“I could have gone blind or had a stroke at any time if I had left it any longer”

Before you went for a sight test, had you experienced any symptoms and how did this affect you in day-to-day life?

Suzanne Delve (SD): I had blurry vision for quite some time but, to be honest, I kept putting it off until one of my colleagues continued to pester me to get it checked. As his wife is an optician, he insisted that it could be quite serious. Once it kept getting worse, I decided to do something about it.

How has COVID-19 changed the way you accessed the services you needed from your optometrist?

SD: The practice was only open for emergencies at the time, so I had to go through the process of telling them my symptoms over the phone and going through the triage to make sure it was an emergency. They also had to make sure they could get me in when no other patient was in practice.

What did the optometrist find, and how did they explain the next steps to you?

SD: After numerous eye scans, Sohail found a bleed on my right eye. He said that it was an emergency and I would have to be referred to Manchester Eye Hospital.

I was a walking time bomb and I had no idea

Can you describe how you felt during the referral?

SD: I wasn’t overly concerned when I was told I would need to go to hospital, and Sohail tried to keep me calm and at ease. However, the panic really started to set in when I had to stay in hospital for three days as my blood pressure was extremely high, which had caused the bleed on my eye, and they couldn’t let me leave for that reason.

Clearly, I had been walking around with very high blood pressure for quite some time and that is what had done the damage. They told me I could have gone blind or had a stroke at any time if I had left it any longer. I was a walking time bomb and I had no idea.

Did you have to undergo further treatment and if so what has been the outcome?

SD: It looks like I will be on tablets for the rest of my life and I’ve also got to go back for more tests to understand any extent of brain damage I experienced. My eyesight is starting to return to normal and Sohail has said he would like me to come in again to keep an eye on me at a local level, so that is really nice of him.

Have your views on the importance of sight tests and eye care changed as a result of this experience?

SD: Without a doubt. What I thought was making something of nothing – that I might need new lenses in my glasses perhaps – was actually something that could have killed me. They identified something life-threatening that I wouldn’t even associate with your eyes. I think I’ve probably skipped my eye tests for the last couple of years and put them off, but I won’t be doing that again.

How has the experience changed your life or impacted you?

SD: It’s caused me some anxiety because it’s such a big change. I’m only 39, so it’s certainly caused me to look at my lifestyle; I’ll definitely be taking a little bit more care with my eyes and not skipping my appointments. My eye test saved my life, so it’s vital that people go.

My eye test saved my life, so it’s vital that people go.

How has COVID-19 affected your practice, and how did you adjust your services/approach to be able to meet the needs of your patients, such as in this case?

Sohail Hakim (SH): COVID-19 has had a profound effect on the day-to-day activities of the practice. What we once saw as normal is now very different, ever since the announcements were made by the Government and NHS England instructing a stop to all routine face-to-face eye care. In line with all guidance and advice from our regulatory bodies, during the lockdown we adjusted our practice to provide all essential, urgent and emergency eye care from behind closed doors and by appointment only, once a patient had been triaged over the phone. Our patients are always our priority and we had to ensure we maintained access to exceptional eye care during the lockdown, albeit with a limited number of staff in order to respect social distancing conditions.

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?

SH: Suzanne called the practice with a report of sudden blurriness in her vision in the right eye. I triaged her over the phone and deemed it as requiring an urgent face-to-face examination in practice, as Suzanne normally has very good vision and is very healthy.

What did you identify during the sight test and what was your reaction?

SH: A vision check confirmed that she did indeed have reduced vision, which could not be corrected with glasses. With the use of the optical coherence tomography device (OCT), I quickly identified that Suzanne had a bleed in the right eye that also involved her macula. There were also a few other abnormal characteristics picked up by the OCT that required urgent investigation.

She was advised by the consultant at the hospital that her condition was potentially life threatening, so she thanked us for saving her life

How do you approach explaining what you had identified/suspected?

SH: Suzanne was understandably concerned about the findings and the sudden need to be referred to the eye department. However, I was very careful and sensitive in my management and explaining to Suzanne what the concern was. I explained to her that there could be an underlying health condition which may have led to the abnormality in her right eye. I assured Suzanne that her level of vision is at a point which can be treated and will hopefully return back to normal. Suzanne felt assured and relaxed; she agreed to attend the hospital eye department immediately with the comfort of knowing she was in good hands.

What were the next steps that you took, and what was the significance of these steps to this case?

SH: I immediately got in touch with the on-call consultant at Manchester Royal Eye Hospital and they requested Suzanne be sent to the hospital eye department that afternoon.

When did you hear about the results of your referral and how have you been involved since?

SH: Suzanne and I spoke over the phone a few days later and explained that she had been admitted for treatment after she was found to have malignant hypertensive retinopathy. She was immediately admitted to hospital and kept in for a few days for treatment and observation. She was advised by the consultant at the hospital that her condition was potentially life threatening, so she thanked us for saving her life.

Had it have not been picked up from her eye examination and managed urgently, she could have had serious complications. She has since been discharged and continues to attend the eye department to monitor the condition of her eye.

What would be your top tips to other practitioners when making a referral, either generally or during COVID-19?

SH: My advice to all practitioners is to continue with the same meticulous and professional care of all our patients. Whilst working in difficult circumstances during COVID-19, it is also very frightening for the patients if there is a problem with their eyes. Knowing that all eye care practitioners are still available to attend to them gives them great comfort and assurance that their eyes and vision are in good care.