eye exam q

[chef]

i'm really right eye dominant, and plus i cant close my right eye only ( i can wink w/ the left eye). thus using the opth scope on the pt's left eye is a real prob b/c i cant see anything w/ my left eye..

what can i do????? any solutions?


also, as a M2 my physical exam skills are stilll horrible, plus i dont know all the lingo & abbreviations ... other than obviously practising more, are there some really good books or websites taht describe what i should be doing? right now i cant tell any abnormalities...

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[MPS]

Try holding both eyes open whilst performing ophthalmoscopy - in order to suppress the image from the eye that isn't looking through the ophthalmoscope, you'll need to turn the room lights down at first. If you still occasionally loose suppression, then cover the eye with your hand. If this fails, try using an eye patch. You should eventually get the hang of suppressing your right eye. If you're having serious problems, and you haven't already done so, have your eyes examined. It's possible (though unlikely) that you're amblyopic.

I should also add that you'd be better off practising under ideal conditions using a model eye, or a friend as a subject. Generally speaking, you don't have nearly enough control over lighting in the hospital environment. If the room illumination is too high it will make it difficult to view a patient's ocular fundus (because their pupil will be small) and will also make it difficult for you to suppress the image from the eye not looking through the ophthalmoscope.

As regards examination techniques, I'd recommend "MacLeod's Clinical Examination" as a starting point (http://www.donfer.co.uk/d-commerce/0443061726.html) . It's basic, but very well written.

 

[Caffeinated]

Chef,

Are you extremely right-eye dominant with 2 normal eyes (i.e., if you use your hand to cover your right eye, is your vision normal with your left eye?). If your vision is essentially normal, but you have a tough time "switching over" to the left eye, then try it with an eye patch at first to get the feel of your left eye on the patient's left eye. However, the idea is not to close either eye when you are using the ophthalmoscope. In order to see what you need to see, I highly recommend practicing through dilated pupils at first (the patient's pupils, that is--not yours).

 

[chef]

fellas, thanks for help. i played around w/ the scope a bit and i think i may have found a solution..

first i tried to teach myself to close my right eye alone, managed to do it after 30 mins but i was making a horrific facial expression while doing it..

so i came up w/ another plan.. instead of holding the pt's eyelid w/ my right thumb, i can hold it w/ my right index finger, and then use the free thumb to close my right eye when i'm up in her face!

 

[TomOD]

Chef,

Another possible idea is to get a PanOptic scope. It will allow you to use your dominant eye to view each patient eye without "kissing" them.

Pro: Claimed 5x the view. In reality about 3 times the view on an undilated pupil (but still much better than a direct).

Con: It's a bit larger and more bulky so might not be the best portable instrument on rounds.

Some hate them, but I like them so much I got 3. I've showed it to the PA students rotating through my office and just about all of them agree it is much better for a basic view than a standard direct scope.

It'll put you back about $500.

http://panoptic.welchallyn.com/faq.html

 

[eyehope]

dood, if you are really interested in ophthalmology, i would recommend that you make sure that you have stereoscopic vision (ie, pick out the wings on the fly, or pick out the dot that sticks out the most). i have heard that certain programs require proof of stereoscopic vision, especially considering the binocular microscopic surgeries in optho.