“I can live safe in the knowledge that care will always be there when I need it”
Optometrist Faheem Sarfraz, from Paul Cheetham Eyecare, and patient Syed Shah discuss a treatment for uveitis during lockdown
Before you went for a sight test, had you experienced any symptoms and how had this affected you in day-to-day life?
Syed Shah (pictured): I was experiencing severe pain in my left eye; the only way I could describe it is that it felt like someone was putting a knife in my eye, the pain was that sharp. I also had light sensitivity and my eye was inflamed and red.
How has COVID-19 changed the way you accessed the services you needed from your optometrist?
SS: I was referred to Paul Cheetham Eyecare by my GP. I rang the practice as I would do normally, but I wasn’t really expecting to see them due to the restrictions. I spoke to Faheem over the phone, relaying my symptoms, and I begged him to relieve the pain. He told me he’d like to see me through their video consultation service, in particular to see the extent of the redness in my eye. Thankfully, Faheem could see how inflamed and red my eye was, as well as how much pain I was in, so he asked me to come into practice. Faheem assured me that the practice was fully PPE-compliant, so that reassured me.
What did the optometrist find, and how did they explain the next steps to you?
SS: Faheem diagnosed that it was uveitis, which explained the redness and pain I was experiencing. He said that it needed emergency care and the normal procedure would be to refer me to hospital.
Can you describe how you felt during the referral?
SS: I made my feelings known to Faheem that I really wanted to avoid going to hospital. We were in the height of the COVID-19 pandemic and I knew that, if I went to hospital, I was putting myself at much greater risk of contracting the virus. I couldn’t even rule out the possibility that I was unknowingly carrying the virus, and a visit to hospital could be putting vulnerable people there at risk. Thankfully I was relieved to hear that, because of Faheem’s qualifications, he could treat me in practice and remove the risk of a hospital visit. That was a massive relief and I can only thank Faheem for understanding and taking my concerns into account.
Did you have to undergo further treatment and what has been the outcome?
SS: Faheem provided me with the prescribed eye drops and their effect was incredible - within 20 minutes of applying them I was feeling so much better. I took two separate drops for four weeks and after a follow-up appointment with Faheem, I was relieved to hear that he was happy with the progress and my eye was clear.
Have your views on the importance of sight tests and eye care changed as a result of this experience?
SS: This experience has definitely made me realise how opticians support the wider health care system, especially during times of crisis. I could have easily gone to hospital and put myself and others at further risk. With the treatments they have available it just shows that opticians are saving lives in more ways than one.
How has the experience changed your life or impacted you?
SS: If it had led to losing my sight, that would have been a life-changing situation and I don’t know how I would have coped. Thankfully, now that my treatment has been completed, I can live safe in the knowledge that care will always be there when I need it.
How has COVID-19 affected your practice, and how did you adjust your services to be able to meet the needs of your patients?
Faheem Sarfraz: The advice of stopping routine eye examinations has had a huge impact on the business as most patients purchase eyewear following an eye examination based on the recommendations of the optometrist.
We have continued to provide essential and emergency eye care and a spectacle repair and delivery service to the local area. As with other Hakim Group practices, we have introduced a selection of frames online on our website so patients can remotely choose a pair of spectacles. We have therefore hand delivered dozens of pairs of spectacles, contact lenses and eye drops to patients who are self-isolating. We have also introduced remote video and telephone consultations under our Minor Eye Conditions Service (MECS) to reduce the need for face-to-face appointments and decrease the burden on secondary eye care at the local hospital eye clinic.
How did you interact with the patient and carry out the sight test - have you introduced any technologies or systems that have helped you during COVID-19
FS: Initially we did a video consultation, but it became very clear the patient was in a lot of pain and significant inflammation was visible, so an urgent face-to-face appointment was arranged with PPE and infection control procedures in place.
What did you identify during the sight test and what was your reaction?
FS: Left eye acute anterior uveitis, which is an ocular emergency and requires immediate referral as, if left untreated, will lead to vision loss and significant pain for the patient.
How do you approach explaining what you had identified/suspected?
FS: The patient was very concerned about the thought of having to be referred to the local eye clinic as he was concerned about the possibility of contracting COVID-19 from attending a hospital clinic setting. This episode occurred at around the peak of the virus and there was great uncertainty and anxiety in the general population as lockdown had begun.
What were the next steps that you took, and what was the significance of these steps to this case?
FS: As I have a further qualification in independent prescribing, I explained to the patient and reassured him that, taking into account his concerns and the reluctance of a referral, I could manage his condition in practice. This allayed his fears of having to attend an eye clinic in hospital and gave him confidence in the management plan I put in place.
What did you hear about the results of your referral and how have you been involved since?
FS: I’ve kept in touch with Syed with regular telephone consultations and a final face-to-face appointment which confirmed the condition has resolved.
What would be your top tips to other practitioners when making a referral, either generally or during COVID-19?
FS: Ensure the urgency of the referral is clearly stated and sent via the appropriate pathway, thus only referring patients who need secondary care intervention. Also, clearly note down the clinical findings and a provisional diagnosis.