Chapter Eight

Bobby Macula looked down at the large cappuccino on the boardroom table in front of him. Ok, he thought, so it wasn’t a mission to Mars, he hadn’t hired anyone, and no one had lost their job. But in all other respects, he’d been right. A certain self-satisfaction crept over him like a money spider on the face of a sleeping baby.

He looked up. From the podium at the front of the room, Sir Roger Logmar was staring at one of the plasma screens on the wall, and fiddling with a small remote control.

“It’s not working,” Sir Roger said, pressing one of the buttons repeatedly.

“You need to open the presentation folder,” said Ivor Snellen. “Here. Click on that, and it should start.”

The two men grappled with a computer mouse behind the podium. Suddenly the plasma screens sprung to life, the singing squirrel vanished, and a title appeared in bold capital letters:

‘MOORFIELDS EYE HOSPITAL: BIN LADEN’S REAL HIDING PLACE’

“Oops,” said Sir Roger. “Wrong folder. Forget you ever saw that.”

The words vanished and the plasma screens went blank. Furious mouse clicks came from behind the podium, and a few seconds later, a new title appeared:

‘THE D GENERATION: SUGARING THE DIABETIC PILL’

“That’s the one,” said Sir Roger.

Ivor Snellen looked confused. “I thought we agreed to go with ‘The Sweet Smell of Diabetes’?” he said.

“No,” replied Roger, “don’t you remember? We had ‘Blood, Sweat & Sugar: An Exercise in Diabetes’ and then ‘I’m In, You’re In, We’re All In Insulin’. But they were both dropped at the last minute. Personally I still prefer my suggestion.”

“‘Glucose, Comatose, God Knows I’ve Numb Toes’?”

“It’s punchy, it’s catchy, and above all, it rhymes. But I’m not a dictator, Snellen. I’m willing to listen to the views of my colleagues. And let’s face it, I can always fire them if they disagree with me. After some frank and open discussion, the board felt that none of those titles actually had anything to do with the matter in hand, and we’d be better off abandoning the brainstorming sessions, pouring the rest of the Red Bull down the sink, and just naming the damn presentation. We finally agreed on ‘The D Generation’.”

“And the rest of it?” asked Snellen.

“I added the subtitle after they’d all left the room,” said Sir Roger. “The D Generation’s too dry. You’ve got to have a pun, or no one will listen. You need to grab your audience from the get-go; make them sit up and take notice.”

The sound of gentle snoring came from the other side of the boardroom table, and the two men turned in unison.

“I think,” said Snellen, looking at the napping figure of Bobby Macula, “that our young friend needs to wake up and smell the coffee”.

“Perhaps,” said Sir Roger, “I should have let him launch that mission to Mars.”

Snellen laughed. He was easily amused. In reality of course, the Oxford Office of Ophthalmic Health really was planning a mission to Mars, and Sir Roger was deadly serious, but Snellen had been off sick the day they discussed it, and was none the wiser. It was probably just as well. Sir Roger’s presentation ‘The Mars Marathon: Across the Galaxy to the Milky Way’ may not have been Snellen’s cup of tea.

Getting down to business, Sir Roger turned up the volume on the PA system and tapped his microphone sharply. Bobby, lulled to sleep by the vibrating massage function of his reclining leather chair, woke up with a jump.

“Good evening,” began Sir Roger. “I am here to talk to you today about a most serious matter.”

He clicked the button on his remote control and a picture of Godzilla appeared on the plasma screen. Bobby wondered if he’d follow the squirrel’s example and sing. He didn’t. Sir Roger continued.

“That photo’s for illustrative purposes only. In reality, the threat we face isn’t green.”

“What colour is it?” asked Bobby, trying to appear interested.

Sir Roger looked down and flicked through his notes. “The latest information I have is that it’s...” He paused. “Cow-coloured.”

“Cow-coloured?” replied Bobby. “That could mean anything.”

“Not at all,” said Sir Roger. “It rules out green. And blue. In fact all the primary colours. I think we can put a cross against stripes too.”

“Ok, so we’re facing a cow-coloured threat,” said Bobby. “What is it?”

Sir Roger Logmar cleared his throat, looked at his notes, and pressed the button on the remote control. Godzilla was replaced with a retinal photograph. It showed the temporal view of a right eye. Bobby looked at the halo around the edge of the image, and wondered if he’d taken it himself.

“Take a look at this,” said Sir Roger. “As you’ll see, it’s a pretty standard left eye.”

“It’s a right eye,” Bobby responded.

Sir Roger turned and looked at the photograph. “No, no,” he said, “the optic disc’s on the right, that means it’s the left, doesn’t it?”

“No,” replied Bobby.

“Hang on,” said Sir Roger, looking at the screen. “If the optic disc’s on the right, and the nose is on the left...”

“It’s on the right.”

“No, as we face it.”

“Yes.”

“But the macula’s on the left...”

“So it’s the right.”

“But this is temporal.”

“I know.”

“Then...” Sir Roger looked confused. “Well look, it doesn’t matter. The important thing is it’s a standard diabetic eye with a bit of background retinopathy.”

“Where?” asked Bobby.

“Here,” said Sir Roger, indicating a dot with his laser pointer.

“That looks like pigment to me.”

“I disagree,” said Sir Roger. “It’s more red than brown.”

“Not from where I’m sitting,” Bobby replied. “Have you got the previous photos?”

“Look,” said Sir Roger, “we don’t have time for all this. Next you’ll be telling me those aren’t exudates!”

Bobby stared at the screen. “You mean the drusen near the macula?”

Ivor Snellen fingered the knuckle-duster in his pocket. Sir Roger rued his decision to use PowerPoint slides.

“Right,” said Sir Roger impatiently, “let’s forget about that.”

He flicked a switch on the podium. The screen went blank. Three seconds later, the singing squirrel returned and started belting out a cheaply produced dance remix of ‘Viva la Vida’ by Coldplay. Bobby congratulated himself on his earlier insight as Ivor Snellen scrambled towards the PA system and turned off the speakers. The room fell silent once again.

“Ok,” said Sir Roger from the podium, “let’s start again.”

He cleared his throat, took a deep breath, and began.

“Bobby,” he said, “the world of retinal screening is changing. Technology is advancing all the time, and if we are to survive, we need to embrace it, move with the times, and turn it to our advantage. We have moved from photographic film to digital images. From card index systems to computer databases. From clipboards to automatic appointment systems.”

“I still use a clipboard,” interrupted Bobby. “It makes me feel more like a doctor.”

“Next you’ll be telling me you don’t have EMIS in every clinic!” said Sir Roger.

Bobby shrugged.

“SystmOne?”

“Is there a point to this?” asked Bobby.

“There is,” replied Sir Roger. “Technology changes. You may have come across the latest automatic grading software...” He looked at Bobby’s blank expression. “Or you may not. Either way, it’s a reality, and it’s progress. We have to live with it. Adapt, adopt and improve.”

Bobby was starting to wonder if Mavis Clutter had been the lucky one to be dragged out of this room by her ankles. It seemed the less painful option. He took a deep breath as Sir Roger Logmar continued:

“Software now exists that can accurately search retinal photographs for signs of diabetic retinopathy, and grade those images accordingly. Understandably, there are those who feel that such technology threatens jobs, livelihoods and the very existence of retinal screeners. After all, the latest generation of this software can process ten thousand images in just 28 hours and 52 minutes.”

“That’s nothing,” said Bobby. “I can click ‘Annual Rescreen’ three times in ten seconds.”

“But the software,” Sir Roger pointed out, “is accurate.”

Bobby shrugged again. “Look at it this way,” he said, “if patients go blind, they’ll never be able to find me.”

“You’re forgetting one thing,” said Sir Roger. “The blind have access to dogs. Big dogs. With sharp teeth.”

“I’m not scared of an Andrex puppy,” said Bobby, putting a brave face on it. Mentally he resolved to look at the patients’ images in future before giving them the all-clear. That’s if he had any kind of future in retinal screening. Tomorrow’s local paper might set the seal on that one. He wondered if Kabul had a retinopathy screening programme, before remembering that the story was fiction, and he wasn’t heading for Afghanistan with a suitcase full of explosives. As far as he knew.

Bobby’s thoughts were interrupted by Ivor Snellen. “I think, Sir,” the man said, “that we’re getting off the point again.”

“You’re right, Snellen,” said Sir Roger. “Let’s move on. Bobby, there is no need to fear the automatic grading software.”

“I don’t,” replied Bobby.

“Good,” said Sir Roger. “No matter how advanced the software becomes, it will never replace the human screener. People will always be required to obtain an accurate visual acuity, administer the eye drops, capture the images, argue with the patients, and differentiate between a blot haemorrhage and a speck of dust on the microchip.”

“Actually,” said Snellen, interrupting his boss, “I think the iGrading software can do that last one for itself.”

“Really?” said Sir Roger, surprised.

“I believe so,” replied Snellen.

“Ok,” said Sir Roger, “we’ll scrub that one off the list. It can’t argue with the patients though, can it?”

“Not that I’m aware.”

“Fine.”

Sir Roger composed himself before continuing.

“But imagine, if you will,” he said, “a system which could detect all levels of diabetic retinopathy within seconds, without the need for any eye drops, without a single photo being taken, and with a hundred per cent accuracy.”

He paused for a few moments to allow Bobby to imagine such a state of affairs. The young screener looked thoughtful. He was still picturing himself being savaged by a Labrador.

“Mr Macula,” Sir Roger continued, “such a system exists.”