The journey to IP

Before I can take the independent prescribing exam, the College of Optometrists requires me to spend 12 days or 24 ‘sessions’ of at least three hours in hospital clinic. This could be done in one fell swoop, but I chose to do regular days spread out over months. This suited our practice scheduling, but also meant I could follow some patients’ treatment through to recovery.

Here be amoebae

In 18 years in practice, I’d never seen Acanthamoebae in the wild: until now, that is. This was a terrible misfortune for the young woman with the cysts buried in her cornea, but I guiltily confess to being very excited when she came in to the clinic. Although it’s notoriously difficult to diagnose, it was spotted early on by a trainee ophthalmologist and confirmed a referral to Manchester for confocal microscopy. There was some consolation; the main corneal lesion was off-axis and she was improving well and smiling the last time I saw her.

"I presented my findings to my mentor and braced while he checked my tonometry readings and questioned my suggested management strategy"

The value of reflection

I remember the first patient I was given to work up: a nonagenarian with glaucoma. I freely admit to feeling a little pleased with myself, walking down the corridor with a hefty hospital record, having rolled up my shirt sleeves (because that’s what the medics do). I presented my findings to my mentor and braced while he checked my tonometry readings and questioned my suggested management strategy. We reached the same conclusion and I breathed out once more.

The general ophthalmology clinic has presented me with a broad spectrum of conditions, but to see more anterior eye and acute cases I asked to attend the emergency on-call clinic. The doctor that day saw 31 patients, supervised two ophthalmologists in training, made emergency phone calls and yet took the time to discuss the cases with me. As I left in the evening, he was trying to get the keys to the laser clinic to zap a retinal tear. There were three young men at varying stages of metallic foreign body trauma (one was having the metal rust ring polished out with a rotating burr) and I made a mental note to post about safety specs on our practice’s social media.

One thing I’ve learned is how often the eye reacts to drops and their preservatives. There have been numerous cases where the decision had to be made to stop medicating to let the ocular surface recover. The more frequent the instillation and the more types of drop the patient is given, the greater the chance of blepharo- or keratoconjunctivitis. Adding lubricant without withdrawing the offending agent won’t resolve the problem.

The College of Optometrists provides an online logbook, in which I write up every case I’ve seen at the hospital. This is a useful exercise in reflective learning as I have to revisit the observations and management decisions, and it gives me the opportunity to read around the subject. Without this exercise, I think my brain would retain a lot less. The next step is to submit my logbook for College approval, pay the exam fee and start revising the clinical management guidelines. Yes, all 59 of them.

Read more on Ms Smith-Jaynes journey to becoming an independent prescriber here.

Image credit: Getty