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IN TOUCH – Eye appointments during lockdown

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TX:Ìý 21.04.20Ìý 2040-2100

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PRESENTER:Ìý ÌýÌýÌýÌýÌýÌýÌý PETER WHITE

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PRODUCER:Ìý ÌýÌýÌýÌýÌýÌýÌýÌýÌý KEV CORE

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White

Good evening.Ìý Tonight, vital information for people with sight-threatening conditions for which appointments must be kept and those which can be safely postponed.Ìý And life without the dog.

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All guide dog training is obviously suspended and obviously very difficult for people with guide dogs to go out, restricted, in the way that we’d normally go out.

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White

Another victim of social distancing.

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And, he ain’t Henry, he’s his brother.

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I mean he was a fascinating man, he worked very fast and very hard.

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White

We meet the other 18th century Fielding.

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But first, however much coronavirus dominates the news other health problems don’t just go away.Ìý We’ve already discussed, on this programme, the fears of people with Age-related Macular disease – the most common cause of sight loss in the UK – that their appointments to receive sight-saving drug injections might be postponed or that they might be risking disease by attending them.

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The Macular Society tried to reassure people on the programme that careful precautions would protect both patients and staff and that appointments for people, who needed injections to keep their sight stable, would be honoured.Ìý But Rita Bulmer, for one, found her own experience of this very confusing.

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Bulmer

I received a letter from the Bradford Macular Centre cancelling all appointments.Ìý So, I was a bit worried about that but I had a phone call from the Bradford Macular Centre saying that the consultant had looked through my notes from previous scans and decided that I should go in for an injection.

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White

Was it your original understanding that all appointments, everyone’s appointments, had been cancelled?

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Bulmer

Yes, but I was sent for and we would just go straight in for the injection and come out and not have all the usual scans and examinations.

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White

That’s Rita Bulmer.

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Well, I’ve been talking to Michael Burdon, ophthalmologist at University Hospital, Birmingham and the President of the Royal College of Ophthalmologists.Ìý I asked him, first, what were the criteria for maintaining appointments at a time when hospitals were under so much pressure.

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Burdon

The criteria that the college is recommending is that patients should only attend their ophthalmology outpatient appointment if there is a significant risk to their eyesight if they don’t attend within the next few months.Ìý Patients who have conditions that are likely to progress quickly, such as Wet Age-related Macular Degeneration, should continue to attend when advised to do so but those with more chronic conditions, such as cataracts and glaucoma, should follow the advice that hopefully has been sent to them, either by letter or telephone, from the clinicians who are reviewing the clinics that are coming up and making decisions as to whether their appointment can be deferred in the patients’ best interests.

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White

So, what about someone, like Rita, who was worried about her situation, she got information to say her appointment was cancelled, it was subsequently reinstated but you can understand why people are a bit confused if different places are making different decisions.

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Burdon

I can certainly understand the confusion and one of the issues I have is that it is not possible to accurately track what’s happening in every department.Ìý However, the college did give a very strong recommendation to members that they should continue to provide injections for Wet Age-related Macular Degeneration during the Covid pandemic, even if they were not performing a full assessment, in other words we felt it was better to treat people, perhaps on a two-monthly basis, without necessarily performing the full set of investigations that we would normally do because we felt that treatment was the key issue.Ìý So, I will go back to the college, my college colleagues, and we will re-emphasise the need to maintain this service and I would encourage people in the same position to phone up the eye department, where they’ve normally received treatment, and ask why their appointment has been cancelled and ask those departments to look at the college guidelines on this area.

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White

Can I ask you about a couple of other conditions?Ìý Take a very common cause of sight deterioration – cataracts – what is the situation about them specifically?

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Burdon

Most patients with cataracts have a slowly progressive deterioration in their eyesight and it is unlikely, for the majority, that over a period of four to six months that they will notice a significant deterioration.Ìý The other thing to bear in mind is that cataracts loss of vision is reversible completely by subsequent surgery.Ìý For a few people they may well have rapidly progressive cataracts or indications related to their eyes that mean that they should still have their cataract surgery during this period but I think that is few and far between.

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White

And what about a condition like glaucoma, which is pressure behind the eye?

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Burdon

Again, most patients with glaucoma have a gradually progressive disorder where they are losing vision over decades.Ìý The difference between glaucoma and cataracts is that unfortunately any vision lost is not recoverable.Ìý But I think for most patients they will unlikely to come to any significant harm if their appointment is postponed for a period of three to six months.Ìý It is very important that they are aware to continue to use their treatment as previously recommended unless specifically contacted by the hospital and advised not to do so.

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White

What are the things which should alert you?Ìý You say it’s a long-running condition, so, what would alert you to the fact that you had got a problem that needed immediate attention?

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Burdon

It’s very difficult in glaucoma because most patients are actually symptom free even when they’re on treatment.Ìý And for most levels of pressure the patient is not going to experience any discomfort in their eye at all.Ìý But any patient who notices any significant loss of vision, any pain in their eyes, must get in contact with their eye department.Ìý And this is not just about glaucoma, this is a strong recommendation that the college is putting out saying that if you notice any significant change in your eyesight, whatever the cause, you need to have it urgently assessed because some conditions can only be treated quickly.Ìý So, one of the things I would encourage people is not to be scared about the Covid pandemic to the point where you don’t attend for urgent treatment.

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White

And of course, the other worry is the precautions to protect either the patient or the clinician.Ìý What can you tell people about what is happening to make sure that it’s safe for everyone?

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Burdon

Early on in this Covid pandemic the eye departments around the country were advised to stop performing routine surgery and to significantly reduce their outpatient workload.Ìý And the impact of that is that most outpatient departments are running at around about 5% or perhaps as much as 10% of their normal activity.Ìý And patients who attend are often the only people waiting to be seen.Ìý We are rigorously enforcing the use of personal protective equipment and obviously we are handwashing and equipment sterilising as we go along.Ìý So, I think the conditions have got to be important enough for people, particularly often elderly people, to break the current social isolation because of the risk of the Covid pandemic, but I can assure you that departments have been putting in all possible measures to minimise that risk.

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White

That’s Michael Burdon, President of the Royal College of Ophthalmologists.

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Well, as Mike mentioned, the approach to existing appointments, across the UK, is similar.Ìý When it comes to serious problems about half of optometry practices in Wales are open to treat emergencies and the Welsh government says that it’s providing additional payments for those remaining open.Ìý In Scotland, they’ve looked at the risk and announced today that routine eye screening for people with diabetes will now be postponed.Ìý But if your sight is immediately at risk in Scotland, you’ll now be referred to a new system of emergency centres.Ìý

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Consultant ophthalmologist, Dr John Olson, told the RNIB Connect podcast how it worked.

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Olson

Local opticians are going to be fielding calls from the general public in the normal way and where they feel that a patient needs to be seen, they will then pass them on to what we’re now calling emergency eye clinics and centres which all boards are setting up for their population.Ìý The unique thing about these – this system is that you’ll all be supported by telly medicine in one way or another.Ìý It may just be by phone call but it may also be by video links.Ìý And the important thing is that this is linking the opticians, who are taking the phone calls, directly with the treatment centres, where there are opticians who can prescribe medication and perform essential examinations, if need be, who can then, if need be, phone an ophthalmologist who can decide whether the patient actually needs to go to hospital directly, purely for intervention.

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White

Dr John Olson.

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Now the frustrations of lockdown are obvious enough but amongst blind people, who’ve been particularly affected, are those who were about to take ownership of a guide dog.Ìý

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Gary Ankin lives in Exmouth and he told us about his situation.

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Ankin

My guide dog, Zag, retired literally two months ago and we rehomed him, so I’m now in the situation of waiting for a new guide dog.Ìý Because of the current situation with the coronavirus, all guide dog training is obviously suspended and obviously very difficult for people with guide dogs to go out, restricted, in the way that we’d normally go out.Ìý I shall be on the waiting list for a dog, potentially, could run into next year.Ìý I know the local hotel that we would normally be using, the Cliffden at Teignmouth, which Guide Dogs use for training, that’s actually closed, like a lot of hotels, so again, it’s an impact nationwide really for guide dog owners.

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White

The challenge for many people, who’ve been reliant on a guide dog for a long time, is that it’s very easy to let crucial skills slip.

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Ankin

Going back, 1990, I did formal long cane training at Manor House Torquay, so that’s a real blast from the past.Ìý So, I literally had two years of long caning and then in 1992 got my very, very first guide dog.Ìý And I know common sense tells you that you should maybe keep up some long cane skills, they do say, when you go and about and you’re free running your guide dog maybe take your cane just to do a little walk along the path while your dog runs around.Ìý Well, yeah, hindsight’s a wonderful thing but I never used to do that, I used to just sort of shuffle along the path, let my dog have a run around.Ìý So, where that’s left me now is I have no long cane mobility skills, so, I struggle, I can’t really safely go out on my own because I am – was very, very dog dependent.Ìý It used to take me 10 minutes with my guide dog, to go down to my local shop now takes me half an hour.Ìý So, yeah, it’s a long haul and I know I won’t be the only one but the guide dog issue is a big impact.

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White

Well there’s no way of telling when guide dog training may resume and it’s not clear when Gary will get his next dog but he is being supported during a worrying time.

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Ankin

One thing I would like to point out, that Guide Dogs have been very good.Ìý We have our local sort of GDMI, the guide dog mobility instructor, and they contacted to explain the situation.Ìý In terms of immediate support, recognised organisations that we have had point of contact, which was really, really good.

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White

Gary Ankin.

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Well, we’re planning to talk to Guide Dogs on the programme in the future.Ìý But meanwhile they do have a Covid information line, calls to 0800 781 1444 from Mondays to Fridays, 10.00 am to 4.00 pm.

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So, are you in a situation like Gary?Ìý How are you coping?Ìý Do keep us posted.

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And we’ll be giving you our contact details at the end of the programme.

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But before that, another of those almost forgotten but remarkable blind figures of history, who we’re hoping will lift your spirits.Ìý Today Kathryn Tyne of Oxford’s Bodleian Law Library, tells us about John Fielding, also known as the Blind Beak of Bow Street.

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Tyne

He was born in 1771 and he intended to become a sailor but at the age of 19 he was blinded.Ìý No one knows exactly what happened but he came home and that changed his life.Ìý

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He was the half brother of Henry Fielding, who is well-known for writing Tom Jones.

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Henry Fielding got the post of the Chief Magistrate in 1748 and he began cleaning it up.Ìý Until then the Westminster Quarter Sessions were held in a pub, which was known locally as hell.Ìý But Henry just happened to be honest and he was said to have taught John the law in his spare time.Ìý And eventually Henry’s health failed and John took over and effectively became the head of the Metropolitan Police for some 26 years.

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And he seems just to have thought that being blind was incidental.

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One of the groups of people he didn’t show any preferential treatment to was blind people because he thought that everybody must feel like him and not think it was a particular impediment, which sounds astonishing.Ìý I mean there wouldn’t have been any possibility of him reading books or listening to recordings back then and so he had a legendary memory and became known, locally, as the Blind Beak of Bow Street and he was reputed to recognise 3,000 criminals by voice along.

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He had a case in Lord Harrington’s house, which was robbed, in 1763 and he investigated it personally, using a helper for his eyes.Ìý He spent the whole day and most of the night examining and questioning and determined that what was made to look like a burglary was actually an inside job.Ìý And his suspicions fell on a servant who later confessed.Ìý So, it was the classic kind of case of the butler did it.

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But he was very lenient very young people. ÌýHe realised that people were forced into crime through poverty.Ìý The age of consent was 12 then and young girls tended to be forced into prostitution and young boys into theft.Ìý He set up charities and reform houses and tried to get young people decent jobs in houses, I mean, hopefully, through his universal register, which was basically an employment agency, and try and prevent what was really abuse of children and starvation.

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There was a gang of armed robbers roaming London in 1753 and the King offered £100 for the capture of each man, which was a huge amount of money.Ìý People then started tricking naïve people into committing robberies so that villains could capture them and get the reward.Ìý John and Henry and Sanders Welch, who was a constable in Holborn, commanded a small group of thieve takers, who were brave men of good repute, and they were the first people to seriously study the detection of crime.Ìý They became the Bow Street Runners.

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I mean he was a fascinating man.Ìý He worked very fast and very hard and within two years of taking over from Henry his runners had broken up most of the gangs of street robbers and then organised a horse patrol to combat the mounted highwaymen.Ìý He set up publications, which were systems of rapid communication going to kind of tollgates and published descriptions of wanted criminals and stolen goods.Ìý And these are things that we just take for granted now, the idea of notifying the airports that somebody may be trying to flee – we take those things for granted but the Fieldings were the first people to think of them and they were the first people, really, to think that young people could fall into crime through abuse or desperation.Ìý And they were honest and fair.

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White

Well, our thanks to Kathryn Tyne for that.Ìý And also, to Judith Martin, because it was Judith who emailed suggesting we should feature John Fielding.

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More of your suggestions please and also tell us your ways of keeping your spirits up as the weeks roll by.

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You can email us at bbc.co.uk or go to our website at bbc.co.uk/intouch from where you can download tonight’s and other editions of the programme.

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From me, Peter White and producer, Kev Core, goodbye.