“If this was left any longer, it could have been fatal”

Patient, Lyn Inman, and optometrist, Pritpal Summan, from Hakim Group practice, Brosgill Opticians in Leeds, on symptoms that uncovered signs of a stroke.

Before you went for a sight test, had you experienced any symptoms and how had this affected you in day-to-day life?

Patient, Lyn Inman (LI): I was becoming suspicious that there was a problem with the sight in the top of my left eye for a couple of days.

The daft thing is that I only realised there was a problem when I was doing things like showering, when you close one eye and look from the other.

When I did that, I realised I couldn’t see when I closed my right eye. I didn’t for one second think it could be a stroke, I thought I had just left a contact lens in.

On the day I phoned, Pritpal was actually on a day off, but fortunately his assistant got in touch with him and then I got a call back to tell me to go into practice there and then.

 

What did the optometrist find, and how did they explain the next steps to you?

LI:    Pritpal found a branch retinal artery occlusion and after he spoke to the eye department we made plans for someone to meet me at St James’s Hospital.

I didn’t for one second think it could be a stroke, I thought I had just left a contact lens in.

Lyn Inman, patient

 

Can you describe how you felt during the referral?

LI: Obviously it was a massive shock as I never thought it would be that serious. But I was just glad that I was with someone who knew what they were doing.

I was glad that the assistant had reacted so quickly in speaking to Pritpal and that he had said he would come in. I think I was calm; Pritpal was certainly very calm when speaking to the specialists.

It was around the time of heading into the second lockdown, so the worry of going into hospital did prey on my mind. But the fear of catching something whilst I was there was not as great as the fear of the stroke, so it had to be sorted.

 

Did you have to undergo further treatment and what has been the outcome?

LI: I was referred to St James’s Hospital, where they did some more tests, and then to Leeds General Infirmary for further tests over a couple of days.

The stroke was due to a blockage in my neck, so after the weekend I was back in hospital having surgery on the carotid artery. I’ve still lost the sight in the top of my eye, but I’m back driving now and doing fine.

I have been married for 49 years, I have four young grandchildren and two children and I want to be here a lot longer, so I needed to change

 

Have your views on the importance of sight tests and eye care changed as a result of this experience?

LI: Absolutely – I think it showed how quickly things can change. I had only been to see the practice about five months earlier when there were no issues, and it only took two days to see there was a problem with my eyes.

In all honesty, if this was left any longer, it could have been fatal. The operation I had was to scrape the artery out and make sure the blood was flowing properly as there was clearly a blockage.

Thankfully for me, it had gone to the eye and not the brain, so it could have been so much worse.

 

How has the experience changed your life or affected you?

LI: At the hospital after the diagnosis they said it was linked to my smoking, so after 50 years I stopped immediately.

The whole thing was really quite a life changer. I knew I needed to stop before, but it is surprising what you can do once things are different in your life.

I have been married for 49 years, I have four young grandchildren and two children and I want to be here a lot longer, so I needed to change.

My initial reaction was relief that a diagnosis was made quickly so the next step of referral could be made as soon as possible

 

How has COVID-19 affected your practice? How did you adjust your services to be able to meet the needs of your patients?

Pritpal Summan (PS), optometrist from Brosgill Opticians in Roundhay, Leeds: The first lockdown proved to be an immense challenge to us all. Initially our main objective was to get the message out to our patients that we were still here to help.

Although the practices were physically closed, we were still contactable via email, telephone and through our website and we could still provide emergency and essential care.

Advice was given by telephone, email, video consultations, and face-to-face if deemed necessary, whilst following the guidelines from the Government and optical bodies.

Acquiring the correct personal protective equipment, hand sanitiser and cleaning products proved difficult in the early stages but being part of the Hakim Group meant that we gained access to the correct supplies quickly as well as guidance on how use it.

The biggest long-term change was in organisation of patient care. From specifying the types of examinations that can be carried out, to pre-examination questions and checks, to how to receive patients and carry out the examinations with the safety of staff and patients being the priority.

We had to eliminate, or at least reduce, the perceived risks in having an examination and to try and make the experience as relaxing as possible for some who were venturing outdoors for the first time in months.

In this case, Lyn had been for a routine examination in July 2020 and was aware of all the precautions we were taking, so had no concerns in attending when she developed symptoms.

 

Have you introduced any technologies or systems that have helped your interactions with the patient and how you carried out the sight test during COVID-19?

PS: Initially I called Lyn after getting a message from a member of staff that Lyn had developed symptoms that she was concerned about.

I asked her to attend the practice after taking an initial history over the phone; this was to minimise the time spent in the testing room and determine which tests to carry out.

The Optomap is carried out on nearly all of our patients and this was carried out at Lyn’s last examination so I could compare the new images.

We have had the device over 15 years and it has proved invaluable in detecting sight threatening pathology, as well as reassuring patients that their eyes are healthy.

The Optomap has come into its own during COVID-19 as it minimises the time spent with patients in close proximity.

 

What did you identify during the consultation and what was your reaction?

PS: Lyn had a branch retinal artery occlusion. My initial reaction was relief that a diagnosis was made quickly so the next step of referral could be made as soon as possible.

 

How did you approach explaining what you had identified?

PS: As I have known Lyn for many years, I knew she would not panic and would want to know the diagnosis so that she could understand the next steps that needed to be taken.

 

What were the next steps that you took, and what was the significance of these steps to this case?

PS: I called St James’s Hospital Primary Care Access Line (PCAL) and got through to an ophthalmologist. He asked if I could email the images, which I did via a secure NHS email. He received these pretty much immediately and agreed with the diagnosis, advising Lyn to attend the eye department as soon as possible.

 

When did you hear about the results of your referral and how have you been involved since?

PS: Lyn called me from her home the following day and explained that she was to have further tests that day. I subsequently found out a few days later that she had surgery on her carotid artery and was making a good recovery.

 

What would be your three top tips to other practitioners when making a referral, either generally or during COVID-19?

1. Be clear and concise
2. Explain how you have come to your diagnosis from the signs and symptoms, as well as any results of tests and scans. Specify how quickly you think the patient should be seen and, if necessary, by which department
3. Make sure that local protocols are adhered to and the correct referral channels are used. Don’t be afraid to contact the hospital eye departments in certain circumstances to discuss findings or symptoms that are proving difficult to determine the urgency of referral.