The task
Assume that today's date is 22 October 2026. You have just completed Mrs Bhatia's annual diabetic eye examination.
You are an optometrist in a community optometry practice. Using the information in the case notes, write a letter to Mrs Bhatia's GP, Dr Suresh Trivedi, to update him on the findings of today's examination and your recommendations. Address the letter to Dr Suresh Trivedi, General Practitioner, 45 King Street. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Update letter.
Case notes
Patient details
- Name: Mrs Orla Bhatia
- DOB: 14/03/1977 (49 yrs)
- Address: 8 Elm Avenue
- GP: Dr Suresh Trivedi; attends practice yearly for diabetic eye exam
Social background
- School administrator, full-time; long hours, irregular meals
- Married, 2 teenage children
- Enjoys gardening and sings in local choir
- Says husband 'keeps nagging her about sweets' and they argue about it
Medical history
- T2DM dx 2019 — metformin
- Hypertension — perindopril
- Hypothyroidism — thyroxine, stable
- Appendicectomy 1995
- Allergies: NKDA
Ocular history
- Last exam 10/2025: no diabetic retinopathy; mild myopia, glasses for distance
- Wore soft contact lenses in her 20s; now glasses only
- Father had cataract surgery aged 70
History today
- Occasional blurred distance vision, varies day to day, past 2/12
- Reports home BGLs often 'in the teens'; admits control poor; missed last 2 GP appts
- Unsure of latest HbA1c result
- Pt critical of GP clinic: 'impossible to ever get an appointment there'
- Complained about cost of new frames last year
Examination
- VA with current specs: R 6/6, L 6/6
- Refraction: small myopic shift both eyes since 10/25 — not prescribed (likely due to fluctuating BGLs)
- IOP within normal limits both eyes; anterior eyes healthy
- Dilated fundus: scattered microaneurysms only both eyes; no retinal haemorrhages
- OCT macula: no oedema; no maculopathy either eye
- Retinal photos taken — copy available for GP
Assessment
- Mild non-proliferative diabetic retinopathy (NPDR) both eyes, no maculopathy — new since last exam
- Blurred vision likely fluctuating refraction from hyperglycaemia, not retinopathy
Plan
- Findings explained; advised good BGL + BP control ↓ risk of progression
- Advised to report promptly any sudden ↓ vision, new floaters or distortion
- Recall 12/12 for dilated exam + OCT; earlier if symptoms
- Recommend GP review of glycaemic and BP management
- Re-check refraction once BGLs stable; new specs then if needed
- Pt intends to book GP appt this week
Who is reading, and what do they need?
Dr Trivedi is the GP managing Mrs Bhatia's diabetes and hypertension. He may not know retinopathy has appeared, and he must act on a request to review glucose and blood pressure management. He needs clear findings, what explains the blurred vision, and follow-up plans, in plain terms without ocular detail.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| Mild NPDR both eyes, no maculopathy; new since last exam 10/2025 | This is the main finding and the reason for writing. The change from no retinopathy last year makes it relevant. |
| Scattered microaneurysms only; no retinal haemorrhages; OCT no oedema | These findings support the grading and show no maculopathy, in a concise form the GP can use. |
| Blurred vision likely fluctuating refraction from hyperglycaemia, not retinopathy | The GP needs to know the symptom's likely explanation, which links to glycaemic control. Keep the hedging as the assessment states it. |
| Home BGLs often 'in the teens'; admits control poor; unsure of latest HbA1c | This is the patient's own report and the basis for the recommended glycaemic review. |
| Missed last 2 GP appts; intends to book appointment this week | It is relevant to follow-up. Word it neutrally, together with her stated intention to book. |
| Hypertension on perindopril; T2DM on metformin | Medicines connect to the recommended review of glycaemic and BP management. Keep it brief as the GP already knows them. |
| Advised to report sudden ↓ vision, new floaters or distortion; recall 12/12 | This shows what advice she has and the follow-up arrangement, so the GP can reinforce it. |
| Retinal photos available; re-check refraction once BGLs stable | The GP can request the photos, and the refraction plan explains why no new spectacles were prescribed. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Says husband 'keeps nagging her about sweets' and they argue | Private family conflict with no role in the findings or requests, and it may sound judgemental. |
| 'Impossible to ever get an appointment there' | Trap: it seems linked to her missed appointments, but it is a complaint about the GP's clinic and including it would be tactless. |
| Complained about cost of new frames last year | A past comment about cost has no bearing on this update. |
| Father had cataract surgery aged 70; soft contacts in her 20s | Old or family eye history that does not affect today's findings or the requests. |
| School administrator, irregular meals; choir; gardening; two teenagers; appendicectomy 1995 | Social colour and unrelated surgery. Do not use job or meals to suggest a cause that the notes do not state. |
| VA 6/6 both eyes, IOP normal, anterior eyes healthy; hypothyroidism | Compress to a very short mention at most. They are normal or stable and do not change what the GP does. |
A paragraph plan for this case
Open with the purpose of the update and today's annual examination, then give the new retinopathy finding with the contrast to last year and the explanation for the blurred vision. Follow with her reported glucose control and appointments, then the advice given, recall and the specific recommendation for the GP.
Where candidates slip on this task
- Do not attribute the blurred vision to retinopathy. The assessment says it is likely fluctuating refraction from hyperglycaemia, and the changed prescription was not issued for that reason.
- State clearly that the retinopathy is new since October 2025 and that there is no maculopathy. Do not drop either detail, and do not suggest progression is certain or impossible.
- The notes record a dilated examination but give no after-dilation advice, so do not invent any. Do not blame the patient for missed appointments or quote her criticism of the practice.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Optometry letter tasks
- Early dry age-related macular degeneration in a smoker update letter
- Routine referral for cataract assessment referral letter
- Bilateral optic disc swelling: urgent referral referral letter
Your profession's guide: OET Optometry. Layout and structure: OET letter format.
Questions about this task
Do I include her complaint about getting GP appointments?
No. It is criticism of the recipient's clinic and is not clinically useful. The relevant facts are that she missed two appointments and intends to book one this week.
Can I state her HbA1c?
No. No result is on the card and she is unsure of her latest one. You can mention her reported home readings and recommend a review of glycaemic management.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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