First Visit

Registration

When you arrive at the eye outpatient clinic make your way to the reception desk. You will be asked for your appointment card and registered on the computer. You may also be asked for your research and teaching consent form and for further information if this is missing from the patient information sheet (which you should already have completed and returned to the ocular oncology secretary).

Examination by Nurse

Once you have registered, you will be asked to take a seat in the waiting area until you are called by the sifting nurse, who will:

Measure your vision with the letters chart;
Measure the intraocular pressure (i.e. tonometry);
Test the pupillary reflexes with a torch;
Ask about your general health, as well as any medications and allergies; and
Instill drops into both your eyes to enable examination of each fundus (i.e., back of the eye) by ophthalmoscopy.

These drops will probably blur your vision so that you may be unable to read without appropriate spectacles (or a magnifying lens) for up to four hours. Remember also that you should not drive a car until you are once again able to read a number plate from the legal distance.

If your tumour is located on the iris, the pupils will not be dilated until the consultant has examined you.

Outpatient Clinic

The nurse can store your luggage in a cupboard, if you wish. However, the hospital cannot be held responsible for any loss or theft, so please keep any valuable items with you.

Examination by Specialist Registrar

After seeing the sift nurse, you will be seated in the waiting area again until you are called to see the specialist registrar, who will:

Introduce himself or herself;
Confirm your name and age;
Ask you about how and when you first became aware of your ocular condition;
Ask about the sequence of events leading to your referral to our centre;
Ask about your general health and previous illnesses;
Examine the front of your eyes with a slit-lamp; and
Examine the back of your eyes with an ophthalmoscope.

We are interested in how your tumour was detected and how your condition was managed prior to your referral to our centre. This is because we are conducting a study into the detection of ocular tumours in the community. We hope this investigation will in future result in earlier diagnosis and treatment.

Photography

: Fundus Photography in progress

After seeing the specialist registrar, you will be asked to wait outside the consulting room until you are called for photography. The photographer will check your name and age before asking you to position yourself at the camera. Please try to keep your eye wide open while the photographs are being taken.

With your consent, your portrait may be taken so that we can see this on our computer screen whenever we are speaking to you by telephone.

Your ocular photographs will be used:

To compare tumour appearances with any future photographs so as to be able to recognize growth or regression; and
For teaching in lectures at scientific meetings and publications.

In any publications, your anonymity will be respected. Your permission for publication will be requested using a consent form. A special section of the form will need to be signed if you may be recognized from the photographs.

After the photography you will be asked to sit in the waiting area until you are seen by the consultant ocular oncologist.

Examination by Consultant

: Counselling by consultant

The consultant will:

Introduce himself;
Review your referral letter and the case notes;
Examine your eyes;
Perform ultrasonography, which is useful for diagnosis and for measuring tumour size;
Explain to you as much as possible about your condition; and
Plan your future care with you.

If any close relatives or friends have come with you to the hospital they are welcome to accompany you during your consultation.

A model eye will be used to help you understand the structure of the eye and you will also be shown any ultrasound images of your tumour.

You are of course encouraged to ask questions, although these are best left to the end of the examination.

An audio-cassette tape recording of your consultation will be given to you to help you remember what was said. Most patients seem to find this very useful and are quite surprised by the amount of information they missed the first time.

Discharge from Clinic

If on the basis of size and appearance your tumour is considered to be benign and if it does not require treatment, you will be allowed home and discharged from our clinic.

A letter will be written to the consultant ophthalmologist at your home hospital describing the clinical findings, stating the diagnosis and advising on future care.

Copies of the letter will be sent to you, your general practitioner and, with your consent, to your optometrist. Letters to your ophthalmologist and GP are faxed the day after your initial visit.

It may be necessary for you to return to our centre for examination after several months, in which case we will give you an appointment sheet. This should be taken to the reception desk, where a specific date for your next appointment will be selected, using the hospital computer system. Finally, you will be given an appointment card by the receptionist.

Treatment Selection

If you require treatment, then all the therapeutic options will be discussed, together with treatment schedules, possible side effects, and likely outcomes. These will be summarized on a special form, in your presence.

You will be helped to select the best treatment for your particular condition. If possible, a decision is made regarding treatment by the end of your consultation, but you would still have the opportunity of changing your mind afterwards.

If you feel that you require more time to reach a decision, this is quite possible, of course.

Counselling by Nurse

: Kiosk in waiting area with information for patients and relatives

After your consultation you will be taken to a quiet room, where a nurse will go over what was said, answering any more questions that might come to mind.

If you would like to speak to another patient who has previously received the same treatment as yourself then the nurse would be able to arrange for you to speak to this volunteer by telephone.

A computerized kiosk in the waiting area is available so that you can find out more about your condition and its treatment.