“Under the detached retina, there was a small round raised lump”

There, through a series of tests, optometrist Hassan Awan identified a retinal detachment – and something else.

OT heard from Awan on the steps taken in this case, while Jackson shared her experience of a chain of events that led to the identification of eye cancer.

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

Hassan Awan (HA), optometrist at Boots Opticians: I was working in Boots Opticians Swindon and Tammy came in to see me for an eye test due to a sudden change in her vision of her right eye. Based on her symptoms, I started to suspect an issue with the retina, so I checked visual acuities and promptly examined her eye with indirect ophthalmoscopy.

I could see a portion of the retina was out of focus and bowing outwards, so I promptly brought Tammy into the pre-screening room and performed an additional optical coherence tomography (OCT) scan of her eye.

What I found was a retinal detachment, which required immediate referral to the hospital, but something else on the scan caught my eye. Under the detached retina, there was a small round raised lump. I decided to get my colleague, Daniel, to take a look, and he agreed on what I was suspicious of. We believed the lump could be a choroidal melanoma.

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

HA: I explained to Tammy what I saw, informing her that the reason her vision had blurred was due to a retinal detachment. I did my best to reassure her that it was a good thing she had come in.

I mentioned there was a small lump behind the detachment, and I would contact the Great Western Hospital to have her seen to as soon as possible to treat the detachment and have further investigations.

Daniel Karlkari, senior clinical supervisor and resident optometrist at Boots Opticians Swindon: Hassan requested my opinion on what he had found and we both concluded that it was a large choroidal melanoma with signs of retinal detachment. As my colleague got in touch with the hospital, I reassured Tammy about what was found, stating that she did a good thing by coming to see us.

What are the next steps that you took?

HA: Daniel stayed to help further reassure Tammy whilst I explained that I would call the hospital to arrange an appointment. I then wrote a letter and sent that to them to give them all of the information.

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

HA: I learned from Tammy that she was sent to Moorfields Eye Hospital for further examination which confirmed she did have a melanoma developing in the eye.

From then, I had some further contact from Tammy when she came back into the opticians to inform us directly about what was currently happening in terms of her treatment.

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

HA:

1. Make sure to use all the tools available to you to investigate a problem a patient has come in with. This will not only make it easier to detect any issues, but giving the relevant information to the appropriate clinic or clinician can aid with the referral process
2. Make sure to follow the appropriate referral pathway for your area and make sure you know how soon a patient needs to be seen based on their pathology – the College of Optometrists management guidelines can be very useful for this
3. Try to reassure your patient as much as possible. Referrals can be unexpected at times and frightening, it’s important to let the patient know what is next and what to expect.