Interactive Patient Consultation
A free sample case featuring Sarah Mitchell, a patient attending after an urgent optometrist referral and abnormal workplace screening results.
Case Briefing for Clinician
Sarah Mitchell, 47, is a secondary school mathematics teacher attending after an urgent referral from her optometrist. Recent workplace health screening has also shown elevated blood glucose results, but she is not yet aware these indicate diabetes.
Patient is unaware of the letter contents.
Test results available to GP
- HbA1c: 68 mmol/mol, diagnostic of Type 2 diabetes.
- Random glucose: 14.2 mmol/L at workplace health check.
- Blood pressure: 138/82 mmHg.
- Lipids: total cholesterol 5.8 mmol/L, LDL 3.9 mmol/L.
- Renal: eGFR 78 ml/min and urine ACR 4.2 mg/mmol.
- Eye examination: background diabetic retinopathy in both eyes; urgent optometrist referral received.
Past medical history
- Hypertension diagnosed 2 years ago, well controlled on medication.
- BMI 32; has struggled with weight since having children.
- Father died of a stroke aged 58 with a history of poorly controlled diabetes.
- Non-smoker; alcohol approximately 14–21 units per week.
Current medications
- Ramipril 5 mg once daily.
- Ibuprofen as required for occasional headaches.
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Resources
Access these essential resources for Type 2 diabetes management, safety-netting and patient support.
- NICE Guidelines: Type 2 Diabetes in Adults (NG28) — Evidence-based assessment and management guidance.
- Diabetes UK: Newly Diagnosed Support — Patient-facing information and support after diagnosis.
- DVLA: Diabetes and Driving — Official driving guidance for people with diabetes.
Optometrist Referral Letter
45 Market Place, Thornbury, Lincolnshire, LN12 4RS
Tel: 01507 567890
Date: 23rd January 2026
To: Meadowview Surgery, Thornbury
Re: Mrs Sarah Mitchell, DOB: 15/08/1983, NHS No: 485 726 3941
Dear Doctor,
I reviewed this patient today during a routine eye examination arranged through her workplace health screening programme. I am writing to refer her urgently due to significant findings on dilated fundoscopy.
Presenting complaint: Patient attended for routine eye examination. She reported no specific visual complaints apart from occasional blurred vision “when tired”, which she attributed to screen work as a teacher.
Visual acuity:
Right eye: 6/9, improved to 6/6 with pinhole.
Left eye: 6/12, improved to 6/6 with pinhole.
Findings on dilated fundoscopy:
- Multiple dot and blot haemorrhages in the posterior pole.
- Microaneurysms present throughout the retina.
- No hard exudates or cotton wool spots visualised.
- Maculae appear intact with no clinically significant macular oedema.
- No evidence of neovascularisation.
- Optic discs appear healthy with clear margins.
Impression: background diabetic retinopathy, both eyes (R2).
Given the presence of established diabetic retinopathy, this suggests the patient has likely had undiagnosed diabetes for a considerable period. I did not discuss the probable diagnosis with the patient as I felt this would be better communicated by yourself in the context of her recent health screening results.
I have advised Mrs Mitchell to make an urgent appointment with yourselves to discuss her eye examination findings, but did not provide specific details about the diabetic retinopathy to avoid confusion prior to formal diagnosis.
Yours sincerely,
Mr James Patel MCOptom
Optometrist
GOC Registration: 12345678
