Current interns: how are you prepping for ophtho?

[ophtho838]

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We're nearing the end of intern year and about to start focusing on that small (but arguably most important) area of the body. How are you preparing for the beginning of ophtho residency?

Anyone have recs on good books, websites, other reading material, etc?

I'm not looking for anything in-depth--just something quick and basic so I don't look like a complete idiot during my first days on call or in the clinic.

 

[DrZeke]

1) Couple of short and good books that are easy to get through:

www.ophthobook.com and all the videos on his website

basic ophthalmology by AAO

2) Helpful for exam techniques and limited fund of knowledge:

Practical ophthalmology
- many programs will give this to you
- I found this a bit tough to read until I was actually doing the technique in clinic. Sometimes you have to try and fail a bit, then look at this book and it helps you to refine your technique after you have practiced.

3) Good Atlas:
- Spalton
- Kanksi

Don't stress too much about looking like a dunce on a call. Reading is a small portion of learning curve when it comes to clinical proficiency, and it is unfortunately just something that needs to happen. You can read all you want about holding a 90 and grading cell and flare, but the things that help the most are doing these things over and over. Many of you will hate hearing that, but it is the truth. You will pick up things fairly quick, most residents do and the purpose of having back up is to be able to call them and use them for their clinical judgment that you are still developing. The worst thing you can do is pretend you know everything or that you see things that you don't.

So, relax, try and read something easy for intern year and when you get that Will's Manual just carry it with you everywhere on call and learn on the go 😉. The rest will fall into place.

 

[CookieMonster55]

I have found "The Eyes Have It" app to be helpful as a quick review of the high yield topics. I'm also hoping to crank through a good chunk of Kanski's "Clinical Ophthalmology" textbook if I have the time/ motivation in the next 2 months.

 

[eye love lamp]

Whenever I was on rounds (usually ICU) we had computers and a very large team. Whenever someone was presenting I would stand there and do a pubmed search for "Ocular manifestations of X" - whatever disease their or my patients had.

You'll learn a bit that way. I bought Kanski as well but I retained nothing of what I read from that book before actually starting in clinic.

 

[Corn Dog]

I haven't done much reading/studying for ophtho yet. I certainly have tried to do some light reading earlier in the year, but I realized that I didn't retain much, and it kinda became pointless trying. One thing that I have been doing is to do dilated fundus exams on patients who could potentially have a relevant exam finding.

My goal for the next two months basically is to know the anatomy and the bread-and-butter stuff relatively well.

 

[OPPforlife]

I haven't done much reading/studying for ophtho yet. I certainly have tried to do some light reading earlier in the year, but I realized that I didn't retain much, and it kinda became pointless trying. One thing that I have been doing is to do dilated fundus exams on patients who could potentially have a relevant exam finding.

My goal for the next two months basically is to know the anatomy and the bread-and-butter stuff relatively well.

Your dilating patients as an intern? That's a first.


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[backrow]

Your dilating patients as an intern? That's a first.


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And likely inappropriate...

 

[peter2013]

I haven't done any dilated exams, but I read Snell's Clinical Anatomy of the Eye and Vaughn and Asbury's General Ophthalmology. I plan on reading Practical Ophthalmology as well.

I've been looking for a good introductory optics book. Does anyone have suggestions? I got Last-Minute Optics but it's more of a review book than something I could learn from.

 

[Corn Dog]

There is nothing inappropriate, unwarranted, or deceptive about my dilated fundus exams. I've done a few DFEs when I was doing my ED month under the supervision of my attending. I've done a couple when I was on floors either at the request of or after discussion with my attending. I've done a few more with an ophtho resident doing ophtho consults. Overall I thought it was a great experience.

Now going back to the original topic/question of this thread....

My goals before July:
- read practical ophthalmology
- try to be at least familiar with the contents in the wills manual.
- flip through Kanski for pics
- Review anatomy: spalton, netter's, neuroanatomy

What did not work for me:
- Eye Pathology by Ralph Eagle. I know a lot of residents/students really like the book, but I thought the book was excessively wordy and could be organized better.

 

[eye love lamp]

I did dilated fundus exams too as an intern. I even showed my medicine attending how to use the indirect. He was ecstatic when he could see massive exudates in an uncontrolled diabetic.

I don't see what the big deal is.

 

[backrow]

There is nothing inappropriate, unwarranted, or deceptive about my dilated fundus exams.

So what were the indications for the DFE? What benefit did the patient gain from having the DFE performed by you? Did they have to undergo secondary dilation by an ophthalmologist after your dilation therefore requiring two different dilated exams? I see absolutely zero point for an intern to dilate a patient unless they are doing it in concert with the ophthalmologist they consulted. For the purposes of your exam a direct undilated exam is more than adequate.

A second question: without looking it up tell me the contraindications to the use of the most common dilating agents? Can you? Off the top of your head? If so, good, you've done your due diligence, if you haven't then you shouldn't be touching dilating drops. I can guarantee your floor/ED staff have no clue.

I've done a few DFEs when I was doing my ED month under the supervision of my attending. I've done a couple when I was on floors either at the request of or after discussion with my attending.

Were those staff credentialed in performing a dilated fundus exam? I don't know, just asking the question. It may be included in the core privileges at the institution in which you work.

I've done a few more with an ophtho resident doing ophtho consults.

A great idea!

I did dilated fundus exams too as an intern. I even showed my medicine attending how to use the indirect. He was ecstatic when he could see massive exudates in an uncontrolled diabetic.

You had an indirect as an intern? Most of my 1st year residents can't do a great indirect exam until several months into residency. I would ask you the same question I asked above...what benefit to the patient did you provide the patient by an intern performing a dilated fundus exam. If someone had "massive exudates" a direct ophthalmoscope is more than adequate.

Overall I'm all for education and trying to expand our capabilities, but sometimes people push the boundaries on what they should really be doing just to "gain the experience" or "learn" when in reality that experience is not necessary or of any benefit to the patient. Although dilated exams are 99.9% of the time a benign experience they still have potential to cause harm and they require the patient to experience unwanted visual changes after dilation for several hours to days depending on the drops used.

 

[ophtho838]

I did a quick browse through prior threads and came up with a few recommended books: AAO Practical ophthalmology, Wills, Kanski, Yanoff

A lot of those threads are from 2005-2009. Any idea if these are still the recommended "beginning resident" books? Or are there better ones out there by now?

 

[DrZeke]

I did a quick browse through prior threads and came up with a few recommended books: AAO Practical ophthalmology, Wills, Kanski, Yanoff

A lot of those threads are from 2005-2009. Any idea if these are still the recommended "beginning resident" books? Or are there better ones out there by now?

They didn't get old yet