Follow up
Follow-up at home hospital
You should be examined by an ophthalmologist about one week after local resection or endoresection and within a month of any other procedures (i.e., plaque radiotherapy, enucleation).
Unless you live very close to Liverpool, this examination will be performed at your own hospital.
Some general ophthalmologists are anxious about having to look after a patient who has undergone treatment for a tumour, because, quite understandably, they may not be very familiar with the surgical techniques involved. Nevertheless, all your ophthalmologist needs to do at this early stage is ensure that there is no infection, no raised intraocular pressure and, indeed, no sign of any other complication that would be common to any eye operation.
After radiotherapy or phototherapy, the tumour does not usually begin to regress for several weeks or months. This is why follow-up assessments at our centre are delayed for six or nine months after such treatments.
If it is likely that treatment is required before this time, for example, after local resection or endoresection, then arrangements will be made for you to attend our centre as necessary.
Ocular examination is recommended every six months for the first six years then once a year for several years and eventually once every 18 months to two years for the rest of your life.
Initially, arrangements are made for these examinations to alternate between your local hospital and our centre. This system of alternating examinations is designed to:
- Ensure that the ophthalmologists at your hospital keep in touch with your progress and become familiar with your condition;
- Make it easier for the ophthalmologists at your hospital to take over full responsibility for your care when the time comes for you to stop attending our centre;
- Reduce the need for you to travel long distances between your home and our hospital, if you live far from Liverpool; and
- Reduce the number of patients attending our follow-up clinics, making it possible for our consultant to see every patient at every clinic visit.
Follow-up at the Oncology Centre
Follow-up clinics are held each Thursday (morning and afternoon). The procedure at our follow-up clinic is similar to that of your first consultation.
You will be registered at the reception desk. Next, the sift nurse will check your vision and, if necessary, dilate your pupils.
A senior house officer, specialist registrar or fellow will first ask you a number of questions, using a structured questionnaire. These questions are designed to cover all possible symptoms and to get some idea of how worried you might be about tumour recurrence and spread. These questions are asked so that we can alleviate symptoms and discuss any of your worries. This is so that appropriate reassurance can be given if such fears are groundless (as they often are) or so that advice can be given if there is genuine cause for concern.
You will next have your photographs taken. We will ask you to sign a consent form for these images for teaching and research.
After your photography, you will be asked to wait until the consultant sees you. Unfortunately, this can be quite a long wait because the consultant routinely sees all patients at every clinic, which means that the morning clinic rarely finishes before 1.30 to 2.00 pm. We have tried to reduce waiting times by spreading appointment times more evenly across the clinic session but this tended to result in slack periods in the early part of the clinic and a rush to catch up later on. It only needs one or two patients to arrive late, because of a train delay or congestion on the motorways, to disrupt the whole clinic.
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- Bertil Damato and Sister
The consultant will review the case notes with you, discuss any symptoms or concerns you might have, and examine your eye, if necessary also performing ultrasonography. If appropriate, he will compare the clinical findings with previous photographs. Next, he will discuss your results with you, answer any questions, dictate a letter to your ophthalmologist with a copy to your general practitioner, computerize any relevant information, and give you an appointment sheet to hand to the clerk at the reception desk.
The specialist nurse can speak to you in a quiet room if there are any important matters you wish to discuss with her. You may also ask to meet our health psychologist.
The letter to your ophthalmologist is usually posted within one or two working days. Delays occasionally occur if our secretary is on leave or if the letter requires correction.
You, your GP and any other practitioner involved in your care will receive a copy of your report, but it is not our current policy to send copies of letters from follow-up clinics to optometrists.
Discharge from our Centre
You will be discharged from our centre when we feel it is safe for you to stop attending.
