Systemic disease: Vascular disorders with neurological consequence - part 2

Optometrists regularly see patients who complain of transient visual loss. Decisions we make with regard to these patients can have long lasting effects on their general well-being. Here I give examples of patients seen in the clinic whose vision and cerebral function was preserved thanks to a rapid referral to the stroke unit. It is essential we are clear about the urgency of referral in such cases. Furthermore, failure by the patient to comply with advice can lead them to suffer irreversible consequences.

A 77-year-old patient has been monitored for her diabetic retinopathy since 2008. At one annual visit there were no symptoms. Her vision was 6/9 and N5 for reading in the left eye and 6/18 and N8 in the right eye. Her right fundus showed an inferior retinal artery with plaque deposition causing restricted blood flow (Figure 1a and b), background (R1) diabetic retinopathy on the inferior nasal fundus and pigmentary changes at the macula. The patient was informed of the findings and a referral letter was written to her general practitioner stipulating a referral to a dedicated stroke unit locally.