Registration
When you arrive at the eye outpatient clinic make your way to the reception desk, which is the second desk on the left. You will be asked for your appointment card and registered on the computer. You may also be asked 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;
• Perform tonometry (ie, measurement of the intraocular pressure);
• Test the pupillary reflexes;
• Ask about your general health, as well as any medications and allergies;
• Instill drops into both your eyes to enable examination of each fundus (ie, 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 would not be able to drive a car until you are once again able to read a number plate from a distance of 25 yards.

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

The nurse can store your luggage in a cupboard, if you wish. However, the hospital can not 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;
• Question 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;
• 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
After seeing the specialist registrar, you again 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, seated with your chin resting on the chin-rest and your forehead pressed against a bar. Please try to keep your eye wide open while the photographs are being taken.

Your photographs will be used:

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

Your anonymity will be respected. If your face is recognizable in the photographs and if there is any intention to publish these, then your permission will be requested using a special consent form. After the photography you will be asked to wait (yet again) in the waiting area until you are seen by the consultant ocular oncologist.

Examination by Consultant
The consultant will:

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

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

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 (ie, not cancerous and therefore relatively harmless) and if it does not require treatment, you will be discharged from the 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 your general practitioner and your optician (if you have given us your consent and informed us of the name and address).

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 will treatment schedules, possible side effects, and likely outcomes.

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.

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

Counselling by Nurse
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.

Screening for metastatic melanoma
Before treatment of an ocular melanoma, screening consists of:

• Systematic enquiry about symptoms and full general medical examination;
• Biochemical liver function tests;
• Liver ultrasonography, if any of the above investigations suggests spread to liver, or if the intraocular tumour is very large;
• Chest x-ray, if any symptoms or clinical signs suggest lung disease.