7ontheline said:
Well, you might as well quit ophthalmology now. If you don't have it by July 1st of your first year, you clearly will never get it.
Anyway, I start by pointing my light at the eye and then sliding the lens into position. This way I know the light is in the right place, and I just have to move the lens around a little to get a good view. Everyone kinda does it differently. You'll figure it out. Don't stress - personally I believe that taking things too seriously doesn't help.
I agree and can remember the frustration of feeling like everyone else can see this amazing new world, and I was stuck in reverse, pretending to see what others were, all the while fearing that I would never "get it".
Here are some pointers. With consistent practice you should be able to focus on parts of the retina within a week or so. This is the first battle. In order to do this best, I think you should do the following steps:
1. First, draw out a diagram of a retina or get a picture to practice on, so you can spend as much time as needed practicing on something that won't get light toxicity. Remember that everything you see is upside-down and backwards!
2. Once you get the hang of it with a piece of paper, you are ready to try real patients. You need to have a consistent pattern of directing the patient where to look so that you maintain your orientation. I start by having the patient look directly up, the up and left, then directly left, etc until I have covered the entire periphery, and then tell them to look straight into the light.
3. In order to get an image to focus on the retina, perform the following steps (if right handed). Look at the right eye first. Take your left hand and with your thumb and index finger, open the patient's eye. Next, shine your indirect light on the dilated pupil. With your right hand holding the 20D lens, slide it into place. I would use the pinky of my right hand against the patient's nose and brace the lens on the dorsum of my left hand. This gave me a stable platform to move my lens in or out. Once you get that flash of red, you are in the ballpark, and fine-tune it from there. Eventually you will not need to brace the lens against your left hand, but it definitely helps at first.
at first I put my headlamp way too close to the patient, and because of that I did not get a very wide view. That is ok at first, because you are trying to learn how to keep an image in focus. As you get better, you will learn to pull your head away from the patient and you'll get a wider view. Also, if you are getting disoriented on drawing what you see, just turn the progress note upside down and draw what you see. It works! Most of all, be persistent. This is the first of many new challenges that make you feel uncomfortable as an ophthalmology resident. I teaches perseverance, which you will definitely need over your residency.
Just my 0.02$
