“As soon as I looked at his OCT scans I could see papilloedema”

A pre-registration optometrist at the time, Khan convinced her brother, Shahroz, to attend the practice for an eye test, where she quickly identified papilloedema through the optical coherence tomography (OCT) scan.

Khan told OT: “I remember rushing downstairs to speak to my supervisor who confirmed that what I suspected was correct and I needed to contact the emergency eye department as soon as possible.”

Shahroz and Mahnoor shared their experiences of the eye examination, referral, and the treatment journey since.

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?

Shahroz Khan (SK), 33: I was experiencing intense headaches, often with nausea. The pain would be so severe, that I would find myself unable to stand. As I had no visual symptoms, I didn’t deem it necessary to have an eye test. However, my sister, who is an optometrist, persisted and ensured I had an eye test.

Shahroz Khan

Shahroz Khan

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

SK: My sister checked my prescription, then moved on to checking the health of my eyes and that’s when the problem began. She noticed that my optic nerve was swollen. I asked her what the matter was and she didn’t reply at once, which worried me. As she was a pre-registration optometrist at the time, she consulted with her supervisor then called the emergency eye department to refer me for further investigation. She tried her best to keep me calm, but I could sense something wasn’t right.

Can you describe how you felt during the referral?

SK: From my perspective, I went for the eye test due to my sister’s insistence – thinking it would all be fine because I have never had any visual concerns. In fact, this was only my second eye test in my life. Seeing my sister pacing up and down the stairs and liaising with other professionals, I started to fear what was to come.

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

SK: I was referred to ophthalmology, who requested an MRI to ascertain why I had the optic nerve swelling as all other eye-related tests were clear. After my first MRI, the radiographer requested an MRI with contrast, following which I was escorted from Weston Park Hospital to the Royal Hallamshire Hospital neurology ward and admitted.

I was then called into the counselling room by the neurologist who informed me that they had found a brain tumour on the MRI scan, which was revealed to be the cause of my headaches. I then had to undergo an urgent craniotomy to fully remove the tumour, which was diagnosed as a meningioma. I stayed in hospital for some time post-surgery, and since then have been continuing my recovery at home, which has been a slow and steady process.

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

SK: Yes. I don’t think I would have gone for a sight test for the headache. It was only because of my sister’s persistence and vigilance that I had a sight test, and this was identified at a stage where, thankfully, it was operable. I now understand how eye tests can help to diagnose other health concerns.

How has the experience changed your life or affected you?

SK: It feels as though I have been given a second life. I am thankful that it was detected and treated in a timely way thanks to my sister’s keen eye and the neurology team’s prompt attention.

It was only because of my sister’s persistence and vigilance that I had a sight test, and this was identified at a stage where, thankfully, it was operable

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

Mahnoor Khan (MK), optometrist at Specsavers Norton, Sheffield: Towards the end of my pre-reg, I encouraged my brother to have an eye test as he was suffering from severe headaches and nausea. As an optometrist, this was a red flag, although I didn’t want to assume the worst. As soon as I looked at his OCT scans I could see papilloedema. I was in a state of shock – as a pre-reg this was the first time I had seen papilloedema and to see it in my own brother was terrifying, to say the least.

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

MK: As a professional, I didn’t want to scare my brother, but I explained that he will need a referral due to this finding. He had a lot of questions that I didn’t have all the answers to at that moment in time, but I assured him everything would be okay and he just needed another professional’s opinion. It was surprising, as he has always been healthy, is an avid gym-goer and has never even had to go to the GP.

This was the first time I had seen papilloedema and to see it in my own brother was terrifying

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

MK: I remember rushing downstairs to speak to my supervisor who confirmed that what I suspected was correct and I needed to contact the emergency eye department as soon as possible, who then arranged an appointment for him to be seen promptly.

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

MK: I finished work on a Friday to accompany my brother to his MRI scan appointment, with hopes of it being all clear. However, a right-sided brain tumour was detected in the scans which required urgent surgical intervention. My brother had to stay in the hospital for most of that month, and myself and my family were there every day to support his recovery. My directors have been very supportive in this time, enabling me to have the time off to care for my brother in those initial weeks.

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

1. There is no harm in getting a second opinion from another colleague. As a pre-reg I had to consult my supervisor, but it is better to be sure than overlook something
2. It is important not to use jargon with the patient, as it creates a sense of fear before they have even received an official diagnosis. Our role requires us to demonstrate empathy and make the patient feel safe and reassured
3. Be aware of local referral pathways so you know what the next steps are going to be in any circumstance as the more confident you are in this, the more the patient feels at ease.