hello there, welcome to your first diabetic eye screening appointment.
Now before we pop any drops in, I need to ask you a few questions from the record here.
So when were you diagnosed diabetic please?
and type two I assume?
how do you manage your diabetes?
Tablets and diet
Do you know the name of the tablet for your diabetes please?
Just metformin?
Okay and what dose is that please?
Is your blood sugar well controlled at the moment?
Excellent
What was your last HBA 1C reading, if you know?
Excellent.
Do you check this yourself at home?
how often do you check?
After meals, right Okay, do you suffer with any eye conditions?
Have you been diagnosed with anything?
Have you ever been to the Eye Hospital for anything?
And when was that?
What was it for?
Foreign body removal.
Can you remember which eye it was?
Okay was it just a simple procedure, scrape removal, removal and drops?
Okay do you feel you fully recovered from that incident?
Thinking about your family, any diabetes there?
That's fine, and do you drive?
Have you driven today?
That's good.
The only reason I ask is because you can't drive after having these drops in, not until
the effects have worn off at least.
More on that a little bit later.
Now before instilling any eye drops, I need to do a few pre-checks, all right, so let's
get you in front of the vision chart.
Okay, so we're going to begin by checking your vision.
I would like you to cover your left eye with the palm of the hand, look off into the distance
at the chart there and just read the smallest row you can please.
Okay, cover the other eye and then read the rows from right to left, as far down as you
can please.
Okay a couple more things to check before we dilate your pupils.
It's always good practice to check the angle of the eye and check the intraocular pressure.
So just looking off into the distance of the charts
or straight if I block your view.
Check of the pupils, and we'll bring the light from the side there
where I can perform the shadow test
Excellent, usually perform this in dimmer conditions
but we should be okay
The chances of a reaction to the drops is extremely low.
I'm going to pop some anaesthetic into the eyes first.
This is lidocaine fluorescein.
It's going to sting a little bit
but it soon wears off.
Okay looking up to the ceiling please
Keep looking up.
One in the left.
I'm just going to give you a few seconds with that in.
So I'm going to check the intraocular pressures with the Perkins here
The sterile probe here gently touches the corneal surface a few seconds.
I want you to keep looking straight ahead, or stare if I block the way, okay.
It's a nice reading there.
And the left.
Two readings of 14 mil of mercury, thank you.
Right, the time has come to dilate the pupils.
As I say most people are fine after having tropicamide in the eyes
That's the 1% solution there.
Now if after having the drops when you leave, you experience any headaches, eye pain, ocular
redness, halos around lights or sickness feelings, that could be a reaction to the drops.
It is extremely unlikely that that's going to happen.
We'll give you an information leaflet about the drops afterwards.
But we would see you again if you've experienced those all right, come straight back.
These drops are going to blur the vision for up to six to eight hours.
Going to have two large pupils.
Going to be a bit sensitive to light afterwards with a bigger pupil, so sunglasses is advised
and as we discussed earlier, no driving until the drops of wear off.
All right, looking up, please shouldn't sting after having the lidocaine in
Good
How do you feel there?
Excellent, so now that the drops are in, you're going to need about 20 to 30 minutes in the
waiting area for the drops to work.
Now I'll come and check on you shortly, when they have worked, I'll call you through to
the photography room to take your retinal images.
Alright so that's it, go and have a seat in the waiting area.
Okay, keep looking into the lens of the camera, at the green lights, I'm just going to focus
it and then there'll be a flash of light.
Just get ready
there we go.
And for the other eye, just keep looking at the light please.
Just focusing the image and I'll take another picture
that's it, keep focusing
Almost there.
There we go, thank you.
Okay, so I've got your retinal images here on the system, ready to review.
This is actually what the back of your right eye looks like.
This is the disc centred image.
The disc is the optic nerve there.
The area here is the macula, can see it's a little bit more pigmented than the rest
of the retina.
I'm going to have a peek at the images, checking for any signs of diabetic retinopathy.
Now if we do see anything else that's not diabetic related we will act accordingly.
Let me start by just
zooming in a little bit
paying close attention to the optic nerve here of the right eye.
Excellent, now in the early stages of diabetic retinopathy, we can see things like microaneurysms,
dot haemorrhaging, blood haemorrhaging -we're looking for all those things.
Just checking the disc first.
Now the vessels are well defined at the crossings
certainly no evidence of any neovascularization, which is a very serious form retinopathy.
Okay I'm just going to review the nasal zone here
the superior portion
Excellent, I'm going down to the inferior part
now these arcuate yellow fibres are actually nerve fibres in the eye.
That's quite normal to see nerve fibres like this ,see how they come around like so and
fan out
excellent and just checking the space between the disc and the macula there
Lovely.
Sometimes you may see things that look like microaneurysms, when in fact they're actually
just pigment spots
and speaking of pigment, there is a little bit there, an innocuous finding on the disk.
Nine o'clock close to the margin
For this particular image, everything looks clear.
Okay, the second shot of the right eye, is the macula centred image.
For more area here this covers.
The retina does extend much further than what the photograph gives us, but we just work
with what we've got.
Just zoom in for you, so you can see.
Here is your macula area, your fine central part of the eye.
Picks up fine detail
just looking at the temporal area here
that's good
and certainly no macular oedema.
Okay, if I just come back, have a general look again
I'm quite confident to say there is no diabetic retinopathy in the right eye or anything else
unusual.
Now for the left eye, you'll notice everything is essentially mirrored.
We'll start off with the disc centred shot of the left eye.
Just have a little bit of flare here, where the pupil maybe wasn't as big as could be.
But the image is adequate enough to grade
Okay, now let me zoom in on your optic nerve.
Excellent, can see the little fine vessels there.
No evidence of any new vessel growth
and the surrounding area
No microaneurysms or haemorrhages.
I've got some nerve fibres here extending out
And this is the nasal portion
let's go to superior
and look at the inferior portion
also the veins look good.
No signs of any beading or loops.
Nice and clear at the crossings as well there
The disc crossings.
You can see the optic cup there, a little depression
in the disc
look at this space here
okay and the macular shot
the macula centred shot of the left
and the macula here
looks clear of any issues
I've got the extra extension here
lovely
Just the superior part
uh let's go for the inferior part as well
so I'm just scanning
Excellent, no signs of diabetic retinopathy in either eye or any other unusual ocular
findings.
Now these images will go off for grading, the results will come through the post within
a week or two.
Quite confident in saying that there's no retinopathy, so everything should come back
fine in that letter
and we need to do this again in one year's time.
You need to be screened every year, all right?
So when you get your invitation letter, book in with us and we'll arrange that for you.
All right so I can let you go now, looking good, thank you