When I first started in optics, I spent all day every day in front of a visual fields screener. Repeating the same instructions, and hearing the same clicks and beeps was frustrating beyond measure at the time, but thanks to Nigel, the locum optometrist teaching and testing me about perimetry, I started to appreciate how important this bane of my working life was.
Fast forward more years than I’d like to count, and nowadays my frustrations have shifted to thoughts such as “I wonder how much I’ll be charged for this next engineer visit on this less than five year old machine which is already one of the most expensive pieces of equipment we own,” or “why is this thing such a money pit when the twenty plus year old Henson in the other room still works perfectly?” But I still do love an interesting field plot.
Recently a family friend emailed me a copy of her six printed fields results from the last two years and told me she was devastated to have received a letter telling her not to drive after her annual DVLA-mandated Esterman test.
I was fairly certain that as she’s asked to do one yearly, it couldn’t have been a complete shock, but she asked me whether I thought there was a chance that another practice had carried out the fields incorrectly, or if the DVLA had misinterpreted the results.
When I looked at the results, I was surprised that she’d held onto her driving licence for so long. There were missed points all over, including centrally, and each result was consistent with the one before it.
I know she’s diabetic so I assumed from the fields that she’d had laser treatments. However, as she wasn’t a clinician, I simply said we’d be happy to see her for a second opinion, but that she should be prepared as it was unlikely to be an error.
A week later she comes in, and it transpires that although well controlled for a while, her diabetes was not always. She did indeed have a history of multiple laser treatments on her eyes and, as a result, had been having a yearly Esterman as requested by the DVLA for many years. She had also been told not to drive before but had managed to appeal the decision and get a reprieve on that occasion.
There was a conversation about laser scars and blind spots, another Esterman was performed and the results sent off to the DVLA. She was unhappy a week or so later to be told that her results had been reviewed and that she still didn’t meet their fields requirements.
When she called the DVLA, the call handler stated that the fields still weren’t good enough and that she should come back and ask for the test to be repeated three times so an average could be taken in the hopes of getting just enough to be allowed to drive again.
She duly came back in, repeated the test three times and we sent the results off. She is hopeful of a better outcome. I’m not so sure, but I don’t make the rules, so who knows?
Great Expectations
Clare, our optometrist, attempted again to manage her expectations, but the patient adamant that she’ll get her licence back and that even if she doesn’t this time, she’d keep appealing until she does. That’s her prerogative, but when the thoughts of this patient whirl around in my mind, I have so many reservations about the system as a whole.
Is it always right that a patient is given multiple opportunities to redo their fields and try for a reversal of the decision? I can’t help thinking that if a driver didn’t see a child walk in front of their car, they wouldn’t get another chance on a different day to not run that child over.
In a similar vein, is it even right that they get an initial three chances to do their Esterman test? The cost alone of a decent fields screener gives you enough reason to believe that, in general, (assuming your fixation losses and false positives/negatives are low) the result is reliable. Besides, there are no second or third chances (or averages taken) when driving.
Almost all of the patients who suspect they may be told they shouldn’t drive tell us that it would be devastating to lose their licence - so should they be signposted towards some counselling? Or at the very least should the letter have something more to say than an instruction not to drive and how to appeal the decision?
Should or could there at least be a sentence that says: ‘If you are struggling with this, contact <these people> for emotional support?’ Moreover, could something be put in place to help patients plan for when (because in many cases it is only a matter of time) they can no longer see well enough to drive?
I think driving is a privilege, not a right – so should more be done to prepare all drivers for the day they shouldn’t drive anymore?
- Francesca Blackmore is owner and practice manager of Pearce & Blackmore Opticians in the Cardiff area.