Ophthalmology (Eye Unit) at Rochdale Infirmary - Patient Leaflet

Do you need help to explain things in English or understand what is said to you? If you do, you can book a language interpreter to help you at the appointment.

Contact the Central Interpretation Booking Office:

• Phone 0161 627 8770 or Email interpretation@nca.nhs.uk

You need to tell them when your appointment is.

We have a policy which says that family or friends are not allowed to help you with English and interpret for you.  If you bring family or friends to interpret for you, you will not be seen.

Please ask someone to bring you and collect you from the Eye Unit.

This is because sometimes the doctor or other staff need use drops in your eye to help them see the back of your eye.  The drops mean that you cannot see well enough to drive for some time afterwards.

You can be dropped off before and collected from the Eye Unit after your appointment.

Sometimes it is too busy in the Eye Unit for the person bringing you to wait with you.  If you need someone to be with you all the time, you can ring to tell the nursing team before the appointment or tell them on the day.

The phone number is 01706 901757.

When you get to the Eye Unit, come through the double doors you can see in the picture above.

Tell one of the reception staff that you have arrived, and they will ask you each time about any changes in your details to be sure our records are right. 

Here is a picture of the Reception Desk.

Staff will either ask you to sit in the reception area or ask you to go to another area if the people you are here to see are based in a different part of the unit. Here is a picture of the reception waiting area.

The time in your letter is the time you should arrive at the Eye Unit.

The pathway you will follow is different for different clinics at the Unit. You will go into the clinic room to see the doctor after this time.

Some tests that staff do with you have to be done every time you come. Some are done because you need them this time. The doctor has always asked for your tests to be done.

Everyone in the waiting area will need to have different tests or be seeing different doctors. This means someone who has arrived after you may be seen before you.  Staff may be working for different clinics or doctors to the one you are seeing, so you may need to wait even if staff seem to be free.

Vision Test Room

A staff member will ask you to come into one of our vision lanes.  They are all slightly different, but they all have the tests you need before you see the doctor.

Different people need different tests. You may not have all the tests in this leaflet, you may not need any drops.

Before you come to the appointment the doctor looks at the information about you from when you were first asked to come or the last time you came.  Different doctors all have their own ways of working so things may be a little different each time you come. Each team member works with the doctor and they are told which tests you need. 

When the doctor has seen you, they may decide that you need more tests. We try to carry out all the tests you need on the same day so that you don’t keep having to come back.  This means it is difficult to say how long you will need to be at the Unit.

About the Tests

The first test is a routine vision test which is done every time you come. This is so the doctor can see any changes in your vision, maybe before you have noticed a change.

Usually, two staff work together.  One will guide you through the test and explain what you need to do.  The other will record the results in the specialist ophthalmology (openeyes) system.

You will be asked to read from a chart on the screen. The picture below shows someone looking at the screen from far away.

You will be asked to put an occlude (mask) over your eyes so that vision is tested in one eye at a time. The person can just see through one eye in the picture below.

You will be asked to read all the letters on the chart and not just one line.  They need to see if there are any patterns in your vision like missing letters or not seeing letters correctly. The next picture shows what the screen might look like.

Pressure checks

Next, we test the pressure in your eyes. We have different machines One machine you sit at like at the opticians, the second is handheld.  We measure the pressure before any drops are put into your eye. The results are recorded in the same ophthalmology (openeyes) system.

There are pictures of the handheld iCare machine we use below.

Routine Health Questions

We will ask you some general health questions.  We need to know this information before we put any drops in your eyes and to help the doctors when they are deciding the diagnosis (what the cause of your eye problem is).

Dilating Drops

Dilating your pupil (the dark area in the middle of the coloured part of your eye) lets more light into your eye — just like opening a door lets light into a dark room. Dilation (or making the pupil bigger) helps your eye doctor check for many eye problems. 

There are different drops that the doctor might prescribe for you (say you should take). They may be put in while you are in the vision lane or when you are with the doctor.  They take 20-30 minutes to work fully. The changes they make to your eyes last 4-6 hours. During this time, you should do the following things:

• take care with hot drinks and walking on stairs as your sight can be blurred
• don’t sign any legal documents as they may not count if you signed them when your sight is blurred
• do not drive – it may be dangerous and you will not be insured during this time.

If you still have dilated or large pupils after 24 hours, or if you have a very bad headache (the headache happens very few times) you should phone us on 01706 901757 between 9am – 5.30pm Monday to Friday.  What to do if it happens at other times is explained at the end of this leaflet.

Local anaesthetic drops

They are usually given to you before you have something done to your eye in the clinic.  Local anaesthetic drops numb your eye so that you cannot feel anything being done to it.  After you have had these drops, you will have no feeling for some time so you should:

• be careful if you rub your eye.
• not have a fan or car heater blowing towards your eye

Local anaesthetic drops with Fluorescein

These drops have a special yellow colour in the drop which is for doing a pressure check with a lamp called a slit lamp that uses blue light. They may be given to you after your eye has been looked at with the slit lamp.

The yellow dye shows as an s shape when the person looking at or examining your eye looks through the eye piece. There is a picture below.

If you have this test you will need to sit completely still and not blink while the test is happening.

The staff member doing the test will record the score number when the parts of the shape line up.

This is the name of a test which uses sound we can’t hear (ultrasound) to measure part of the eye called the cornea (the dome-shaped window covering the front of the eye). It is only used once with people who have a disease in the eye called Glaucoma but it may need to be done regularly if your cornea is being treated.

The test measures the thickness of the cornea and is used with the pressure in the eye to help plan your treatment.

Your doctor may have decided before or during your appointment that you need one or more scans. The team will be asked to do these scans before you see the doctor.  The scans will show if there have been any changes since the last time you came. The changes may be to your eye condition, or they may show how well treatment is working.

Staff will tell you where you need to go for any scans that you need.

Sometimes the doctor may see you and then decide after they have looked at your eye that you need scans.  If this happens, we will try to do the scans while you are here so that you don’t need to come back 2 or 3 more times to get them done.

This may mean you are at the Eye Unit for longer than you expected.

The doctor may ask for a Visual Field Examination before seeing you in clinic.

This may seem like a test you have already had at your opticians, but we do not get the results of the tests they do.  Also, our machine can do more which may be why they have sent you to see us.  Some doctors ask for all their patients to have this test.

The test will tell us how much all-round vision you have. 

Your field of vision is what you can see in front of you without moving your head.  It has two parts – the central or middle vision straight in front and the peripheral or outside edge of your vision.

The test is not difficult to do and will be done by a technician.  They can tell you what to do for the test but they are not allowed to tell you about any results.  Only a doctor or other staff who are trained to treat eye problems can give you the results.  

• Keep your head still while the test is happening.
• You will be asked to cover one eye and use the other to focus on or look straight at a yellow light inside the machine.
• You will be asked to press a button every time you see the light. Sometimes it will be very bright and sometimes very dim.  If you think you have missed one or cannot see anything, this is normal and happens for most people.

The test usually takes up to 10 minutes per eye. If you have a recent glasses prescription from your optician, please bring this with you.

The room lights will be off, but there is still enough light for the technician to move around and help you safely.

The technician will be able to see on their monitor if you lose focus or are looking for the lights instead of looking ahead and they will remind you what to do.

The pictures below show a technician doing the test with someone.

Optical Coherence Tomography is a special camera that takes pictures of the inside of your eye without touching it. It helps doctors see detailed pictures of different layers in the eye, especially the retina. This helps them find and understand eye problems early on.

What can an OCT tell the doctors?

An OCT scan can find and understand different eye problems. It helps your eye doctor find or diagnose things like:

• problems with the macula, which is a part of the eye, including swelling (macular oedema), age-related macular degeneration, and holes or weak spots in the macula.
• glaucoma, which is a disease that happens when there's too much pressure in the optic nerve. It's a leading cause of blindness in people over 60 years old.

You will be asked to put your chin on a rest. The technician will tell you where to look and ask you to follow the cross so that they can get the best pictures.  Some of the technicians have been doing these scans for years and are very good at getting the best scan even if you find it difficult to see the lights.  If your sight is poor, it may take a little longer to get the best scan, and they may ask a colleague for help.  They often help each other so it doesn’t mean there is a problem.

The picture below shows a technician doing an OCT scan.

The optomap can scan most of retina at the back of your eye.  It can take pictures in different ways to see more different eye diseases so that they can be treated.

The pictures below show the scanner being used.

The Optomap retinal exam gives us a wide view to look at the health of your retina, producing an image that is as unique as your fingerprint.

The retina is the part of your eye that captures the image of what you are looking at, like film in a camera. Optomap retinal imaging uses a camera that gives the technician a wide view of the eye. 

Optomap retinal imaging offers several important benefits, including:

• a wide field of view of the retina which we cannot get with other cameras
• a permanent record of your retina so that we can look for changes in future
• we can find diseases and disorders when they are just starting to happen
• no need for dilation drops
• it is a comfortable process 
• it's suitable for all ages (including children)
• you can have Optomap taken even if you have cataracts, glaucoma, small pupils or don't like bright lights.

You will look through a scanning instrument at a green spot surrounded by a red outer circle. When you see that the circle has become red, an Optomap photograph is taken. It takes less than a second to take an Optomap photograph of the back of the eye. The technician then looks at the photograph to check for any eye problems.

The Anterion Cornea App is a special tool that helps eye doctors understand the shape of a person's cornea, which is the clear front part of the eye. It helps diagnose (decide what is wrong) or keep an eye on changes in the cornea. It makes planning eye surgeries better and tells us how well the surgery has gone afterwards. This tool combines detailed pictures with measurements of the cornea's shape. It provides maps that show the curve and height of both the front and back of the cornea. Other information, like the total corneal power, thickness, and how light moves through the cornea, helps doctors make confident decisions about eye care.

The picture below shows the Anterion being used.

What is a Fundus Fluorescein Angiogram (FFA)?

It is a simple test which is carried out on our OCT machine to tell the doctors about the back of your eye. It helps them to decide what is the best treatment for you.

Before the scan

Before the scan, please eat, drink, and take your medication as normal. Please do not drive to this appointment if you have been booked to come for this test. We advise you to get a taxi home if you have had this done on the day if you have come alone. 

You might want to bring some sunglasses with you to protect your eyes from bright lights after the scan.

What does the procedure involve?

When you get to the Eye Unit, we will ask you some questions about your general heath and we will check your blood pressure.  You will be asked to sign a consent form which says that you agree to have this treatment.

Eye drops will be put into your eyes. These drops will make the pupil bigger (the pupil is the black hole in the middle of the coloured part of your eye). These drops may cause your vision to be blurred for a few hours. It is important that you inform the nurse if you have any drug sensitivities, are pregnant or are breast feeding.

The procedure

• a cannula (fine tube) will be put into one of the veins in your arm.
• when your pupil has dilated enough (after about 20 - 30 minutes), you will be taken into the OCT room.
• the Technician or Nurse will explain to you how the images are taken and what they want you to do during the scan.
• a small amount of dye will then be injected into the vein in your arm.
• the photographs and a video will then be taken as the dye is passing through the blood vessels at the back of the eye.
• the procedure takes about twenty minutes.
• the Nurse may help to hold your eyelid open if needed.

After the scan you will need to stay in the Eye Unit for half an hour. This is to make sure that we can look after you if you have any problems after the scan.

Side effects

• the dye will give your skin a faint yellow colour and your urine (wee) will be bright yellow for one or two days.
• your vision may be blurred from the drops, and you may be dazzled by the camera flash.
• one in ten patients will feel slightly sick or short of breath during the procedure, but the feeling usually only lasts for a few seconds.
• very unusually, some patients may have bad breathing or circulatory difficulties and require emergency treatment. When you go home If you begin to feel unwell, please contact your own GP.

The doctor who requested your FFA will be told when it is finished, and they will look at the results online through our systems.  If they want to see you after the FFA you will get a new clinic appointment through the post.  If they are happy with the results, they will see you at your next routine appointment.

Your vision should return to normal after 24 hours. If you have any worries or concerns or wish to talk to someone about the FFA, you can contact us on 01706 901757.

When you have had all your scans and tests you will then go to another waiting area to see the doctor unless you are on the virtual list (more information about this below).

Other patients in the same waiting area may get seen more quickly because they are waiting to see different doctors.

Your doctor or Healthcare Professional will look at the scans and the results of the tests you have had.

The doctor will call you in to their clinic and may look in your eye with the slit lamp which is special lamp which makes the images of your eye much bigger (like a microscope) so the doctor can see the details more clearly.  They may also check the pressure in your eye with this lamp.

This means that the doctor who will look at your tests is not working with us on the day you come in.  They will not look at your results when you are in the Eye Unit, but on a later date when they are planned to review them.

If you have been told that you are a virtual patient or are on virtual list, you can go home when all the tests and scans have been done. The doctor should write to you with their decisions and send out in the post.

If you have any questions or problems after your clinic appointment, please do as asked below.

To speak to staff about

• anything that happened in the eye clinic or how you feel afterwards
• to ask for repeat prescriptions that your GP cannot prescribe for you

Phone Eye Outpatients Nursing line– we are open:

Monday to Friday 9am - 5pm

Phone number is 01706 901757.

If staffing is low this may be unavailable.

If you injure an eye or need emergency eye treatment:

Phone Eye casualty clinic – we are open:

Every day 8am - 8pm

Phone number is 01706 901765.

You must phone first – you cannot just walk in and be seen.

At other times please go to your local urgent care centre or accident and emergency department.

If you have a general eye surgery question or problem:

Phone the Eye Ward – we are open:

Every day 8am - 8pm

Phone number is 01706 901776.