BIO versus Volk Superfield (dilation)

[michalod]

Hey gang. I've been in practice for about 5 years but I've got a question regarding regulatory requirements for dilation.

I try to dilate almost all of my patients but I find that I prefer doing Volk Superfield fundoscopy rather than BIO. If I get a well-dilated pupil (which is most of the time as I use the phenylephrine with my tropicamide 1%), I can get pretty far out there in the periphery with the Superfield as with the BIO.

I don't see as well with the BIO (too many reflections and low-res imaging) as with the Volk, nor do I have nearly as much control. Plus, I don't like using the BIO as it's heavy and clunky on my head (yes, the darn thing can give me a headache - don't laugh).

So my question is, do state or provincial boards require you to do BIO when you do a dilated exam, or would a Volk Superfield be considered adequate for a DFE? I'd suspect that the Volk should be fine, as it often takes most people longer to do a Volk than to do a BIO. But I'd like the expert opinions on the board.

I'd be particularly interested if anyone knows if the Ontario College requires ODs to do BIO or if it lets you use the Volk? From what I understand, the College regs only specify dilation, not the actual procedure to use, so I'd guess that Volk-only would be fine.

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[362.04]

I cannot talk to your regulations but on a professional level, I would highly recommend dilation. With Dilation, the handheld fundus exam and slit lamp is much easier and the field of view is much greater.

I do not think that there is any substitute for dilating or any justification short of iritis or acute angle closure glaucoma from dilating someone and using both the BIO and the Super field Volk lens.

 

[sniklegem]

I'm pretty sure the OP was meaning he dilates but wants to know whether state regs say you must use BIO or you can use Superfield.

I'm just a student, so please tell me what you like so much about the superfield. I always like to hear about the current opinions on technology in our field.

 

[eyestrain]

Hmmm. I've never really thought about it, but I can't imagine that it wouldn't be okay to do it that way. I'll occasionally do the same thing if my BIO battery dies and my charger isn't with me. I think I get at least as good of a look, but it does take longer, like you said.

 

[362.04]

I'm pretty sure the OP was meaning he dilates but wants to know whether state regs say you must use BIO or you can use Superfield.

I'm just a student, so please tell me what you like so much about the superfield. I always like to hear about the current opinions on technology in our field.

The Superfield is much like the 90D but easeir to hold between two fingers and has the same field of view of a 90D lens. It has a slightly greater working distance.

 

[michalod]

I cannot talk to your regulations but on a professional level, I would highly recommend dilation. With Dilation, the handheld fundus exam and slit lamp is much easier and the field of view is much greater.

I do not think that there is any substitute for dilating or any justification short of iritis or acute angle closure glaucoma from dilating someone and using both the BIO and the Super field Volk lens.

I'm referring evidently to using the Volk Superfield UNDER dilation. I still believe you can get to the ora or pretty close with the Superfield, and thus there's minimal actual need for the BIO.

I know some older (and well-regarded in the area) docs use the 3-mirror gonio lens instead of BIO, in fact they never do BIO at all.

I believe the Superfield (with the patient gazing in the 8 key positions of regard) under dilation would let you go as the 3-mirror gonio.

 

[362.04]

I'm referring evidently to using the Volk Superfield UNDER dilation. I still believe you can get to the ora or pretty close with the Superfield, and thus there's minimal actual need for the BIO.

I know some older (and well-regarded in the area) docs use the 3-mirror gonio lens instead of BIO, in fact they never do BIO at all.

I believe the Superfield (with the patient gazing in the 8 key positions of regard) under dilation would let you go as the 3-mirror gonio.

Thanks for the clarification. No doubt that the Superfield is a good lens under dilation. I think under dilation, any number of lenses can be used to achieve results and whether one is more proficient than another or not should be not neccessarily be the determinign factor. I think it is possible to equal the Gonio lens with a SUper field although the 3 mirror lens does have its advantages.

 

[sniklegem]

although the 3 mirror lens does have its advantages.

Like using a viscous substance to get it to stick.
I actually like being a patient for 3 mirror. It feels so lovely on the eye.

In my short time doing 90D I must say I like getting more mag and seeing stuff way close up!