Imperial College Healthcare NHS Trust

4. Miss L complains about care and treatment provided by Imperial College Healthcare NHS Trust in the eye clinic in November 2024.

5. In particular Miss L complains the Trust did not recommend an ultrasound when she attended with poor eyesight. She says this did not give them the full information needed to rule out retinal detachment. She also complains the Trust did not complete a slit exam.

6. Miss L tells us that as she was worried she might go blind she had to seek private healthcare. Her vision, and light sensitivity have not fully recovered in her good eye. Her other eye is already impaired. She also suffers from chronic fatigue and as a result of the stress on her she developed shingles.

7. Miss L would like the Trust to acknowledge the mistakes it made and service improvements to prevent these from happening again. She would also like to be reimbursed for her private care fees.

8. Miss L attended the ED with symptoms of floaters and flashing lights in her right eye in November 2024. The Trust began investigations for retinal detachment. It arranged for an Optos exam. The Optos exam is a non-invasive imaging test that captures up to 200 degrees of the retina. It does not require dilation of the pupil, so is faster and more comfortable than other exams. It helps detect serious eye problems including retinal detachment.

9. The Trust was unable to complete a slit exam, due to Miss L’s sensitivity to light. A slit exam is a detailed eye test using a specialised microscope and bright light to examine the front and back structures of the eye.

10. Miss L felt an ultrasound was required to determine whether or not she had detached her retina. Miss L then attended two private health appointments where she had repeat scans and tests, which affected her already sensitive vision. An ultrasound was undertaken and a slit exam was completed.

14. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indications that something has gone wrong. We have explained our decision on each point below.

Ultrasound

15. Miss L complains the Trust did not perform an ultrasound when investigating her eye for a retinal detachment. This is where the layer at the back of the eye (the retina) becomes loose. It can lead to vision loss if not treated promptly.

16. The Retinal Detachment CKS says that medical professionals should suspect retinal detachment when there is a new onset of floaters (which can be mobile dots, lines or haze), or a new onset of flashes (which are recurrent brief flashes of light).

17. Our adviser explained that floaters and flashing lights are usually due to a posterior vitreous detachment. This can lead to a retinal tear, and subsequently a retinal detachment. Posterior vitreous detachment (PVD) is a common age related issue where the gel which fills the eyeball separates from the retina.

18. The Cleveland clinic guidelines say an ultrasound is only necessary when the back of the eye is not visible.

19. Our adviser has explained the purpose of an ultrasound is to determine whether there is a retinal tear or detachment. They have also explained that other imaging tests can be used such as Optos. This is a scan that uses laser wavelengths to scan different layers of the retina.

20. Miss L attended the ED with blurred vision, floaters and flashes the Trust dilated her pupil and attempted to use a slit lamp. As Miss L was unable to tolerate the slit lamp, the Trust arranged for an Optos scan.

21. Our adviser has said that an Optos scan can show most of the retina and can be used to rule out a retinal detachment. They have explained that because this scan was used to clearly visualise the retina in Miss L’s case, an ultrasound scan was not required.

22. We understand that Miss L was concerned about the lack of an ultrasound scan. From the evidence we have seen it appears the Trust’s attempts to visualise her retina and rule out a retinal detachment are in line with guidelines. The Trust attempted to use the slit lamp, and when this was not tolerable it arranged for a different scan to visualise the retina. As this scan was able to see the retina clearly, an ultrasound was not necessary.

23. We hope our explanation above provides Miss L with some reassurance about the Trust’s actions. We have not seen an indication of a failing here and so we will not be considering this part of Miss L’s complaint further.

Slit exam

24. Miss L also complains the Trust failed to conduct a slit exam as the consultant did not turn down the brightness on the machine. Miss L says that the private clinic she attended was able to complete this test by turning the brightness down.

25. As explained above, the Cleveland clinic guidelines say that if a person has symptoms of PVD an eye specialist should conduct a dilated eye examination. This means putting drops in the eye to dilate the pupil then looking inside using a bright light and magnifying lenses, known as a slit lamp, to examine the structures of the eye.

26. Our adviser has explained the brightness of the lamp needs to be bright enough for the doctor to see the retina and rule out retinal detachment. Our adviser has explained the purpose of this test is to determine whether there is a retinal tear or detachment. They have also explained that other imaging tests can be used such as Optos.

27. The records show the Trust attempted to perform this test, however Miss L was unable to tolerate the lamp due to light sensitivity. Our adviser said the records indicate that every attempt was made to perform the test including turning the brightness down.

28. The Trust then arranged an alternative scan to visualise the retina and rule out a retinal tear or detachment. As discussed above, this scan was able to fully visualise the retina, and so a further scan or test was unnecessary.

29. We understand Miss L was concerned that the slit exam was necessary to rule out a retinal detachment, and the lack of this meant a retinal detachment could not be ruled out.

30. It appears the Trust’s actions when attempting to conduct a slit exam are in line with guidelines. We can see the Trust attempted to use the slit lamp to view Miss L’s retina. When this was not possible it arranged for an alternative scan.

31. We acknowledge the lack of slit examination caused Miss L worry and concern. We have not seen an indication of a failing here, and so we will not be considering this part of Miss L’s complaint further.

1. We have carefully considered Miss L’s complaint about Imperial College Healthcare NHS Trust (the Trust). We are sorry to hear of Miss L’s experience and the distress and worry these events caused her.

2. We have not seen an indication of a failing when the Trust did not perform an ultrasound, or when it attempted to perform a slit exam.

3. Because of this, we have decided not to take further action on Miss L’s complaint. We recognise the importance of these matters for Miss L. We hope our explanation below provides her with some reassurance.