What to expect at your consultation
Your relationship with your doctor should be built on trust and confidence and Miss Zakir would like you to feel at ease when seeing her. She believes in giving you the care and information you want in a way that helps you understand your treatment.
When you first see Rahila she will ask about your eye problems, but also about your general medical health, current or recent medicines, allergies, and a little bit about yourself – your interests and activities, partly as eye and vision problems can affect your quality of life by interfering with your ability to do what you need or want to do, but also because she would like to understand your visual needs. This then helps her to help you make decisions about your care and treatment.
Vision test
If you use glasses or contact lenses please bring them with you. Miss Zakir will start by checking your vision, and you will need your distance glasses or contact lenses for this. Don’t worry if you forget them, though, this part of the test can still be done. Depending on the kind of problems you describe, you may also need some additional vision tests before the eyes are examined, such as colour vision testing or eye movements. Miss Zakir does not refract (prescribe glasses) routinely, but can refer you to some excellent optometrists, who are specially trained to give you the best outcomes for glasses and contact lenses.
Autorefraction
This gives an indication of any refractive error you may have and helps decide if glasses might resolve some or all of your visual problems.
Visual fields
This test maps out your field of vision. You sit at a machine with a dome shaped front, and press a button as you see various small lights flashing at the edges of your vision. You will have a specially trained technician or orthoptist monitor you throughout this test to help you.
Slitlamp Examination
You will sit at a machine called a slit lamp, which is like a microscope – it allows Miss Zakir to see your eye in very great detail and she will use this to examine the front of the eye first.
Intraocular Pressure check
The pressure in the eye is usually checked at the first visit. This requires numbing drops and a yellow dye called fluorescein, and is not uncomfortable. Goldmann applanation tonometry is the technique Rahila uses – it is accurate and considered the gold standard in eye pressure measurement.
Dilating drops
To examine the back of the eye, if Miss Zakir suspects that this is necessary, she will put in dilating drops. These take about 20 minutes to take effect (it can take longer in darker eyes) and the pupils will remain dilated for a few hours. While the pupils are dilated you will have blurred vision, particularly if you try to focus on something up close. If you are shortsighted (myopic) then it is advisable to have a dilated retinal examination as there is a slightly higher risk of conditions such as retinal holes and retinal detachments, which can sometimes be detected before you develop symptoms.
Examining the retina
Your retinal examination starts at the slitlamp with special lenses to see the back of the eye. In some cases the eye will need to be examined in more detail, and Miss Zakir will take you into a different examining room where you will lie down and she will use a technique called binocular indirect ophthalmoscopy with scleral indentation – this helps to see far out to the periphery of the retina, particularly important to be sure that a retinal tear or hole isn’t missed.
Points to note
Driving after your consultation if your pupils have been dilated
You must not drive until your pupils return to normal, as you will not meet the DVLA standard for driving vision Driving Eyesight Rules – please make arrangements to get home safely after the consultation. You may not feel confident travelling alone with blurred vision on public transport, so you may want to arrange for someone to travel with you, or arrange a lift or cab.
Light sensitivity after dilating drops
While the pupils are dilated your eyes may feel light sensitive, and you may wish to bring sunglasses and a hat with a brim to shade your eyes for comfort.
Other tests that might be necessary
OCT scan (Ophthalmic Coherence Tomography)
This test shows the macula in 3D, and is particularly useful to see if there is any swelling or fluid at the back of your eye.
Autofluorescence
This test is a photograph of the eye that shows up some of the deeper layers in the retina.
Retinal Photography
This is a photograph of the back of the eye, the retina, and is often useful to establish a baseline for future comparison. In some patients, for example with diabetes, it helps show up subtle changes as the image can be magnified and adjusted to identify changes not always easily seen with the naked eye.
Fundus Fluorescein Angiography
This is an imaging test that takes photographs of retinal blood vessels after a dye called fluorescein has been injected into a small vein in your arm. The dye travels to the blood vessels in the eye, and photographs are taken over a period of several minutes while you rest your chin and forehead on a stand to help you keep still. Most people cope very well with the test. Some people have an allergic reaction to the dye, and like any allergy the reaction can range from a mild rash, to wheezing or, in exceptionally rare cases, anaphylaxis. The test is therefore done in an appropriate setting with a specialist team supporting the patient throughout. You will usually be monitored for up to 30 minutes after the angiography, as most allergic reactions will have shown up by this time.
Other things to know about fundus fluorescein angiography
· The fluorescein dye is can make the whites of the eyes and the skin look slightly yellow tinged for a day or two
· The fluorescein dye is washed out by your kidneys in urine, so the urine can be very orange for a day or two as the dye leaves your body
· You will need drops to dilate the pupils for this test, and should follow the precautions for dilated pupils Driving after your consultation if your pupils have been dilated
· You must not drive until your pupils return to normal, as you will not meet the DVLA standard for driving vision Driving Eyesight Rules – please make arrangements to get home safely after the consultation. You may not feel confident travelling alone on public transport with blurred vision, so you may want to arrange for someone to travel with you, or arrange a lift or cab.
· Light sensitivity after dilating drops
While the pupils are dilated your eyes may feel light sensitive, and you may wish to bring sunglasses and a hat with a brim to shade your eyes for comfort.
Anterior Segment Photography
This takes photos of the front part of the eye and does not usually need dilating drops. Your vision should remain unaffected.
Visual fields
This test maps out your field of vision. You sit at a machine with a dome shaped front, and press a button as you see various small lights flashing at the edges of your vision. You will have a specially trained technician or orthoptist monitor you throughout this test to help you.
Central Corneal Thickness
This is a very quick and simple test done with a very fine probe on the front surface of your eye. It is not painful and does not affect your vision afterwards.