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Alternative eye screening?

Amanda Gee

Amanda Gee

Member
Messages
18
Location
South west
Type of diabetes
Type 2
Treatment type
Tablets (oral)
hi all

Sorry about the length of this post.... But here is most of a copy of a letter i sent to the diabetic section managed at my local hospital, and of their reply.... They have totally ignored my request.... Anyone found any solution to this?

My letter to them:

"......................I arrived for my appointment in February, and the surly man on reception, turned out to be the optician. He took me in to the room and I asked if, what was in the drops was the same or similar to the anaesthetic drops which are sometimes used...... or if they had formaldehyde as a preservative (I really don’t have a good time with formaldehyde).

He was quite short with me, told me he couldn’t do the screen without using drops, but wouldn’t tell me what was in them..... he then said I could have them but it would be at my own risk.....

I walked out and went to see my own optician (xxxxxxxxxxxx) He said that because of the reaction I had to the anaestheic drops at an earlier eye exam, he believed that my having the drops for a screen would be a bad idea. He said if you wish to contact him he will be happy to speak to you, and That i should be able to have my eyes examined the old fashioned way. (Is this with a slit lamp?)

So, one disastrous visit, a dislike of the optician and still no eye exam.

Please can you arrange for some other method which doesn’t involve putting unknown chemicals in my eyes, at my own risk.

Any help you can give will be......."
------------------------------------------------------

Their reply:

".................Thank you for your xxxxxxxxxxxxx. to the Diabetic Eye Screening Programme.

I am sorry to hear that you had a bad experience at Xxxxxxxxxxxxx. I will follow this up and investigate.

Drops to dilate the pupils are necessary as the bright flashing light that occurs when the photographs are taken makes the pupil constrict to a very small size. If the drops are not used there is insufficient light getting in to the eye to take good photographs.

The National Programme recommends that all patients should have dilating drops instilled when diabetic eye screening is undertaken. I have looked in to the ingredients in Tropicamide 1% dilating drops that we use and apart from Tropicamide they contain sodium hyrdroxide, Hydrochloric acid and purified water. The sodium hydroxide and hydrochloric acid are of a very low concentration and are the preservatives. There is no formaldehyde in these drops.

I have made a note on your patient records about your concerns with the drops. Any information that you may have about the drops that caused the previous problem would be useful to the eye screeners.

I am going to suggest that you book an appointment for diabetic eye screening at our xxxxxx Clinic, which is held in Xxxxx. Xxxxx Hospital Diabetes Centre. The screening will be undertaken by one of the specialised screeners working in our programme. They will be able to talk you through the process. If you are still very concerned about having the eye drops, it would be possible to try without the drops but I think the chances of success are small. We do try to be as flexible as possible so that all our patients have their eyes screened.
Please contact the office to arrange your appointment for diabetic eye screening. This is done through our admin office. If you wish to speak to one of the screeners it is possible for this to be arranged,........."
—--------------------------------------

So... Basically, they are just offering me drops, despite my regular optitian advising against it....... Any one had any other method?

Thanks

Amanda.
 
Hi @Amanda Gee , sorry to hear the hospital optician was so unhelpful/rude. Have you show the letter from the hospital to your friendly optician? It sounds like they are confident Tropicamide should not cause you an issue but it might be worth getting the optician who knows your history and your poor reaction to the previous anaesthetic drops to consider whether there is any risk posed by the dilating drops when he can see what is in them.

It is possible to have the screening without the drops - I have had it done without drops on a number of occasions. But it could be that that only works for some people, whose pupils are a tiny bit slow at reacting to light.
 
It may be that the hospital "optician" was actually a screening technician who wouldn't know enough to compare anaesthetic drops with the dilating drops used at screening and it may be that your optician doesn't know what's in the drops used in screening so is being over-cautious.

I thought the letter from the Diabetic Eye Screening Programme was very good. They have clearly stated the ingredients of the drops they use so you know that they don't contain formaldehyde and you can show the letter to other health professionals if you need advice. I think it highly unlikely that your sensitivity to anaesthetic drops previously would result in a cross-reaction to the dilating drops. However, to be reassured, it would be a good idea to take the letter to your GP or local pharmacist along with the details of the anaesthetic drops you had previously (there are several different types and you probably wouldn't have a reaction to all of them) and have a chat with them.

The Eye Screening Programme are also being dutiful by explaining the importance of having the dilating drops yet at the same time offering to proceed with photos without drops if that is what you ultimately decide. Sometimes photos can be assessed without drops but usually they are not as clear and referable pathology may be missed. If this happens, treatment would be delayed which makes it less effective. If the photos are very unclear, you may be sent for a slit-lamp examination. This is not as good as being screened with photos because a) photographic screening is very sensitive and picks up problems early b) photos are subject to quality assurance checks and may be graded by up to 4 people making it less likely that pathology is missed c) photos allow comparison to previous screenings making it easier to detect changes specific to you.

I know it's very worrying if you've previously had a bad reaction, but there are many different types of eye drops and if they don't have any ingredients in common, you shouldn't experience a cross-reaction.

Edited to add: It is a good idea to confirm that it was anaesthetic drops that you reacted to and you were not previously given tropicamide dilating drops. Also, I should mention that slit-lamp examiners usually use the same type of dilating drops as the eye screening photographers to get a clear view of the eye.
 
Last edited by a moderator:
At my very first eye screening appointment, I was warned that they MAY have to use drops, but when they switched off the light they said there was no problem and the screening went ahead. I have never required drops for retinopathy screening, though my optician always uses them when she takes the same photos.

Have they actually tried your screening without drops? If not, you should go ahead and try it that way. From what I've seen, it only seems to be a minority who require drops . . . but I suppose that could just be a coincidence.
 
dancer said:
At my very first eye screening appointment, I was warned that they MAY have to use drops, but when they switched off the light they said there was no problem and the screening went ahead. I have never required drops for retinopathy screening, though my optician always uses them when she takes the same photos.

Have they actually tried your screening without drops? If not, you should go ahead and try it that way. From what I've seen, it only seems to be a minority who require drops . . . but I suppose that could just be a coincidence.
Click to expand...
In Scotland where they take a single photo of each eye, not everybody requires drops, especially younger people. The screening programme in England and Wales, however, screens with 2 photos per eye and even if the first photo is acceptable without drops, the second photo is usually poor, particularly in older people.
 
Dark Horse said:
In Scotland where they take a single photo of each eye, not everybody requires drops, especially younger people. The screening programme in England and Wales, however, screens with 2 photos per eye and even if the first photo is acceptable without drops, the second photo is usually poor, particularly in older people.
Click to expand...
Funnily enough, at my last screening, the 1st photo of my right eye wasn't good but the 2nd one was fine (no drops required!)
 
dancer said:
Funnily enough, at my last screening, the 1st photo of my right eye wasn't good but the 2nd one was fine (no drops required!)
Click to expand...
Interesting. Sometimes the first photo is not clear if someone has cataract or vitreous opacities. Out of interest what area of the country are you in? As mentioned in the letter quoted above, the National Programme in England and Wales is based on mydriatic (dilated) eye screening.
 
Dark Horse said:
Interesting. Sometimes the first photo is not clear if someone has cataract or vitreous opacities. Out of interest what area of the country are you in? As mentioned in the letter quoted above, the National Programme in England and Wales is based on mydriatic (dilated) eye screening.
Click to expand...
I'm in the Greater Glasgow and Clyde area, so normally one photo of each eye . . . but I do have a cataract.
 
dancer said:
I'm in the Greater Glasgow and Clyde area, so normally one photo of each eye . . . but I do have a cataract.
Click to expand...
That might explain it - if the position of the cataract obscures the macula, the image may not be gradable. On noticing this, the screening photographer can a slightly off-centre shot which might be gradable by itself or in combination with the first image.
 
It is possible to have the screening without the drops - I have had it done without drops on a number of occasions. But it could be that that only works for some people, whose pupils are a tiny bit slow at reacting to light.[/QUOTE]


How come you have tried it without the drops? Did you have a reaction? I am getting more and more paraoid about it the more i read....... Will take the note to my optitian next week.......
Have you ever tried the slit lamp?

Xx.
 
Dark Horse said:
It may be that the hospital "optician" was actually a screening technician who wouldn't know enough to compare anaesthetic drops with the dilating drops used at screening and it may be that your optician doesn't know what's in the drops used in screening so is being over-cautious.

I thought the letter from the Diabetic Eye Screening Programme was very good. They have clearly stated the ingredients of the drops they use so you know that they don't contain formaldehyde and you can show the letter to other health professionals if you need advice. I think it highly unlikely that your sensitivity to anaesthetic drops previously would result in a cross-reaction to the dilating drops. However, to be reassured, it would be a good idea to take the letter to your GP or local pharmacist along with the details of the anaesthetic drops you had previously (there are several different types and you probably wouldn't have a reaction to all of them) and have a chat with them.

The Eye Screening Programme are also being dutiful by explaining the importance of having the dilating drops yet at the same time offering to proceed with photos without drops if that is what you ultimately decide. Sometimes photos can be assessed without drops but usually they are not as clear and referable pathology may be missed. If this happens, treatment would be delayed which makes it less effective. If the photos are very unclear, you may be sent for a slit-lamp examination. This is not as good as being screened with photos because a) photographic screening is very sensitive and picks up problems early b) photos are subject to quality assurance checks and may be graded by up to 4 people making it less likely that pathology is missed c) photos allow comparison to previous screenings making it easier to detect changes specific to you.

I know it's very worrying if you've previously had a bad reaction, but there are many different types of eye drops and if they don't have any ingredients in common, you shouldn't experience a cross-reaction.

Edited to add: It is a good idea to confirm that it was anaesthetic drops that you reacted to and you were not previously given tropicamide dilating drops. Also, I should mention that slit-lamp examiners usually use the same type of dilating drops as the eye screening photographers to get a clear view of the eye.
Click to expand...

Thanks..... Will double check with my optician...... Xx
 
Dark Horse said:
Interesting. Sometimes the first photo is not clear if someone has cataract or vitreous opacities. Out of interest what area of the country are you in? As mentioned in the letter quoted above, the National Programme in England and Wales is based on mydriatic (dilated) eye screening.
Click to expand...

I am in Dorset, but happy to travel anywhere if i can just avoid the drops..... Which i am getting quite paranoid about......
 
dancer said:
At my very first eye screening appointment, I was warned that they MAY have to use drops, but when they switched off the light they said there was no problem and the screening went ahead. I have never required drops for retinopathy screening, though my optician always uses them when she takes the same photos.

Have they actually tried your screening without drops? If not, you should go ahead and try it that way. From what I've seen, it only seems to be a minority who require drops . . . but I suppose that could just be a coincidence.
Click to expand...

No, no one has tried anything...... I was given no options but to have the drops, "at my own risk" . Xx
 
Amanda Gee said:
It is possible to have the screening without the drops - I have had it done without drops on a number of occasions. But it could be that that only works for some people, whose pupils are a tiny bit slow at reacting to light.
Click to expand...


How come you have tried it without the drops? Did you have a reaction? I am getting more and more paraoid about it the more i read....... Will take the note to my optitian next week.......
Have you ever tried the slit lamp?

Xx.[/QUOTE]

They will just sometimes try it without the drops if you've got "lovely big pupils" (maybe read a bit of 50 shades of grey before you go in :) ).

When I have had the drops I've never had any problems with them.

I don't know what a slit lamp is, sorry.
 
Amanda Gee said:
It is possible to have the screening without the drops - I have had it done without drops on a number of occasions. But it could be that that only works for some people, whose pupils are a tiny bit slow at reacting to light.
Click to expand...


How come you have tried it without the drops? Did you have a reaction? I am getting more and more paraoid about it the more i read....... Will take the note to my optitian next week.......
Have you ever tried the slit lamp?

Xx.[/QUOTE]
Try not to get paranoid, the drops are generally very, very safe and are even given to 12-year olds! Obviously if you have an allergy to tropicamide it's not a good idea to have them but if you are allergic to an anaesthetic, they shouldn't affect you. Just find out exactly what was in the drops you reacted to before. If there was tropicamide in the drops, you need this documented by your GP and the screening service will not give you tropicamide but might offer you another dilating drop - phenylephrine - or may try taking photos without dilation. If there was no tropicamide in the drops you reacted to previously, it is extremely unlikely that there would be a problem with the drops used at screening. No-one will make you have tropicamide - it's your decision. However, if you don't have dilating drops the photos might turn out to be ungradable (or they might be OK).
 
Amanda Gee said:
hi all

Sorry about the length of this post.... But here is most of a copy of a letter i sent to the diabetic section managed at my local hospital, and of their reply.... They have totally ignored my request.... Anyone found any solution to this?

My letter to them:

"......................I arrived for my appointment in February, and the surly man on reception, turned out to be the optician. He took me in to the room and I asked if, what was in the drops was the same or similar to the anaesthetic drops which are sometimes used...... or if they had formaldehyde as a preservative (I really don’t have a good time with formaldehyde).

He was quite short with me, told me he couldn’t do the screen without using drops, but wouldn’t tell me what was in them..... he then said I could have them but it would be at my own risk.....

I walked out and went to see my own optician (xxxxxxxxxxxx) He said that because of the reaction I had to the anaestheic drops at an earlier eye exam, he believed that my having the drops for a screen would be a bad idea. He said if you wish to contact him he will be happy to speak to you, and That i should be able to have my eyes examined the old fashioned way. (Is this with a slit lamp?)

So, one disastrous visit, a dislike of the optician and still no eye exam.

Please can you arrange for some other method which doesn’t involve putting unknown chemicals in my eyes, at my own risk.

Any help you can give will be......."
------------------------------------------------------

Their reply:

".................Thank you for your xxxxxxxxxxxxx. to the Diabetic Eye Screening Programme.

I am sorry to hear that you had a bad experience at Xxxxxxxxxxxxx. I will follow this up and investigate.

Drops to dilate the pupils are necessary as the bright flashing light that occurs when the photographs are taken makes the pupil constrict to a very small size. If the drops are not used there is insufficient light getting in to the eye to take good photographs.

The National Programme recommends that all patients should have dilating drops instilled when diabetic eye screening is undertaken. I have looked in to the ingredients in Tropicamide 1% dilating drops that we use and apart from Tropicamide they contain sodium hyrdroxide, Hydrochloric acid and purified water. The sodium hydroxide and hydrochloric acid are of a very low concentration and are the preservatives. There is no formaldehyde in these drops.

I have made a note on your patient records about your concerns with the drops. Any information that you may have about the drops that caused the previous problem would be useful to the eye screeners.

I am going to suggest that you book an appointment for diabetic eye screening at our xxxxxx Clinic, which is held in Xxxxx. Xxxxx Hospital Diabetes Centre. The screening will be undertaken by one of the specialised screeners working in our programme. They will be able to talk you through the process. If you are still very concerned about having the eye drops, it would be possible to try without the drops but I think the chances of success are small. We do try to be as flexible as possible so that all our patients have their eyes screened.
Please contact the office to arrange your appointment for diabetic eye screening. This is done through our admin office. If you wish to speak to one of the screeners it is possible for this to be arranged,........."
—--------------------------------------

So... Basically, they are just offering me drops, despite my regular optitian advising against it....... Any one had any other method?

Thanks

Amanda.
Click to expand...

If I can just comment on a couple of points.

Your letter is basically telling the hospital you expect them to subordinate themselves to someone they perhaps don't know. Professionals don't usually like to be told they're not good enough. That may not be what you were trying to say, but they could have read it that way.

However, onto the dreaded drops. I have only had two screenings. On both occasions I was given a piece of paper detailing the drops I had had; in case I had any reaction and had to seek help later. I have scanned those records, as part of my record keeping. (I'm a data monster!). I'm away from home at the moment, with no access to that archive, so I can't quote the details. Did you receive anything similar? If you did, it would be useful to do more detailed research into exactly what you had, versus what is proposed this time around. That could either ease your mind, or give you more robust information with which to argue.

Does your own optician do retinal screening himself at all, as an interim measure? I know some High Street opticians now have this kit.
 
Sorry to read your problem here.

I've only had the one retinal scan atm (except for a couple I paid for at the optician), however because I was driving and only had limited time on my parking the optician did my scan without drops in my eyes. He did say that I might have to have the drops. However I did ask if they were the same as the drops my optician uses in my contact lens check up (both dilate the eyes, but the opticians use a dye version where the hospital use a plain version).
 
I may be unusual here as I get my eye tests at Specsavers free of charge as my Mum had Glucoma so I am classified at risk.

I get tested every year and they always do a battery of tests, including a visual field, pressure test and they always take a photograph of both my eyeballs.....never needed drops.

Is this photograph differant to a retinal scan?
 
Lindy1706 said:
I may be unusual here as I get my eye tests at Specsavers free of charge as my Mum had Glucoma so I am classified at risk.

I get tested every year and they always do a battery of tests, including a visual field, pressure test and they always take a photograph of both my eyeballs.....never needed drops.

Is this photograph differant to a retinal scan?
Click to expand...
The photos normally taken by opticians are not a substitute for Diabetic Eye Screening for a variety of reasons. It's confusing because in some parts of the country, the initial part of the screening is contracted out to accredited opticians. However, to be accredited, opticians have to undergo specialist training, take part in regular testing and follow the same guidelines for administering drops as the rest of the screening service. The images they take will also be viewed by specialist graders and subject to quality assurance.The average optician is not qualified to screen for diabetic retinopathy and does not have access to the very sophisticated software the screening service uses to enhance the photos.
 
I had my screening test done at Specsavers it is not a normal eye sight test and was done with drops the opticians where linked on line directly to the local diabetes unit and I had the result within a week.This all within 4 weeks of being formally diagnosed.

And BTW I do have back ground retinopathy it is important to get it done. As far as I know the drops do not contain formaldehyde the last time I got any in my eye during an anatomy and dissection session at Uni it stung like hell so I think I would have noticed if I ever got it in my eye again.
 
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