“A simple eye check can really save your life”

After testing in practice revealed a unilateral right eye hemifield defect, Walker made the decision to urgently refer Taylor to the local hospital eye service for further tests and treatments.

OT spoke with Walker about the steps he took in the case.

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

Craig Walker (CW), optometrist at Hartlepool Specsavers: Nicola came to me complaining of poor vision, affecting her distance and near vision. This was with regards to the right eye. During the eye examination, the right eye was found to have reduced vision and best corrected visual acuity. It was also apparent that Nicola was only able to visualise half of the chart – unilateral hemifield loss.

As the visual acuity was below the expected standards, I requested a visual fields assessment. This revealed a unilateral right eye hemifield defect, which did not obey the horizontal or vertical midlines. This was therefore suggesting some retrobulbar lesion was the cause, as the orbit and eye itself seemed to be perfectly fine.

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

CW: I explained as calmy, but as honestly, as I could that I was concerned about a lesion behind the eye. The only similar case I have had in the past was due to an aneurysm. I stressed the need to be referred to the hospital eye service for more investigations and likely treatment.

Nicola had been accompanied by her mother, who has been very supportive throughout Nicola’s treatment journey.

What were the next steps that you took? What was the significance of these steps in this case?

CW: With the reduced visual acuity and field defect, as well as Nicola having had these symptoms for 14 months that seemed to be worsening, I made the decision to refer her urgently to have hospital eye service investigations – especially as this field plot did not have the expected losses for most expected pathologies.

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

CW: Nicola has been amazing in keeping me informed of her care and treatment. She rang me the same day as her appointment with the consultant to be informed of the type of tumour that was present. At this point, Nicola was happy to have a diagnosis. She then explained to me what the plan was for treatment.

I left it with Nicola to keep me informed of progress. I later found out that Nicola’s appointment had taken place and most of the tumour had been removed, with a view to have another visual field test and MRI in 2026.

Nicola has since returned to the practice for an eye examination, and I’m pleased to report that her unaided vision is very good and she does not require spectacles at this time. Nicola is a nurse so has an extremely good grasp of what the ongoing care is to be.

My plan with Nicola is to see her for routine eye examinations – and she knows if she has any concerns then she can come and see me sooner. This is advice I give to all patients, but it is an honest invitation, as I firmly believe patients know if there is something not ‘right’ with their eyes.

What are your three top tips for other practitioners when making a referral?

1. Ensure you have listened to the patient’s symptoms and how these match with any signs that have presented during the eye examination
2. Select the most appropriate time frame: emergency, urgent, or routine. The College of Optometrists offers excellent guidance on this, but so will colleagues in practice
3. Follow up. There is nothing more frustrating for me than referring a patient to then never find out what happened, athough this must be handled delicately, depending on what your differential diagnosis is. I would recommend asking the patient to contact you with the outcome and supply the patient with the practice phone number or your work email address – this way the patient retains control of their information.