“Through examination, I found a full thickness macula hole”
Ella Rudge, optometrist at Specsavers in Bexhill-on-Sea, and patient, Sacha Pink, on how noticing a change in vision started a journey towards vitrectomy surgery
30 November 2023
What led you to go have an eye test? Before you went for a sight test, had you experienced any symptoms and how had this affected you in day-to-day life?Sacha Pink (SP), patient: I’ve been wearing glasses and lenses since I was seven, so I’ve had a lot of check-ups and prescription changes over the years. As I was on the contact lens scheme, I went to the optician whenever I felt something wasn’t right or the same. In December at my contact lens appointment, I was told that I had the beginning of a cataract but that it was not ready for surgery yet. This March I felt that I was losing a little vision in the middle of my field of vision so I went along.
What did the optometrist find, and how did they explain the next steps to you?SP: From my answers to the sight chart, Ella suggested a scan of my eye. I have never had the scan before as I felt my eyes were being looked at all the time by contact lens specialists and didn’t feel I needed to. I had discounted the scan offer every time as something people needed who didn’t go to the opticians as much as me.
Can you describe how you felt during the referral?SP: I felt cared for. Ella was very clear and conscientious in her explanation of what she saw on the scan. She was calm and really took time to explain what the hole was, what kind of surgery I would need, and impressed upon me the need for speed as it was quite a big hole.
Did you have to undergo further treatment and what has the outcome been?SP: I had NHS exploration first and then private to speed things up. The hole was repaired by Professor Riaz Asaria at St John & St Elizabeth Hospital in London in May. Then I had double cataract surgery in August.
Have your views on the importance of sight tests and eye care changed as a result of this experience?SP: 100%. If I had had the scan earlier perhaps the hole wouldn’t have gotten so big.
How has the experience changed your life or affected you?SP: It made me appreciate Ella, Riaz and all the hospital staff. Over the last six month I have gone from having only a 60% chance of saving my sight in the eye with the ‘hole,’ to being able to see long distance with no contact lenses or glasses at all. I have a small reading prescription now.
I felt cared for. Ella was very clear and conscientious in her explanation of what she saw on the scan
What did you identify during the sight test and what was your reaction?Ella Rudge (ER), optometrist at Specsavers in Bexhill-on-Sea,: Sacha came in and mentioned that her left eye felt blurry, especially in the central vision area. Through examination, I found a full thickness macula hole. I was glad that Sacha had decided to come in rather than wait for her routine appointment so I could refer her on for treatment.
How did you approach explaining what you had identified?ER: Sacha opted to have an optical coherence tomography scan done of both eyes. Being able to sit with Sacha and show her the scans helped immensely with explaining that she had a full thickness macula hole. I showed her the scan of the right eye which was completely normal, and I pointed out that the macula is responsible for the central vision. I then showed her the left eye scan and explained that there was a hole in the central vision part which is why she had noticed a change to her vision.
What were the next steps that you took, and what was the significance of these steps to this case?ER: To begin with I spoke to Sacha and said to her that she had done the best possible thing by coming in for an early test. I let her know that unfortunately it was a problem that I wouldn’t be able to fix, however we could send a referral letter on to the hospital eye service so they could assess and treat it for her. She agreed to a referral and so I then explained some of the possible treatment options, so when it came round to being discussed at the hospital, Sacha already had some information, and it wasn’t a shock.
When did you hear about the results of your referral and how have you been involved since?ER: Sacha came back into practice after having vitrectomy surgery to thank me for spotting the issue originally and getting her to the right place. An article was published in the local newspaper highlighting our story. Since then, I have seen lots of people that have mentioned the article and have opted to have the additional imaging done as this story has shown the importance of having the health of the eyes checked thoroughly.
What would be your three top tips to other practitioners when making a referral?
- Make sure your referral is as clear and concise as possible
- Use imaging where you can to support your referral. For example, including a copy of an OCT scan so practitioners you have referred on to will already have a clearer idea of what they’re dealing with before they see the patient
- Make sure the patient understands the reasons behind a referral in the first place. Mentioning that a patient might need treatment at hospital might seem very trivial to us, but it can be quite scary for some people. If you ensure you always explain the reasons why a referral is necessary and where possible, what to expect, the patient will hopefully leave feeling informed and more relaxed.