fortunately, I was able to get a same-day appointment, and my wife drove me there.

What did the optometrist find, and how did they explain the next steps to you?

KT: At first the eye exam went well. When it came to the test for field of vision, alarm bells rang. The eyes had been tested individually, and it was explained that the results for both eyes displayed the same error. This revealed that I hadn’t seen much of the left-side lights in the test.

Samiriah explained that as both eyes displayed the same result, something might be happening beyond the eye. She explained that I needed an immediate hospital referral and sent an urgent email to the hospital eye clinic. The optometrist told me to go home and wait for a phone call.

Can you describe how you felt during the referral?

KT: I felt quite calm and confident that all was being dealt with efficiently.

I realised that my vision wasn’t right

Did you have to undergo further treatment and what has the outcome been?

KT: The phone call came within the hour and I was told to go immediately to A&E. My wife drove me and once there I was given some initial tests, such as blood pressure, a blood test, and an ECG, finishing with a CT scan. The immediate concern was that I had had a bleed on the brain, however the scan confirmed that this was not the case. I was told that I would need an MRI scan, which was booked for a couple of days later.

During the consultation following the scan, it was confirmed that I had had a stroke in the optical area of the brain, but fortunately this was only in a very small area. The consultant was surprised that I had had a stroke at all, bearing in mind that I was on anti-coagulant medication. He recommended a change of medication.

I visited Samiriah after four weeks to update her and order my new glasses. She arranged for another field of vision test, which was satisfactory, and I was told I could resume driving.

Have your views on the importance of sight tests and eye care changed as a result of this experience?

KT: I agree that sight tests are very important, not only to ensure good sight but also as an indicator of one’s general health.

How has the experience changed your life or affected you?

KT: I was very grateful for the prompt and professional way that this event has been handled, both at the optometry practice and the hospital, in spite of what we hear about the NHS with all its apparent faults.

I believe this and past events have been triggered by my sleep apnoea and I am sure that many people have this condition without being aware of it. One further point is that the acronym, FAST, which is promoted as a means of recognising the symptoms of a stroke, makes no mention of sight which is just as important. I feel very fortunate, as things could have turned out much worse.

Both eyes were working, but the information was not being processed on one side

What did you identify during the sight test and what was your reaction?

Samiriah Shaikh (SS), senior optometrist at Specsavers Maldon: Keith had attended for an eye exam and mentioned changes within his peripheral vision, although found it difficult to explain what he was experiencing. He did mention this had improved since first occurring a few hours ago, and otherwise was fit and well, experiencing no other symptoms.

On conducting his eye exams, the eyes appeared healthy, and I requested a visual field test to be done to rule out any pathology. On receiving the results, these indicated that Keith had a homonymous hemianopia. I understood the possible causes which result in this field loss, and how quickly the patient needs to be seen in urgent care, especially as the onset of the symptoms had been that morning.

How did you approach explaining what you had identified?

SS: I approached the situation in a calm, empathetic and reassuring way. I showed Keith the field plots and explained in layman’s terminology what the results showed. This included the patient missing half of the field of view on his right side. Both eyes were working, but the information was not being processed on one side, which signifies a problem beyond the eyes. This can make everyday tasks like walking and reading challenging, as it may be difficult to notice things within the lost field of view unless turning the head.

I explained that, due to the onset of symptoms, I would need to make a referral to the hospital, and we also discussed driving legality.

What were the next steps that you took, and what was the significance of these steps to this case?

SS: I followed local protocols by referring Keith as an emergency and contacted the triage nurse to confirm the referral was received and acted on. The triage teams reached out to Keith to arrange an urgent clinic appointment for immediate assessment. Prompt action in such cases is critical to prioritising patient care, ensuring the patient gets the appropriate support.

When did you hear about the results of your referral and how have you been involved since?

SS: I heard the results of the referral a few days later as Keith’s wife came to the practice to thank the team and I for acting so quickly. I have seen Keith for a follow-up since and he was very grateful for the action taken on the day. He brought us some chocolates – which we loved.

What would be your top tips to other practitioners when making a referral?

1. Provide comprehensive and clear information. Include all relevant clinical findings, history, and suspected diagnosis or concerns. Highlight key details such as visual acuity, intraocular pressure, fundus findings, or concerning symptoms. Ensure the referral is concise with appropriate clinical terminology.
2. Prioritise communication and urgency. Clearly indicate the urgency of the referral and provide reasoning to guide triage decisions. If the case is urgent, contact the receiving practitioner or clinic directly to ensure timely action. Follow-up to confirm receipt of the referral, especially in emergencies, to avoid delays in patient care
3. Empower and inform the patient. Clearly explain to the patient why the referral is necessary, what to expect, and the potential implications. This ensures they understand the importance of attending their appointment and what to do if they have not heard anything
4. Ensure accessibility of supporting data. Share any supporting documents, such as visual field results, optical coherence tomography scans, or fundus photos, when applicable.