I had a check up appointment at Moorfields last Monday. As always, I’d spent the previous night tossing and turning as various scenarios were presented to me by the incredibly unhelpful and irritatingly omnipresent Mr Pip: ‘what if the area of detachment in your right retina has increased?’, ‘what if the oil has emulsified?’, ‘what if your pressure has skyrocketed?’ Or – horror of horrors – ‘what if they find another retinal tear in your good eye?’. I was so relieved when my alarm finally went off at 6am that I immediately got up and read a few articles about the impending General Election just to calm myself down. It comes to something when you find yourself reading about the continued chaos of your country as a method of distraction from your internal torment. I briefly contemplated whether I could add, ‘Is Brexit bad for ophthalmology?’ to my usual list of pre-prepared questions to ask my consultant, but decided this might be bad form as he was probably like the Queen and had to remain impartial (in clinic at least).
I headed to the station with my sister and we were both pleased not to have to shell out the ‘milk the commuter’ fare as my appointment was late morning. Nevertheless, the train was still rammed, although thankfully it wasn’t as bad as our last venture up to Moorfields, as related in the post ‘Sardines and stitches‘. We arrived to a packed clinic and settled down for the customary long wait. Before long, it was time for visual acuity and pressure checks (all fine – yay!), followed by dilation drops – ouch, ouch, ouch! A nurse once told me that they sting more in tired eyes, and this certainly seemed to be the case that day. More waiting followed until eventually I was called through by a pleasant Fellow, in two senses of the word. (I had to explain all about medical Fellows to a friend recently, who was confused as to why I’d suddenly started speaking like Jacob Rees-Mogg… [pauses to shudder].)
After a thorough slit-lamp examination, the aforementioned Fellow pronounced that everything was still stable, and I felt the muscles in my neck relax slightly. He then asked if anything had been discussed about trying to get the oil out, and my shoulders shot up to my ears as I explained the situation: multiple surgeries, PVR, retina keeps detaching, etc etc. He nodded understandingly and said, ‘Ah yes, so it’s better to leave things as they are for now’. My shoulders lowered slightly as I noted that even if my retina could be made to actually remain attached, I’d been told that my vision in that eye won’t improve now. He agreed, and after cramming in a few more questions we headed out of the clinic and up to the incredibly hot cafe for lunch and a celebratory cuppa.
Ironically, we then had about three hours to kill before we were due to attend an event put on by Moorfields Eye Charity, entitled, ‘A day in the life of a clinical trial’. This was held for members of Moorfields Visionaries Circle, a new group recently set up for people who have left a gift to Moorfields Eye Charity in their wills. After finally getting around to doing just that (you can read about this in my post ‘Where there’s a will, there’s a way‘), I had been delighted to receive a letter inviting me to join the group. My enthusiasm was mainly because the letter explained that members would be given opportunities to attend certain ‘behind the scenes’ tours and talks. As a person who always wants to slip behind doors marked ‘private’ in National Trust properties, and obviously with my obsession with optics in mind, this was far too good an opportunity to miss. So when I realised that one of the first events was to take place on the afternoon of my appointment, I leapt at the chance to sign up.
We spent the three hours wandering through freezing streets to cool down after the hot cafe before finding an alternative cooler cafe and then returning to the hospital to explore some of the corridors and admire some tactile artwork displayed on the walls. Upon doubtfully questioning my sister about whether we should really be wandering around the hospital corridors she replied casually, ‘Oh, I do this all the time when you’re in surgery!’, which of course explains why she always seems to know exactly where to go as I confusedly stumble after her with dilated eyes.
Fortunately, the morning’s dilation drops had subsided by the time the event began. We were met by staff from Moorfields Eye Charity as well as a team of researchers. To our surprise, there were only eight of us as visitors to the event, so it was much smaller than we’d expected! There were some introductory talks, and we were told that we were going to have a whistle-stop tour of what a patient taking part in a clinical trial might experience. We were told that ten patients had attended on that day, and they underwent over sixty tests altogether. It was explained that the process was very different from that of attending a clinic as there wasn’t the same amount of waiting around, although patients were given breaks between tests.
We were split into two groups of four, with a mixture of researchers and Moorfields Eye Charity staff in each group, and we were told that the aim was for us to experience ‘a day in the life of a clinical trial, from bench to bed’. One group would start at the bench; the other group at the bed. Personally, I think ‘Moorfields Russian Dolls’ may have been a more accurate description, due to the smaller and smaller rooms we were shown into, to observe live demonstrations of various machines. In each case, one member of the research team acted as a human guinea-pig while the other explained how it all worked.
The first room contained various OCT scanners. Having undergone an OCT scan in my local high street at my recent eye test appointment (have a read of ‘The surprise OCT scan‘), I think my optometrist would leap up and down in excitement if he were to enter that room. (Perhaps in my next appointment I should encourage him to consider leaving a gift to Moorfields in his will…) We were told that the OCT scanner used in the demonstration was top of the range. Apparently, OCT scanners are a bit like mobile ‘phones in that new and improved versions come out all the time. This one was able to produce an image of the retina which previously was only possible by injecting dye into the patient’s arm and waiting for it to travel through to the eye. So of course the benefit was that the data could be produced much more quickly and without having to faff about with needles and dyes.
One machine we were shown took up most of the room – a huge, black, foreboding-looking monster of a machine. Again, this produced scans and pictures of the retina – in particular very detailed images of the macula area and the different layers within it. The researcher demonstrated how it was possible to see the network of tiny blood vessels in incredible detail, and even individual cells themselves. We were told that the reason the machine was so huge was that it had originally been used in astronomy and had a number of mirrors inside it to eliminate atmospheric ‘noise’ on the images. Cold War spying was also mentioned in relation to its history, which I found immensely intriguing.
We were also shown alternative eye charts. One of these was set out so that the distance between the letters was equal in proportion to the size of the letters, meaning that there was more space between the letters as they went down the chart. The aim of this was to cut out distortion created as a result of the disproportionately smaller gaps between the letters on the Snellen chart. Another chart had a greyish background colour, to reduce the glare of the white surround, which certain patients (e.g. those with cataracts) find more difficult to focus on.
After the final demonstration of a visual fields machine in the tiniest room of all, we were led through a maze of back corridors (there were jokes about leaving a trail of breadcrumbs to find our way out) to a boardroom containing tea and biscuits… the perfect finale! There, we were given the opportunity to chat to the Moorfields Eye Charity staff and researchers, which was really interesting. There was a short talk from one of the researchers working on artificial intelligence, who asked how we’d feel – as patients – about the prospect of a computer diagnosing us and sending us off as ‘ok’ or referring us for further investigations and/or treatment. He wanted to know whether we would feel comfortable with this or would want the human element of an actual doctor there as well. The general feedback suggested that people were uncertain. I feel that it depends on what tests the computer is doing… for example, if it’s testing eye pressure or visual acuity, perhaps this is easier than checking for retinal tears? Ultimately, I know it’s already been proven that there are huge benefits to artificial intelligence (e.g. robots performing retinal surgery can eliminate the risk of tremor in the hand of the surgeon and thereby reduce the amount of inflammation caused). I guess how patients respond is largely influenced by what we’re accustomed to, but I’d argue that our response can also be influenced by clear education on the potential benefits of artificial intelligence in certain situations.
To end, I just want to say thank you to Moorfields Eye Charity and the researchers for such an interesting, informative, and thoroughly enjoyable event. Also, to encourage anyone who hasn’t yet written a will to just go and crack on with it – it’s really not as bad as you think! And please consider leaving a gift to Moorfields Eye Charity! You can find a few tips and hopefully useful bits of information about making a will in my post, ‘Where there’s a will, there’s a way‘. Now maybe I can ask them to consider some research into PVR next… 😉