When writing my last article, I had only just begun my pre-reg year. I was just getting into the swing of working in a busy hospital clinic, getting through the required elements of competence and assessment visits, and getting to know my team. Now that Christmas has come and gone, I am almost halfway through my training. It might be hard to believe, but it has taken me this long to feel fully settled into life as a pre-reg.
“Often, patients will have complex prescriptions and commonly present ocular pathology are keratoconus, intra-ocular lenses post-cataract surgery, glaucoma and age-related macular degeneration, among others”
Through the looking glassThe bulk of what I do can be considered ‘core services.’ This includes refraction, contact lenses and low vision. Performing refraction is usually done in support of the ophthalmologist so that they can spend more time looking at the condition of the eyes and discussing appropriate management. Often, patients will have complex prescriptions and commonly present ocular pathology are keratoconus, intraocular lenses post-cataract surgery, glaucoma and age-related macular degeneration, among others.
In the contact lens clinic, I fit and monitor patients with a medical reason for wearing contact lenses. Rigid gas permeable lenses, mini-sclerals and sclerals are commonly first-choice, with soft lenses being reserved for aphakia and piggyback systems.
Finally, we have low vision where I elicit how independent the visually impaired patient is at home, whether a magnifier or telescope would help them day to day, and whether they need to be referred to outside services, such as Henshaws.
I am very lucky that we have dispensing opticians in-house as this affords me the opportunity to spend some time with them during my week getting my dispensing numbers.
The patients I see coming into the dispensing area are often children with high prescriptions. We have special paediatric frames that can be adjusted to fit the patient. It can be a challenge taking measurements from infants who would rather be asleep, but it is very rewarding nonetheless.
“I often follow patients through when their fields seem to suggest progression of glaucoma, and I sit in on the OLGA with a senior optometrist”
More than meets the eyeHowever, that’s not all I do. In addition to sight testing and dispensing, I also do visual field testing. Using a Humphrey Visual Field Analyser II, I take the fields of patients who are seen in an optometry-led glaucoma assessment clinic (OLGA), as well as those seeing the consultants for glaucoma monitoring.
I often follow patients through when their fields seem to suggest progression of glaucoma, and I sit in on the OLGA with a senior optometrist.
Furthermore, there are a variety of other clinics that are largely observational on my part, but I sometimes find myself getting involved in some techniques, whether that be doing a cover test in orthoptics, or looking at the macula using both Volk and optical coherence tomography at the Macula Treatment Centre.
As well as sitting in with orthoptists, ophthalmic science practitioners and fellow optometrists, I have also had the opportunity to observe consultants and trainee ophthalmologists in clinic. On Wednesday afternoons, the clinic is closed and I attend teaching sessions run by an ensemble of eye health professionals. All of this has been fascinating to watch and conducive to my learning – it further inspires me to think about the areas in which I would like to work in future.
Having provided you with a whistlestop tour of my typical week at work, I am currently focusing on getting my competencies ready for Visit 3, while also revising during the festive break. This year, I am looking forward to having the opportunity to sit in on theatre and in the laser clinic. 2020, here I come.
Image credit: Getty/erllre