“It was shocking and scary to be told that there was a risk to my sight”
Amit Nakum, senior lead optometrist at SpaMedica Chelmsford, describes how a conversation with a colleague led to a referral for recurrent corneal erosion syndrome with anterior uveitis
23 July 2023
Had you experienced any symptoms? How had this affected you in day-to-day life?Lynsey Chapman, patient co-ordinator at SpaMedica in Chelmsford (LC): I’d had soreness in my eye on and off for over a year. It was sensitive to light and would stream. It was one of those things I knew I should get looked at, but it would flare up every couple of months and calm down again. On this occasion though, it was worse than ever – by the time I got to hospital [SpaMedica Chelmsford], my eye was completely red with no white in it at all.
What did the optometrist find, and how did they explain the next steps to you?LC: Amit explained that I had an issue with inflammation in the eye alongside a problem with my cornea at the front of my eye. He explained the seriousness of the problem but made sure my questions and concerns were answered. Amit then arranged my referral directly and gave me a letter describing what he’d found and what to expect when visiting the hospital.
Can you describe how you felt during the referral?LC: It was shocking and scary to be told that there was a risk to my sight, but because Amit explained everything thoroughly, I was aware of what to expect from the treatment and was reassured that permanent damage was unlikely, because I was being treated so quickly. It was mainly a fear of the unknown, as I’d not had any issues with my eyes in the past.
Did you have to undergo further treatment and what has the outcome been?LC: I was treated with a combination of eye drops and will need to manage the condition with drops and regular check-ups for the rest of my life. However, thanks to Amit, my eye now feels more comfortable than it has in months.
Have your views on the importance of sight tests and eye care changed as a result of this experience?LC: Yes. I’d put off getting my eyes checked, which I realise now could have led to a terrible outcome. It’s so important to look after your eyes, and I’d encourage anyone with ongoing soreness or something not quite right to make an appointment with their optometrist straight away.
How has the experience changed your life or affected you?LC: I think I’m more aware of health matters in general – and I’m very grateful to have such a fantastic colleague in Amit, and to work with such a great team here at SpaMedica Chelmsford. I now understand what to do in the long-term and what drops and medication to take if I have any flare-ups. I also know now not to ignore any issues with my eyes.
I’m very grateful to have such a fantastic colleague in Amit
What did you identify during the sight test and what was your reaction?Amit Nakum, senior lead optometrist in medical retina at SpaMedica Chelmsford, (AM): I spotted Lynsey’s sore eye while she was working in our hospital reception area, where she had been applying dry eye drops to try to reduce the discomfort. When it was no better the following day, I asked to examine her eye. It was then I saw the extensiveness of her corneal problem with presenting uveitis, which potentially could end up being sight-threatening.
How did you approach explaining what you had identified?AM: I told Lynsey that I had identified the problem and explained the cause of her symptoms. I tried to be empathetic in describing what I had found but realistic in the importance of her requiring treatment to ensure her sight was not permanently affected.
I then proceeded to explain to Lynsey the next steps that would be taken – a hospital referral and treatment. I’m always aware of how I explain diagnoses and treatment to patients – a clear and relatable manner is essential, and so with Lynsey it was no different.
What were the next steps that you took, and what was the significance of these steps to this case?AM: After examining Lynsey’s eye, I arranged an emergency appointment for her at Southend General Hospital the same day, and she was treated with a combination of eye drops. Uveitis, in relation to her corneal problem, can be very serious indeed and worsens the longer it is left untreated, so prompt treatment is crucial. If I’d seen a patient with Lynsey’s symptoms in community practice, I would have referred them in the same way.
Continuity of care is an integral part of our role as an optometrist
When did you hear about the results of your referral and how have you been involved since?
AM: I had contacted Lynsey following her appointment that afternoon and was pleased to know my provisional diagnosis was correct and Lynsey had been given not only a short-term but long-term management plan. Continuity of care is an integral part of our role as an optometrist, especially with eye conditions like Lynsey’s which can persist long term. I regularly give advice to Lynsey to keep on top of recurrences and to ensure she maintains her routine optometrist and hospital eye examinations.
What would be your three top tips to other practitioners when making a referral?
- List your provisional diagnosis and differential diagnosis. Keep your referral concise, relevant and to the point and always state the urgency required
- Ensure you include information on tests and results that applies to the condition you suspect. For example, optical coherence tomography scan results in macula conditions or pupil examination in patients presenting with sudden loss of vision. It is useful to include whether you have dilated a patient
- Always give a copy of the referral to the patient and keep in touch to ensure they have been seen. Your patient will appreciate the time and personal approach.