gonio, tonom, BIO, etc

[Mixin Marc]

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what is it about these tests that make them so hard (according to some people): biomicroscopy/anterior segment evaluation, tonometry, gonioscopy, binocular indirect ophthalmoscopy, and Goldmann three-mirror fundus evaluation

I haven't learned them yet, but from what I believe, the Goldman fundus allows for one to simply evaluate the health of an eye.

What are the problems that people usually get with these tests? ( in learning them)

Any hints on doing them?

 

[christie]

The procedures that you mentioned are not really hard to perform..it just takes practice. You'll be comfortable with all the procedures you mentioned by third year. 🙂

 

[cpw]

i second that... 🙂 the only tip is just to practice practice practice.

 

[r_salis]

I think what makes these things difficult is that they seem so awkward to perform when you're first learning them. You can *know* what you're supposed to do, but these aren't mental tasks, they're fine-motor skills -- you have to understand and be able to analyze what you're seeing, but doing the procedure is just a matter of getting your hands to do the thing you want them to do.

It seems to me that the people who over-think what they're doing have the hardest time getting the procedures down, you just have to sort of Jedi-master them. 😉

And like christie and cpw said... PRACTICE! 😀

 

[Rosanna]

Like everyone else said, you really need to practice a lot. The first years here learn most of the procedures you mentioned (exception is gonioscopy with a Goldmann 3-mirror lens) so they can practice it throughout the year and also during the summer. My friends and I went into the clinic several times a month during the summer to practice so that is what you really need to do.

For BIO, you can ask your clinic professors if they lend out schematic eyes to practice. They cost about $200 if you were to buy them from the reps. The schematic eye allows you a target when practicing BIO if you can?t find a friend during the summer to dilate, and you can also vary the aperture opening to do small pupil BIO. If you find that you are moving your head a lot during BIO, switch to a small aperture (the small circle) to get a view and then sweep with that so you can control your head a bit better. Once you master that, move on to a larger aperture setting.

Students don't learn how to do gonioscopy until the 2nd year (we actually just learned it last month). You'll definitely need to practice hard and I would say you can't be nervous about putting the patient in pain. I was a bit scared putting the lens on my classmates' cornea and that caused me to shake too much, and then I put the lens on too slowly (thinking I can reduce his discomfort that way) and there were too many bubbles introduced. Once the lens is on the cornea, apply gentle pressure to keep it on. You can see the eye through the lens so you can put it on and then go behind your slit lamp to do the evaluation.

If your school teaches you these procedures early in the program then it'll be great for you to practice the techniques. You'll find that once you master the equipment and logistics of just getting a view 🙂 then things become quite interesting when you actually are looking for something besides just trying to hold your view steady.

Best wishes,

Rosanna

 

[r_salis]

For BIO, you can ask your clinic professors if they lend out schematic eyes to practice.

Are these the same schematic eyes used to practice ret with?

 

[Rosanna]

Are these the same schematic eyes used to practice ret with?

The model that I use to practice BIO is the Heine Ophthalmoscope Trainer which looks like this: http://www.starop.com/indirect_ophthalmoscopes/heine/accessories.htm

To practice ret, I use a schematic eye that looks like this: http://www.sussexvision.co.uk/schematic_eye.htm

I don't know if you can use either model to practice both techniques.

- Rosanna

 

[Mixin Marc]

The model that I use to practice BIO is the Heine Ophthalmoscope Trainer which looks like this: http://www.starop.com/indirect_ophthalmoscopes/heine/accessories.htm

To practice ret, I use a schematic eye that looks like this: http://www.sussexvision.co.uk/schematic_eye.htm

I don't know if you can use either model to practice both techniques.

- Rosanna

those are so neat! I wish i was given the opportunity to use those before. My ret ain't too good!

 

[Andrew_Doan]

Many ophthalmic diseases require attention to detail and subtle findings. Performing the examination tasks are challenging, but with practice, they can be mastered. However, I think the most challenging thing is the ability to use these examination techniques to find small details that will assist in the diagnosis of a particular disorder.

For instance, if one doesn't think of ICE syndrome, then this diagnosis will be missed: http://webeye.ophth.uiowa.edu/eyeforum/case14.htm

The diagnosis of ICE syndrome is based on the finding of the unilateral, hammered silver appearance of the corneal endothelium.

 

[Mixin Marc]

for the goldman 3 way mirror, how is this better/different than the goldman 4 way mirror?

 

[Andrew_Doan]

for the goldman 3 way mirror, how is this better/different than the goldman 4 way mirror?

http://www.nova.edu/hpd/otm/otm-c/GONIO_A.HTM