“Your heart drops because given what Emma has already gone through, you’re hoping to find nothing”

Following a series of retinal tears, Williams is quick to act on anything that feels out-of-the-norm, telling OT: “I know that I can just phone Hamza and tell him: ‘I don’t know if it’s anything,’ and he will tell me to pop in.’”

Williams and Mussa spoke to OT about a recent visit which led to an urgent referral.

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?

Emma Williams (EW), patient, Warwickshire: In 2022 I had two retinal tears in my right eye. It was like black ink in my eye. I saw Hamza and he explained what had happened and referred me. Last year, again I had floaters in my eye and so I returned to Hamza and I was referred on because I had a tear and a detached retina. A month later, I woke up with a shadow in the corner of my left eye and my eye was red and bloodshot.

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

EW: I know that I can just phone Hamza and tell him “I don’t know if it’s anything,” and he will tell me to pop in. He jokes that he sees me more than his brother. Hamza is fantastic. He says things, but doesn’t panic you and stays optimistic.

Can you describe how you felt during the referral?

EW: The John Radcliff in Oxford is brilliant. It is scary because you think: “I’ve done it once and it hasn’t work.” It’s not just having the operation, which was fine, it’s the time after when you are off work, so you think even more and start to think of the worst things. Because you’re recovering you can’t do a lot, and you’re a bit scared to do anything as well.

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

EW: I had a silicone oil bubble put in at the beginning of December. The eye has been fine so far. The eyesight in the eye has changed and I have got a cataract coming on the eye, which isn’t brilliant. I’ve had to change my lenses. I will be able to have a cataract operation, which should help. Hopefully the outcome is quite good.

I have a nightlight which I keep on, because I don’t want to wake up in the pitch-black and panic that I’ve gone blind

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

EW: I definitely suggest regularly going to the optometrist. In my right eye, I have a floater all the time, but if something doesn’t seem right, I will still go and see Hamza to check.

When I had my first retinal detachment, I was supposed to go for a dentist appointment but had to cancel. At my rescheduled appointment, I explained what had happened. When I next saw the dentist, he told me: ‘After I saw you, I went to the opticians and got my eyes checked.” I thought: “Well there you are – keep an eye on your eyes.”

How has the experience changed your life or affected you?

EW: I have always gone for check-ups. It does worry me quite a bit. I have a nightlight which I keep on, because I don’t want to wake up in the pitch-black and panic that I’ve gone blind. It sounds silly, but I need that. It affects you because you think: should I be lifting? Can I go on holiday? Can I get on a plane? I don’t want anything to happen to me.

Get your eyes checked. If you see anything, don’t leave it for a few days and think it’s alright. Just go and get it checked.

Emma knows to come straight in if she has concerns, and I will squeeze her in for assessment given her history

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

Hamza Mussa (HM), lead optometrist for Specsavers in Banbury: I have looked after Emma for the past three years and in that time she has had four retinal tears in the right eye. Emma knows to come straight in if she has concerns, and I will squeeze her in for assessment given her history. She attended practice complaining about floaters and blur in her left eye. I carried out a dilated examination and identified a vitreous haemorrhage and retinal tear in her left eye.

Your heart drops because given what Emma has already gone through, you’re hoping to find nothing. At the same time, you are relieved because with prompt action you can get the patient into the hospital eye service for treatment.

How did you approach explaining what you had identified/suspected?

HM: On this occasion, because Emma had already had four previous repairs, I was very direct in my explanation of what I had found and what happens next. Because of how busy things can get at the hospital, I’ve always found it helpful to be open and honest with patients about what you suspect and what to expect when they get to the hospital, so they aren’t blindsided upon reaching the hospital.

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

HM: I arranged for Emma to be seen at the eye casualty at the John Radcliffe Hospital in Oxford, where later that day she had a vitrectomy and laser repair for the tear. Retinal tears, if untreated, can progress to a retinal detachment which means prompt treatment is essential to prevent sight loss.

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

HM: Emma came in to see me a few days after treatment to update me on what happened at the hospital. Since then, I’ve seen Emma on a couple of occasions to manage the cataract that formed following the vitreoretinal surgery on the left eye. Because of the cataract, she has had a big shift in her prescription in that eye, but we are trying to manage this with contact lenses for as long as possible to give her a break from the eye hospital.

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

1. Explain the situation and findings in clear layman’s terms to avoid technical jargon and outline the likely next steps for the patient, but also don’t downplay the sight-threatening nature of your findings so patients understand the need for urgency in referring them
2. Always give patients clear written supporting information – patient leaflets, referral letters, address and contact details for the hospital. Sometimes in the shock of the situation, patients don’t always register what you have said, so supporting information gives them something to refer to
3. Ask the patient if it is okay to call them in a few days just to see how they got on. This serves two purposes: it allows you to find out the outcome of the referral, which helps you to improve as a practitioner. Also, if there were any issue with the referral, such as if the patient hasn’t been contacted, it means you can communicate with the hospital to make sure they have received and actioned the referral.