“My typical day as a hospital optometrist begins in the intravitreal injection clinic. I carry out intravitreal injections of Lucentis (Ranibizumab) and Eylea (Aflibercept) for patients with various retinal pathologies. I’ve been performing intravitreal injections for around 18 months and have carried out over 1,000 injections to date. I work alongside three specialist ophthalmic nurses to help deliver this service, which was previously managed by ophthalmologists. On average it takes me around seven minutes per injection from the moment the patient enters the treatment room, to when they leave.
“After a quick lunch break, I move onto the medical retina review clinic. This involves assessing and reviewing patients primarily with age-related macular degeneration, retinal vein occlusions and diabetic macular oedema. Recent guidance issued by the Royal College of Ophthalmologists meant that some of the patients in this service, such as those with previous vein occlusions and non-significant diabetic macular oedema, are having their appointments temporarily deferred.
“Many of the patients I speak to haven’t left their homes for a number of weeks. One lady I see hasn’t attended the review clinic for over three months. Her OCT scans reveal a significant increase in choroidal neovascularization in her right eye compared to her previous visit, and her visual acuity has dropped noticeably. When I discuss this with her she reveals that her daughter passed away from COVID-19 since her last visit, and she’s been reluctant to leave her home ever since. Times like this make me realise how far reaching the effects of this virus are.
“I spend Wednesday afternoons working in the urgent eye clinic. The ophthalmologists initially triage all patients over the phone, assessing their symptoms before bringing them in for a face-to-face assessment. In the clinic, we’ve seen a big change in the pathologies that patients present with. My most recent list consisted of a patient with preseptal cellulitis, two patients with corneal foreign bodies and one with recurrent iritis. My final patient of the day was a gentleman who’d had a retinal detachment repair two months ago. He was unable to attend his follow up appointment a few weeks earlier due to COVID-19, and presented to the clinic with a one day history of flashes and floaters and blurred vision in the same eye. After examination, I found he had developed another retinal detachment in a different quadrant with macula off. Thankfully the vitreoretinal consultant was able to see the patient the following morning for a further repair.
“I feel that the pandemic will certainly accelerate change in optometric care at a considerably quicker rate than ever envisaged. This will help to bridge the gap between primary and secondary care as many of the roles and responsibilities once reserved for ophthalmologists are delegated to optometrists. I’m used to hearing many of my colleagues speak about how the profession is changing so rapidly. Never did I think it would change like this.”
Jagdeep Singh MCOptom is a hospital optometrist at a NHS Trust and a private provider of NHS cataract and medical retina services.
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