“The experience has changed my life”
Patient, Steven Hudson, and Shane Abbas Bhimani, clinical director of Specsavers Hemel Hempstead, on the OCT scan that indicated dangerously high blood pressure
Before you went for a sight test, had you experienced any symptoms and how had this affected you in day-to-day life?
Steven Hudson, patient (SH): Before the sight test I was having bad migraines, which were a gripping pain. The headaches felt as if the blood vessel in my forehead was going to pop. It also felt as if insects were flying into my eyes, which I thought was strange. I shared how I was feeling with a few people and was told to have my eyes checked because if it was serious, they would be able to see from the scan if something was wrong.
Did COVID-19 change the way you accessed the services you needed from your optometrist?
SH: COVID-19 did not stop Shane and his team from seeing me: we all had our face masks on to protect ourselves the best way we knew how during these uncertain times.
What did the optometrist find and how did they explain the next steps to you?
SH: Shane and his team were very professional. He was honest with me about his findings during my eye examination and appeared concerned. He contacted Stoke Mandeville Hospital to see me urgently, and they did. I felt that this was very serious and that I had needed to go quite urgently.
I stayed overnight in the hospital because my blood pressure was too high, and they would not release me until my blood pressure had gone down. I believe my blood pressure was 227/119 when I went to A&E.
I hope that my story will encourage others to get their eyes tested
Did you have to undergo further treatment and what has been the outcome?
SH: I have had an MRI scan, eye scans, chest scans, kidney scans and a scan of my heart which were all normal except for my eyes. The eye scan revealed that I had blood in the back of my eyes. The sight test also showed that blood vessels had burst in my eyes which caused the blurred vision in both of my eyes. I have since been discharged from the hospital and I am doing fine.
How has this experience affected you?
SH: The experience has changed my life. I have given up certain foods such as bacon, hamburgers, and red meat. I have also given up coffee, which I had loved, but the caffeine in the coffee was one of my migraine triggers; therefore, I had to give it up to prevent myself from having headaches which could cause me to lose my eyesight.
Initially, I was shocked that this was happening to me, but my family has a history of high blood pressure. I have recently told one of my brothers and one of my cousins to make lifestyle changes in dieting and exercising as we are getting older. I will be making similar recommendations to others.
Today, I am truly on the mend and thankful to everyone who was involved in my road to recovery. I am blessed to be still alive to share my story, and I hope that my story will encourage others to get their eyes tested.
The picture was the kind of thing you get at the end of a university lecture of cases you would probably never see, but that if you did it would be a blue-light situation
How has COVID-19 affected your practice, and how did you adjust your services to be able to meet the needs of your patients, such as in this case?
Shane Abbas Bhimani, clinical director of Specsavers Hemel Hampstead (SB): Early on, we were not seeing anything apart from emergencies and urgent cases and we struggled to get our hands on personal protective equipment (PPE). When we had PPE and were able to go back to more regular opening hours around July 2020, we found we were relying more on machinery. I think the pandemic highlighted the importance of fundus photography and optical coherence tomography (OCT).
We changed our patient journey to start talking about OCT right from the very beginning. From the moment they call in, or if they were booking online, OCT was at the forefront, explaining: ‘It is in your best interest to have this scan, it is a bit extra but it can pick up certain things and we’re restricted because of the limitations that COVID-19 has brought about.’
All the staff were trained so that patients were exposed to OCT from the first call, in the practice, the person performing the initial screening would explain when they were using the advanced device.
The optometrist would also bring it up early in the test. It was important to highlight it right at the beginning, because we know that patients generally remember the beginning of the test, a random thing in the middle, and something at the end and any points that stand out. We really wanted the OCT to stand out and for them to go home and talk about it with friends and family.
What did you identify during the sight test and what was your reaction?
SB: When Steven came to the practice in April, his symptoms were very vague and he said: “I’ve hit 50, I don’t feel like myself and I’m going downhill.”
It was the retina scan and the glaucoma scan that triggered alarm bells. As we went through the retina scan, I could see that he had oedema at his macular, so his vision was going to be affected, and there were several exudates resembling the beginning of a macular star. He had papilledema and the glaucoma scan picked that up. The black line that represents the patient was way above the normative database, so his retina was swollen quite above a level we would expect.
The picture was the kind of thing you get at the end of a university lecture of cases you would probably never see, but that if you did it would be a blue-light situation. I was almost recalling my university days a decade ago when we were taught: ‘This is a malignant hypertension, the patient’s life is at risk, you need to act now.”
How did you approach explaining what you had identified/suspected?
SB: I told Steven: “I need to be honest with you, I don’t think this looks good. We are going to get you the help you need: you’re in the right place, and you’ve done something about it. But I need you to realise the urgency of the matter, and I’m going to be calling the hospital.”
I asked him about his blood pressure and he shared that the doctors weren’t happy with it. He was trying to get his blood pressure down, but he was very stressed and spinning a lot of plates. It was only because his vision had taken a turn for the worse that he thought he might need some glasses.
I’m not sure how I composed myself in the moment, I think you just do it when the situation calls for it. I work in Moorfields one day a week in a consultant-led glaucoma clinic. We see patients who have pressures of 80+ and you have to keep it together for the patient because you are the one who needs to formulate the management plan to get them better.
If you are unsure, be honest with your patients – they will thank you for it
What were the next steps that you took, and what was the significance of these steps to this case?
SB: I called Stoke Mandeville Hospital and explained the signs and that I thought he might have malignant hypertension. I asked if they would like to see him or if I should send him to A&E.
I sent over the images to the consultant and he told me to send Steven straightaway. He said: “It is better we see him and can start treating him for the high blood pressure and work with the admissions team to admit him.”
When did you hear about the results of your referral and how have you been involved since?
SB: I spoke to Steven that evening and he confirmed he was at the hospital and was being admitted. I called a week later to check on him and the hospital told me he was much better.
About six weeks later he gave me a call and said he was feeling much better. We booked him back in to the practice in August, four months after the initial appointment, and his eyes had almost 90% recovered. His distance vision had returned and I was able to give him reading glasses to let him do his work, so it was a really good prognosis.
What would be your three top tips to other practitioners when making a referral, either generally or during COVID-19?
- Make sure you have an excellent relationship with your hospital department. You need to have that ability to phone or email
- If you are unsure, be honest with your patients – they will thank you for it. No-one knows everything. You can tell them that something doesn’t look right; be candid and explain that you are going to send an email to find out. If in doubt, do seek that advice
- Students and pre-regs have a tendency to spend copious amounts of time reviewing notes and almost experience analysis paralysis. I would say, go through the experience with your patient and realise that, yes you are the professional, but you still need to look for help and rely on these machines too. People are divided on this, but I think that if I had studied his notes before, I would have been very anxious and worried about how I was going to explain it all to him, but because I noticed it while Steven was in the room, we experienced the shock together, and I think that my sense of urgency was portrayed.
Do you have a story to share? Get in touch with Optometry Today.