14 May 2020

COVID-19: Diary of an optometrist - part four

The fourth and final part of Dr Deacon Harle's experiences of providing urgent and essential care during the COVID-19 pandemic.


“I was due to attend the wedding of an old friend from primary school in May. It’s cancelled now, and postponed for a year. The upshot is that I find myself in a WhatsApp group with half-a-dozen old school friends, some of whom I haven’t spoken to for 40 years. It’s wonderful. We share stories and catch up on old times. 

“It turns out that none of us have moved on in our musical tastes, and we spend the evening sharing songs from Aztec Camera, China Crisis, Nik Kershaw and Haircut100 through to The Squeeze and oddly, Van Halen. The night finishes late with The The blasted out. My wife is delighted.”

The week

“We are into a routine in practice. The triage rota is working and the APCOS team do phone consultations to field cases that can be managed remotely. The acute maculopathy cases come in from the new virtual AMD service, A&E and NHS111 send patients directly, GPs use the triage email service. Ophthalmologists from the local Trust send us post-ops and worry cases directly using new nhs.net emails set up for each subspecialty; oculoplastics, VR, DMO and so on. Consultations are booked and spaced. I see about 12-15 patients face-to-face a day. PPE has now arrived via the Kent Resilience Forum and we are protected as best we can be.

“I’d seen the patient with a right eye RD repair and oil in his vitreous last week, at the request of Tim, his surgeon. His post op IOP was 31 last week, and his disc, through the oil fuzz, was a good 0.8. I’d taken him off the maxidex last week but today the IOP is still 31 and I’m a bit twitchy. Old barriers broken down, I email his surgeon directly who calls me back and we have a chat. It feels like a two-way conversation and we talk about the pros and cons of a treatment plan. He tells me that we have decided between us that oral Diamox is the way forward, which I duly prescribe. The FP10 is delivered to his pharmacist and the patient picks up the pills from there and calls me to say he’s got them. I’ll see him again in a week.

“I know Robert well as a regular patient. He is my age, and larger than life with an out-of-control white beard. He has glaucoma. He sees me every six months to a year for checks and always asks what his IOPs are. If they are OK, he rewards himself with a bag of chips. It’s his compliance aid. He is the sort of man that keeps bees, is creative, and tinkers. His foreign body came from tinkering this morning, and sent from A&E near where he lives, he arrives at my door that afternoon. The sub tarsal foreign body has led to a corneal abrasion and I remove the former and patch him up for the latter. The glaucoma checks are on hold and for that he’ll have to wait.   

“Sally is a monthly contact lens wearer. She gets them delivered directly to her, and hasn’t seen her own optometrist for over two years. She has had a red painful light sensitive right eye with reduced vision for three days. She has still been wearing her contacts because, she tells me, that way she can use her sunglasses now the weather is nice. In my mind the diagnosis has been made before she sits in my chair. Five minutes later and things are not as expected. There is no corneal ulcer. Instead, I find she has a screaming anterior uveitis (screaming is part of the grading scale from meh to OMG). Treated and back to see me in a few days. I wonder how badly her case might have gone if she had been seen remotely rather than face-to-face.”

Daughter and son

“I feel a bit rough at the end of the day. I come home with a wheeze and a tightness in my chest. I cough. I look at my kids as I come through the door, my daughter sits me down. A cup of tea is delivered.

“I immediately feel much better. My son shrugs and wanders off.

“It turns out that part of the differential diagnoses of COVID-19 is that is does not improve with a bit of a sit down and a nice cup of tea.”    

Post script

“I don’t think this ‘war’ will be won quickly or easily. I don’t think there will be one final great battle and one final great victory. I believe we’ll make it through in a sticky, messy, mixed-up way. And we will make it thanks to many small ships, all playing their own small part, in their own small way.”  

Dr Deacon Harle FCOptom DipOC DipTp(AS) DipTp(IP) is an IP optometrist and director at Osborne Harle.

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