“He’s probably saved my life”
Malcolm Carroll and his optometrist, Craig Walker, on a routine eye examination that uncovered visual field loss and raised concerns
28 May 2022
Before you went for a sight test, had you experienced any symptoms and how had this affected you in day-to-day life?
Malcolm Carroll, patient (MC): I had been off of work for an operation. My wife suggested I should go and have my eyes tested because when I had been driving to work in the early mornings, I was struggling to see the side of the road in the dark. I hadn’t had my eyes tested for seven years.
What did the optometrist find, and how did they explain the next steps to you?
MC: Craig carried out a few tests and then said: “I’ve seen something at the back of your eye.” He didn’t say what it was, but he said there was something there and he wanted to refer me to Sunderland Eye Infirmary to see what they had to say.
Can you describe how you felt during the referral?
MC: I was anxious when he said there was something there but we knew we needed to find out what it was. At the eye infirmary they booked me in for scans and after an overnight stay they told me they were transferring me to the Royal Victoria Infirmary in Newcastle.
If it wasn’t for going to get my eyes tested in the first place, who knows what would have happened
Did you have to undergo further treatment and what has been the outcome?
MC: At first they thought I had experienced a mini stroke [a transient ischaemic attack or TIA] but because I had no symptoms they needed to have a look. In Newcastle I had a two hour operation to look at the blood vessels on my brain. They found one of the smaller blood vessels was bleeding.
I then had to have a second operation of about four hours to cap the bleed. When I came around and they told me they had successfully capped it off, I was over the moon with relief. It gives you a new lease of life.
Have your views on the importance of sight tests and eye care changed as a result of this experience?
MC: My view of sight tests has definitely changed. I’ll be there for my next eye exam straightaway. Now I tell everybody that I talk to. If it wasn’t for going to get my eyes tested in the first place, who knows what would have happened. Because I probably wouldn’t have gone otherwise, and it could have been too late. It’s not something you can leave.
How has the experience changed your life?
MC: It’s changed my outlook on life. I eat better, I keep fit and I walk for miles a day. I think there’s nothing scarier than hearing that there is something there that wasn’t expected. We went back to visit Craig and took him a box of biscuits to say thank you. He’s probably saved my life.
The feedback from the consultant was that if it had been left longer it could have been worse
What did you identify during the sight test and what was your reaction?
Craig Walker, optometrist in Specsavers Hartlepool, (CW): We saw Mr Carroll in November 2021 for a routine eye examination. It was after the end of the lockdown period, but we have still been observing our personal protective equipment requirements with masks and wipe downs.
It had been a long time since anyone had taken a look in Mr Carroll’s eyes, as his last test was in 2014. He was asymptomatic – there were no headaches that would have pointed us in the direction of what the issue turned out to be. We found his prescription and everything was unremarkable.
He had the pre-screening and also elected to have an optical coherence tomography (OCT) scan. While I knew there was quite a sizeable time difference since his last visit, I noticed a difference in his pressures and planned to carry out a visual fields test.
The tests revealed a quadrantanopic loss. We repeated the test and had the same result: a loss in the superior nasal quadrant.
How did you approach explaining what you suspected?
CW: Though there was nothing obvious, the loss had to be coming from somewhere and I was just a bit suspicious. I didn’t think it was glaucoma, so thought it could be vascular in nature and would likely be going to neurology.
To explain the reason for a referral, I tell the patient what the result is telling me. In this instance, I would have described the repeated visual field loss, and that this type of result might indicate some form of vascular incident, so perhaps something to do with the blood system, and perhaps indicate a TIA.
I explained: “It hasn’t done anything drastic yet, but it is worth me getting this to a consultant to decide what is going on,” and to expect contact within two to four weeks.
I always tell patients that if there is anything they are unsure about, they can email or ring me. Patients can only retain so much. If they have come in for a routine eye examination and then you bombard them with information about something you are seeing in their eyes, it’s very easy for them to miss potentially key points.
What were the next steps that you took, and what was the significance of these steps to this case?
CW: We’re really fortunate in the North East that we have one of the three stand-alone eye hospitals in the UK, Sunderland Eye Infirmary, which is really good for direct referrals.
I wrote an urgent referral saying I suspected the gentleman either had, or was going to have, a TIA. I explained that the patient had presented for an overdue eye examination complaining of struggling to see in the dark. I shared the fields results and the OCT, remarking that there were no symptoms. The hospital received this and contacted Mr Carroll directly.
Patients can only retain so much. If they have come in for a routine eye examination and then you bombard them with information about something you are seeing in their eyes, it’s very easy for them to miss potentially key points
When did you hear about the results of your referral and how have you been involved since?
CW: I’ve heard the results from Mr Carroll, who was seen very quickly. At the eye infirmary they confirmed the visual field loss, but they couldn’t find a diagnosis. He was sent to Newcastle where, after an exploratory surgery, they diagnosed a right temporalparietal subacute cerebral haematoma.
It was not the outcome I had expected. I thought it could have been a mini stroke that had a lasting side effect, but I knew enough to have a suspicion that something needed to be looked at.
Mr Carroll initially came in to thank me for making a timely referral, which I really appreciated. I think he’s a convert and is keen to spread the message of the importance of routine eye examinations even without symptoms. The feedback from the consultant was that if it had been left longer it could have been worse.
What would be your three top tips to other practitioners when making a referral?
In the referral I recommend outlining your suspected diagnosis. You don’t necessarily have to tell the patient this, but you should have the ability to let the consultant know what you think it could be and that is why you are referring. That headliner is what can help them make a decision on how to prioritise the referral
- You then need to follow up and explain why you are referring or suspect a certain diagnosis. What are the symptoms? What evidence points to what you suspect? Also list any relevant patient history
- Ensure the referral is necessary and that it is not something you can diagnose and manage at a local level.