Diagnosis and difficult conversations as a pre-reg

I am very fortunate to be working at Peter Ivins Eye Care, which is home to advanced equipment and technology – it has even won an award for it. It has been very interesting learning how to use each machine and how to integrate them into the investigation and management of patients. This has allowed me to investigate patients further than I was able to at university and develop new skills, including fitting complex contact lenses and managing myopia progression in children.

At first, when I worked part-time in the practice during university, the complex equipment seemed quite daunting. However, I was able to build up my knowledge and confidence using each machine. I could get used to the equipment when I was pre-screening patients, and then discuss with the optometrist how to interpret the results.

It has been very interesting learning how to use each machine and how to integrate them into the investigation and management of patients

An interest in complex contact lenses

Now, during pre-reg, the technology has allowed me to upskill and start fitting complex contact lenses using the topographer. I have worked with my colleagues to learn how to fit scleral lenses, which was a really rewarding process as it improved the vision in keratoconus patients to levels they had not reached before. This has really sparked my interest in complex lenses, and I am excited to fit more of these in the future.

As well as these, I have also had some experience with ortho-k lenses to correct myopia. It has been really interesting to see how effective these lenses are in slowing down the rate of myopia progression using the Myopia Master, which measures axial length. It is a fulfilling part of the job: the child is happy to be able to continue with their sports and daily activities as normal, and the parents are always extremely thankful and relieved that the lenses are working.

Diagnosing cystoid macular oedema

Using the equipment has also made me feel more confident in my diagnoses and management plans. For example, I examined a patient with a branch retinal vein occlusion and, with the use of optical coherence tomography (OCT), discovered cystoid macular oedema (CMO) as a result. This was an important find, as the management of a case without CMO is slightly different to one with CMO. The OCT and fundus camera also enable a longer and more in-depth discussion with my supervisor and are useful to refer back to if needed.

Despite my confidence improving, I still find it difficult to break bad news to patients, for example with a branch retinal vein occlusion case. It is difficult to strike the balance between being empathetic, whilst emphasising the urgency of the situation. Whilst I do feel that I have improved since the start of pre-reg, it is still something I am working on.

I am now preparing for my Stage two visit, which is very different from Stage one. I had found my flow and what worked best for me when revising for Stage one visits, however Stage two is a different format, so I am having to work out which approach is best when revising the overarching competencies. Many of the case scenarios are a good talking point with my colleagues and it will be interesting to hear how more experienced optometrists would approach them. I still can’t comprehend that I am already working towards Stage two – this year is flying by.