Ophthalmology: Malcolm, 70
Malcolm is a 70 year old who knows his optometrist well and attends yearly for sight test having previously been noted to have early cataracts in both eyes. Malcolm had become aware over the last couple of months that his Left eye is slightly blurry, more so on reading, so arranged to see his optometrist for a sight test.
His optometrist found that the visual acuity was slightly reduced from previous year measurements of 6/7.5 Right and Left to Right 6/7.5 Left 6/9. No improvement was found with spectacle prescription change.
The previously noted cataract was still mild and stable to previous examination.
OCT assessment was carried out and alerted the optometrist to the presence of macular pathology which along with the change in visual acuity triggered the desire to seek further advise.
Advice and Guidance was requested using Advisr, the ophthalmologist requested that the full volumetric OCT scan was provided, because although a single image was included in the original request the full scan would allow thorough assessment.
The optometrist confirmed that although Malcolm was aware that Left eye was not as good this was not causing him any significant problems with day to day visual tasks and was still happy with quality of vision for driving, television and his crosswords.
It was possible to provide a diagnosis of Vitreomacular traction, not affecting the lower layers of the retinal surface.
Due to the patients mild symptoms the ophthalmologist was able to reassure the optometrist that there was no need for referral at this stage and in a large proportion of cases of vitreomacular traction the vitreous naturally separated from the retinal surface without intervention.
Dentistry: Sammy, 34
Sammy’s dentist was concerned about frequent mouth ulcers. He didn’t think they were serious, but Sammy had read that ulcers can be associated with oral cancer. Using Advisr Sammy’s dentist was able to ask the advice of a Consultant in oral medicine, and the episode of care was resolved without the need to attend a hospital appointment.
Using Advisr’s image function the dentist was able to upload an image of the ulcers to the advice session. These images are not only visible in the session, but are also sent to our PACS integration for high resolution viewing and reporting.
The Consultant in this case also took advantage of Advisr’s document library. Users, commissioners, hospitals etc can upload frequently used documents – in this case a PDF document of the Oral Medicine referral guidelines. Patient information leaflets, guides to attending an appointment, sedation information etc can all be sent to the user requiring only a few clicks ensuring high quality, consistent information.
In this case the patient was managed in primary care and assured that their condition was not cancer and provided with a patient information leaflet on the management of recurrent oral ulceration. Within only a few interactions, a patient has been assured, the dentist has complied with their obligation to seek advice and a hospital appointment has been avoided.
Dentistry: John, 45
A new optometrist to the area was seeing Janice, a 62 year old with a complex medical history of diabetes, learning difficulties, deaf and communicates through lip reading. He notices raised eye pressures. He sends the history and request to Advisr to ask what should be done next and who would be best to see this lady. He is advised in the first instance to access the local GRR services (links for pathways sent) and repeat pressures to be taken. Due to the complex history the consultant holds the case opens on Advisr and suggests they have a catch up on the patient in four months, and then ongoing as required.
A new optometrist to the area was seeing Janice, a 62 year old with a complex medical history of diabetes, learning difficulties, deaf and communicates through lip reading. He notices raised eye pressures. He sends the history and request to Advisr to ask what should be done next and who would be best to see this lady. He is advised in the first instance to access the local GRR services (links for pathways sent) and repeat pressures to be taken. Due to the complex history the consultant holds the case opens on Advisr and suggests they have a catch up on the patient in four months, and then ongoing as required.
A new optometrist to the area was seeing Janice, a 62 year old with a complex medical history of diabetes, learning difficulties, deaf and communicates through lip reading. He notices raised eye pressures. He sends the history and request to Advisr to ask what should be done next and who would be best to see this lady. He is advised in the first instance to access the local GRR services (links for pathways sent) and repeat pressures to be taken. Due to the complex history the consultant holds the case opens on Advisr and suggests they have a catch up on the patient in four months, and then ongoing as required.
Ophthalmology: Amy, 34
Amy is registered with a GP practice within a CCG that commissions the Community Urgent Eyecare Service (CUES). She rang her GP practice with a 2 day history of a red painful R eye and was signposted to her local optometrist who delivers CUES. She arranged an appointment the same day to be seen in practice.
Through discussion with the optometrist Amy recalled a similar incident occurred in the Right eye about 2 years ago at which time she was referred to the emergency eye clinic at the local hospital and had to use drops for some week. She is slightly under the weather at the moment with a lot of pressure on at work, she is otherwise well but
does suffer with cold sores.
The optometrist examined Amy and noted a dendritic ulcer on the Right cornea along with significant conjunctival and limbal redness. There is no corneal stromal involvement and the anterior chamber shows no inflammatory response.
The optometrist was keen to seek further advise through Advisr regarding the best management plan, all of the above was provided to the ophthalmologist along with a slit lamp image showing the dendritic ulcer.
The ophthalmologist recommended commencement of Ganciclovir 0,15% ophthalmic gel 5 times daily for review in 3 days time.
When Amy returned to the optometrist they noted that the ulcer had healed, the optometrist updated the ophthalmologist who suggested that the ganciclovir was reduced to 3 time a day for 7 days and then can stop and to return if redness or discomfort persists or returns.