AHHHH! Senior residents please help!

[golgi]

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How long did it take you guys to get good at scleral depressing? I am sucking at it big time and am starting to worry that i'll never get the hang of it....

 

[idoc]

Scleral Depression is an art form that gets better with time. I first noticed my scleral depressor during an actual exam during my 2nd year. It is really disorienting at first though. Here are some tips:

Try to scrub in on some retina cases and ask to depress during endolaser or other parts of the case. The patient will be anesthetized, so it will give you an idea of where to place the depressor and how hard you have to push to see the desired effect.

Second: Pick a stoic old guy to try it on first. Give them a drop of proparacaine, and go on top of the lid rather than under it. Also, when trying to get the hang of it, I think it is easiest to see the superior retina. Make sure the patient is reclined. Also, use your non-dominant hand for the depressing, because it is all for naught if you can't get the 20D lens in focus. Hope that helps!

 

[Mirror Form]

Well I'm not a chief resident, but I'm pretty comfortable w/ the depressed exam. I actually think it's significantly easier to do when depressing w/ my dominant hand and holding the lens in my left hand, but that just goes to show you that there is no one right way to do it (and you'll probably want to change hands for different angles anyway). Most people develop their own preferred technique over time.

A few pointers for learning:

1. It's easy to do on patients that have the more proptotic eyes. Find a patient that has their eyes sticking out to practice on.
2. Always use topical anesthetic.
3. watch the techniques of your retina staff as they do depressed exams. Make a mental note of the way that they hold their hands and go about the exam.
4. Unfortunately, a lot of the exam is actually just motor skills and motor memory. No matter what, at first you'll stink at it. But do it a lot, and you'll get good.

 

[Mirror Form]

Oh yeah, one more thing. It can be a lot easier to see peripherally if you set your headlamp to the small pupil setting. Of course this also causes you to lose a bit of stereopsis, but you should still have enough to do a decent exam. After you get better you can go up to the bigger pupil settings.

 

[Wolverine98]

I think that all of the above advice is very good. For me, I would often switch hands based on my position relative to the patient. In some of our rooms it can really difficult to go around the head of the patient, especially if there are residents and medical students milling about, so it was just easier to switch hands and have the patient tilt his head to where I need it.

I will also say that there are many residents who, IME, never get completely comfortable with SD. They tend to go into more anterior segment subspecialties.

Dave

 

[retinasurgeon]

Just a hint, try doing it to yourself, get the feel of when it becomes a bit uncomfortable, that is when you will feel what your threshold depression will be.