Back behind the wheel… for now

After my upsetting Moorfields appointment described in my last blog post, “It’s worse“, in which I received the news that the vision in my good eye had deteriorated due to the extent that I no longer met the eyesight requirements for driving, I lost no time in following up the glimmer of hope offered to me by the ophthalmologist – that updated lenses might help. Sitting on the train back to my mum’s, shivering in a state of shock which even a takeaway cup of steaming, strong tea and a warm almond croissant couldn’t soothe, my sister rang her local optician’s practice in Surrey. She managed to get me an appointment for that Saturday – a mere five days away, although it felt as if I was in for a month’s wait. Fortunately, they rang the following day with a cancellation appointment, which I accepted with alacrity.

Seeing a different optometrist is always something of an experience – for them, rather than for me – as I explain my history. This appointment began with confusion over my prescription glasses: a single vision lens for long sight in my bad eye (for all the good it does) and a varifocal lens for short sight in my good eye. “Is that right?”, I was asked in a puzzled manner. I assured them that it was. Then an OCT scan, where the silicone oil in my right eye apparently looked “pretty”, and difficulties were encountered getting a clear image of my left eye because of the cataract. The optometrist proceeded to ask me if I had a letter from Moorfields explaining my situation. “All my paperwork’s at home in Kent”, I told her, “but I can give you a history.” Her slightly dubious look faded, as I launched into a brief but concise account of my ocular troubles, and she scribbled somewhat frantically to keep up.

We eventually got onto the, “And which is clearer… this… or this…?” part of the eye test. It seemed to take a long time, and she occasionally urged me not to overthink it (clearly she doesn’t know me). I was delighted and astonished in equal measure when she told me: “We can correct your vision to 6/9+3 with new lenses”. As my chin hit my knees, she smilingly observed, “You weren’t expecting that, were you?!” She emphasised that the new lenses probably won’t help for very long, as the posterior sub-capsular cataract is progressing rapidly but, as always, I’ll take any improvement I can possibly get as far as my eyes are concerned. We talked about the cheapest method of obtaining the most improvement possible in terms of what lenses to get (Moorfields had already advised me not to spend too much on new glasses). The verdict was to have a new varifocal left lens fitted in my spare pair of glasses, and use a pair of over-the-top sunglasses or clip-on lenses when needed. It became clear that it would be best for me to order these at my local opticians back in Kent, so the next puzzle to solve was how to get back there and what to do with my car.

Fortunately, this was solved relatively quickly. My sister extended her job title from Eye Secretary Extraordinaire to Personal Chauffeur (Nigel Mansell style), and drove me home. Then it was off for another optician’s visit, to sort out a new lens. As we were waiting to see the optician, my own optometrist sauntered down the stairs, saw me, and said, chirpily: “Hello! How are you?” “Not great”, I answered truthfully, before feeling instantly guilty for not smiling and fibbing, “Fine, thanks; how are you?”, as is generally customary. He proceeded to get on with his task before hot-footing it back upstairs and quite possibly hiding until I was safely out of the door.

My glasses were ready within just a few days, which was far faster than I’d hoped, after being warned that they could take up to two weeks. I think the optician took pity on me. Even so, I spent those few days carrying out repeated visual checks within ridiculously short intervals, paranoid that my cataracts would continue to worsen so quickly that my new lens would be of no help by the time it was ready. I was so worried about this prospect when I went to collect the glasses, that I asked if the optometrist could do a quick test to ensure that I still met DVLA standards for driving, with the new lens.

After a bit of a wait, I was called into the consulting room, where I settled into the chair with a pounding heart. “Hello, I don’t think I’ve seen you before – usually I see your colleague”, I told the optometrist, as I attempted to calm myself. This was made easier as he consulted his notes and declared that he’d seen me in 2018, professing himself to be greatly offended that I didn’t remember him. He then let me off, pointing out that he looked different in a mask. (Optometrists, you see, are aware that the pandemic is not over.)

“Can you read these letters?”, he asked, indicating the screen. I reeled them off with ease. “How about these?”, he continued. Again, I read them without effort. “Good”, he said, “You meet driving standards”. I suppressed a whoop and asked, “Is that line 6/12 then?” “It is”, he confirmed, “You know your stuff!” He then moved onto another set of letters, and again I was able to read them without any problems. “Excellent!”, he declared, “Now you can drive a heavy goods vehicle.” “Really?!”, I spluttered, “Even with no useful vision in my other eye?!” “Oh yes – you only need good vision in one eye”, he confirmed. “Well although I’d quite like a career change, that seems a bit drastic so I think I’ll steer clear of heavy goods vehicles”, I responded. “Yes, fair enough”, he agreed. After quizzing him a little on the various visual effects of cataracts, I thanked him and the receptionist before metaphorically holding my nose and gulping as I paid the bill for my new lens. I then emerged onto the high street, feeling somewhat lighter in spirits.

The surprise OCT scan

The time came around for my yearly eye test at the optometrist’s (or optician’s, as they’re generally but incorrectly known here in the UK) a week or so ago.  A couple of people quizzed me on why I couldn’t just get this done at my imminent appointment at Moorfields Eye Hospital, and I carefully explained that although they do test my visual acuity at Moorfields, my appointments there are specific to my retinas rather than overall general eye health and determining my prescription.  So off I went, and was delighted that my appointment was with the friendly and knowledgeable optometrist with the fun sense of humour, whom I’d seen a couple of years ago.

‘So’, he declared with purpose, peering at my notes in front of him, scribbled on a small card, ‘how are your eyes?’  ‘Hmm, okay, I hope!’, I answered with a nervous note of caution as I watched him continuing to scan my notes before raising an eyebrow.  ‘Ah yes – multiple retinal detachments, I remember.  Any flashes or floaters?’  ‘No more than usual’, I replied truthfully.  He shot me a sharp glance and proceeded to relate the standard drill which I should have been told years ago when my floaters were first noted: that if they increase, or if anything changes in my vision, get it checked out immediately.  ‘Don’t worry’, I assured him, ‘I know to go straight to Moorfields if there are any changes.’

He listed off my various diagnoses and treatments, which I helpfully continued for him when he began to falter, reciting, ‘silicone oil in the right eye, lattice degeneration, PVR…’ ‘Ah yes – what is PVR?’, he enquired, looking at me in some confusion.  ‘Proliferative vitreoretinopathy’, I informed him, wondering whether I should refer him to my blog post, ‘The curse of PVR‘ which answers precisely that question.  ‘It’s basically where cells from one part of the eye get into another part of the eye where they shouldn’t be, and they proliferate and cause scar tissue which then causes traction and pulls the retina off again’.  He nodded but still looked a little bemused, proceeding to ask me if it was hereditary.  I explained that no, it’s a complication of retinal detachment and only occurs in 8-10% of cases so I’m just massively unlucky.  I really should have referred him to that blog post.  However, as I was his last customer of the day, time was short and we had to move on from discussions of PVR to testing my visual acuity.

He covered my left eye and asked me to tell him what I could read of the Snellen chart using my right eye.  I proudly declared the top letter with confidence and shifted my eye back and forth until the two letters below became visible enough for me to be reasonably sure of what they were.  Next was my left eye, and I rattled off the line of letters at the bottom of the chart with ease.  ‘Am I still 6/36 in the right and 6/5 in the left?’, I asked him for confirmation just for peace of mind.  ‘Yes’, he said, ‘but 6/36 with A LOT of effort.’  ‘Alright!’, I replied indignantly in my head, ‘Don’t relegate me to 6/60 in my right eye again, after I’ve practised so hard to read the chart!’  Out loud, however, I merely observed that I was using eccentric viewing in order to read the second line down, at which he nodded with approval.  (You can read an explanation of eccentric viewing in ‘It’s not odd, it’s just eccentric‘, if you’re interested.)

Next came eye pressures, and a sigh of relief when they were okay, followed by the slit lamp examination.  As always, I began to worry when he started focussing on one portion of the inside of my eye in particular, as was made clear by his instruction, ‘look left again’, ‘look up and left’, ‘now left again’, and hesitating for longer than previously.  Fortunately, everything was okay, but after checking various lenses and determining that my prescription remained unchanged, he then freaked me out by declaring, ‘Now, I’d just like you to have a scan if that’s okay?’  ‘What kind of scan?’, I asked, assuming it would be digital retinal photography.  ‘OCT scan’, he replied, adding with a hint of pride that the practice had obtained an OCT machine about a year ago.  I looked at him in alarm, which he obviously clocked immediately as he patted me gently and said reassuringly, ‘Don’t worry – everything’s fine; I just want to do this for my own interest.’  I stared at him doubtfully.  ‘Really’, he confirmed, ‘it’s fine, don’t worry!’

Off we went into the OCT scanner room, after I’d paid for my eye test first as the receptionist was about to go home.  ‘It’s just payment for the test but not the OCT scan’, he instructed her as I sent up a prayer of thanks in the knowledge that OCT scans aren’t exactly cheap.  ‘Now, just pop your chin on the rest there and keep looking ahead at the blue cross’, he instructed, as I struggled to locate the blue cross with my waffy right eye.  Once scans of both eyes were completed, he decided to go for a wide angle one of my left eye as well, before showing me the results on the screen.

For those readers who don’t know what OCT scans are, let me explain a little.  OCT (Optical Coherence Tomography) is non-invasive, and uses light waves to take cross-section pictures of the retina, thereby showing its multiple layers and assisting in the detection of any issues.  These particular scans were macular scans (3x3mm) so I knew they wouldn’t pick up any of the issues in my peripheral retinas.  I was therefore somewhat perplexed as to why he wanted to do them.  When I asked, he said that it was because I only have useful vision in one eye and so he wanted to check the state of my better retina.  ‘Alright!’, I exclaimed in my head again, ‘No need to rub it in!’.  I suspect he was also simply curious and wanted to try out his fancy new machine on an unusual case.

Happily, despite my nervousness that he must have seen something to worry about, all was fine.  He proceeded to show me various images and explain them, noting the complete lack of foveal dip in the scan of my right retina.  I gazed at the image sorrowfully and asked him if that was because my first detachment was macular off.  ‘Yes, that’s right’, he replied, adding cheerfully, ‘They did a good job on the surgery but there’s no way they’d be able to get that back.’  I wanted to ask more questions about this, but time was ticking on and we’d already clearly overrun my allotted appointment time.  With several more assurances that yes, everything was fine, he showed me out of the now deserted shop and I emerged, blinking, onto the high street with a sigh of relief.

Hunt the optometrist: round 4

As the day of my annual ‘normal’ eye examination loomed, I decided to continue my quest to find a decent optometrist in Canterbury.  Now, before going any further here, let me explain that I’m talking about what most people refer to as an optician, for a standard eye test.  However, if we want to be accurate about things (and, trust me, I usually do), an optician is actually the person who makes and fits glasses and contact lenses.  An optometrist carries out eye tests, prescribes corrective lenses, and is qualified to diagnose certain eye abnormalities and diseases and prescribe medication for them or refer for further treatment.  An ophthalmologist is a medical doctor who specialises in eyes and is qualified to practice medicine and surgery.

After my first retinal detachment, I stopped going to the high street optometrists I’d been visiting for years, because I realised that they hadn’t given me the correct information about floaters.  (See ‘How it all began‘ if you’re wondering what they told me and why it was wrong.)  If they’d given me the correct advice, it’s possible that things may have been very different for me.  I then began using another popular high street optometrist, until I was informed one day upon going in for a quick eye pressure check, as I’d been doing sporadically for the past year or so, that they could no longer do this.  In my attempts to discover the reason for their abrupt policy change, I became involved in several heated discussions in which they told me that a) the hospital should be doing the pressure checks and was just ‘fobbing off’ their work; and b) as my eyes had so many problems, I might sue them if they got the pressure readings wrong.  Needless to say, my blood was boiling by this point and I vowed never to darken their door again.  In contrast to their customary advertising campaign, I think this behaviour demonstrates precisely why people shouldn’t go to this particular optometrists.

On my next visit to an optometrist, I plumped for an independent one (as detailed in ‘Post appointment panic‘).  Apart from the fact that he reminded me of John Major and had a sense of humour (or lack, thereof) to match, this grey-faced chap put me off by trying to tell me that it was possible to see enough of the retina to check it properly without using dilation drops.  I know that this simply isn’t true – not when checking for tears, anyway.

So it was after extensive research that I set off early on Saturday morning to another carefully selected independent optometrist, to put them through their paces for my eye test.  It started well, as I was greeted by a smiling receptionist and then a polite fellow who bore no resemblance to any politician I can think of.  He began the appointment by asking cheerfully, “So, is everything okay with your eyes then?”  I shifted uncomfortably in the chair as I responded almost guiltily, “Err… no, not exactly.  I’ve had multiple retinal detachments in my right eye, and I’ve got PVR.  I’ve got silicone oil in there at the moment.”  He looked slightly taken aback at this, and went on to ask about my left eye.  “It had two retinal tears which were fixed with cryotherapy and I have a cataract and lots of floaters”, I told him.  He shook his head in sympathy and told me how unlucky I was to have so many problems in both eyes, before asking with a slightly incredulous undertone, “Is there anything else?”  I completely forgot to tell him about the lattice degeneration, although that came up later, and the abnormal blood vessels, and just replied that I hoped that was enough for now, at which he nodded in agreement.

He carried on with the usual business of the eye test, and when we reached the pressure check, we had an interesting discussion about high pressure.  Much to my delight, he told me that he’d be happy to check my eye pressure if necessary, between my appointments at Moorfields.  He even told me that he’d be happy to dilate my eyes and check for tears if I wanted him to, at which point I almost toppled off the chair in shock.  Previous optometrists have been all but backing away from me by this point!  This one told me that he loves dilating because it allows the opportunity to get a proper look at the back of the eye, which he finds really interesting!  He did, however, also say that it was only necessary for him to dilate if there were symptoms suggestive of a retinal tear or detachment: i.e. showers of floaters, flashing lights, or the much-feared ‘curtain’.

He went on to do a spot of digital retinal photography and was happy to show me the images and explain various things.  It was somewhat depressing to see the image of my right retina, which bore certain similarities to a teenager’s bedroom,  but at least the left one looked far more clean and tidy.  He also checked for dry eye.  As he asked me to look up while he put the drops in, I asked what they would do.  “They’ll make all your problems disappear”, he joked, with an air of mystery.  I imagined my future – bright and colourful, with 6/6 vision and no more worries – and told him that he’d be my hero forever if the drops did that.  He clearly decided that his pants wouldn’t look very professional worn over his trousers, as when I’d blinked the drops away, my view of the world was just the same.  Or, almost the same… for I finally seemed to have found a decent local optometrist.  Perhaps he’ll work on those magic drops ready for my next visit…