Any videos/tips on scleral depression

[golgi]

I'm still having a heck of a hard time scleral depressing no matter how many times I try practicing. I'm not sure what I am doing wrong and neither do the people I ask to watch me do it. Any videos out there that show how it is done or perhaps any other tips?

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[Jokestr]

1. Press harder and go more posterior on the globe....You can't be shy with scleral depression when you are starting out. If you are too timid, you will never see anything because you will not be indenting the eye enough. Tell the patient it is going to be uncomfortable/hurt, because it does.....Do it to yourself if you don't believe me.

2. "Practice" on soft eyes. Premie eyes get soft quickly on depression, so if your peds person does neonate exams, ask if you can do a couple with them(make sure the babies are healthy enough!)...A better option would be go with your retina specialist to the OR and ask them to allow you to depress after they have just done a buckle. Although the view will be horrible, the eye should be soft and easy to depress. This also has the benefit of not causing the patient pain as they were probably blocked/anesthetized.

If these don't work I suggest you ask your friendly retina specialist for some help because they will be able to offer both good advice and plenty of patients who need to be depressed.

 

[Meibomian SxN]

I'm still having a heck of a hard time scleral depressing no matter how many times I try practicing. I'm not sure what I am doing wrong and neither do the people I ask to watch me do it. Any videos out there that show how it is done or perhaps any other tips?

What helped me become proficiant at scleral depressing is that I actually had a need to do it at times when viewing holes. It really serves no purpose unless you're viewing a hole or soome fluid etc.

I agree with going to a retinal surgeon because their patients have holes etc that you can depress and gain appreciation for the technique.

 

[MstaKing10]

What helped me become proficiant at scleral depressing is that I actually had a need to do it at times when viewing holes. It really serves no purpose unless you're viewing a hole or soome fluid etc.

I agree with going to a retinal surgeon because their patients have holes etc that you can depress and gain appreciation for the technique.

That's a pretty important purpose don't you think?? How about identifying tears, differentiating schesis from detachment, performing laser retinopexy, etc...

It's definitely a necessary skill for any ophthalmologist and worth mastering. It takes a lot of pressure and posterior placement of your depressor to get a good view. Try to get as close to the equator as you can. Also get a good scleral depressor, Iv'e seen some use a cotton tipped applicator or the like but this is not as good or easy to master.

I don't think you have to be in a retina clinic to do this. Any patient with flashes or floaters should be depressed...and if your clinic is anything like mine, that's 3-4 patients a day. Practice makes perfect.

 

[Meibomian SxN]

That's a pretty important purpose don't you think?? How about identifying tears, differentiating schesis from detachment, performing laser retinopexy, etc...

...And the list goes on & on ...
What I meant was its more purposeful to scleral depress actual anatomical lesions rather than a "clear" retina. In the latter all you'll see is the retina turn colors and the patient squirm.

 

[Stark]

I was never good until I went to the OR with a retina surgeon.

Find a retina surgeon doing an emergency case on a weekend or whenever you are not in clinic. Ask to scrub in and assist.

As the surgeon is completing the vitrectomy, he will want you to depress so he can get the vitreous base (he uses both hands for the light pipe and the vitrector). Same goes for when the surgeon is applying laser to the retinal periphery.

In the OR you will 1. see what scleral depression really looks like and 2. what scleral depression really feels like.

When you return to clinic you try to reproduce that look and feel on your patients (without the benefit of anesthesia).

Good Luck,

Stark