When is it time to stop pretending I can see anything through an opthalmoscope?

  1. Ha! I asked the same question in clinic a year or so back...only honest answer I got was: "Im really looking for red reflex and if I can see the optic disk then great! But if not, and the patient is complaining about eye issues, opthomologists have all the cool tools to actually see the eye...so they get referred"

  2. I saw my SO’s optic disc once at the beginning of medical school and never saw an optic disc again. I think maybe cus you have to be comfortable getting in close?

  3. Preferably just talk to Jonathan so that they can set up an outpatient appointment with minimal levels of follow-up questions from the ophthalmologist that you cannot possibly answer. Source: see latest Dr. Glaucomflecken sketch.

  4. Preferably before the attending says, “do you see the Optic Neuritis?” And you say yes and he says, “well it’s not there so I’m not sure how.”

  5. If you don't dilate the pupil, you probably won't see much. I never pretended; only time I've used one was to check babies' red reflexes on peds.

  6. Also the same with murmurs. I know it’s important but I can’t hear crap with the stethoscope other than like obvious crackles from a lifelong smoker or something lol

  7. Nah you can hear murmurs, next patient that has a really significant echo finding eg large endocarditis or severe regurg, would go and give it a good listen when it’s quiet. Once you hear one you’ll keep hearing them.

  8. For me it was day 1. Straight up told my prof I see squat. Ironically I spent a bit of time practicing with it and can now see optic disk, but I hate all eye pathology so I still tell people I can’t get it right. Better to be mechanically deficient than mentally deficient is my play.

  9. Sometimes in between intern year and 2nd year. On a side note, my husbands ophthalmologist let me look at husband’s eyeballs with his super fancy equipment because hubs told him I was a resident. HOLY SHIT you guys I could see everything!! It was so cool!! It’s a joke they give us those dinky little hand held things and ask us to see anything in a nondilated eye.

  10. Grab yourself a Pan-Opto, and you can see the whole disc quite easily without dilation. The question is how many headaches, CRAOs, optic neuritides do you see to justify the cost?

  11. This. I got told to buy them for the urgent care I worked at. Handed the owner the quote from McKesson. We did not get the ophthalmoscope or the otoscope.

  12. You gotta spend some time in an ophtho clinic and practice doing some slit eye exams. Those are a bit easier since more stuff is stationary and you can actually get an excellent view of the retina.

  13. It can be pretty important for seeing alarms like papilledema. Just turn off the lights and wait a minute or two for the pupil to dilate and it is way easier

  14. PGY-10 of FM here working in urgent care. It is very important with certain headaches or eye complaints . Lights off and a pan-otoscope makes it

  15. As a IM resident I used to send the patients to ophto and when they come back with dilated pupils I had a look myself and compared to the report. I did that for months, finally saw something but realized and I can never diagnose retinal pathology myself.

  16. Technique is everything and it's the hardest clinical skill/examination which requires the most amount of practice. I've been with nephrologists who would whip out an ophthalmoscope to check the eyes of a patient with long standing HTN in clinic and with neurologists checking optic discs regularly. If those boomers can do it, why can't we? I practiced heaps on other students and on patients on the ward and now I can see the optic disc in a decent percentage of people without dilating the pupils, assuming that they aren't on heaps of opiates.

  17. As a board certified ophthalmologist…here’s what I would hope you can do with an ophthalmoscope: —Do a penlight exam of the anterior segment and describe anything you see that is abnormal. —Check and compare red reflexes —Check for an APD

  18. Just curious, I haven't seen an attending do this yet, but tbf, I haven't done ER medicine. How frequently do you see ppl do it?

  19. My advice is to practice a lot on younger people with big pupils in a dark room. It's essentially impossible to do it on an older person or someone on opiates.

  20. I wish more emphasis was put on just seeing the red reflex and understanding when it's abnormal. This actually affects what we do. Your view of the optic nerve will rarely ever influence something I do when you call us. A good history can tease out if someone might have a IIH/ICP picture and be sufficient to get us to look (or Neuro). Otherwise a vision and pupil exam is enough for optic neuropathy at the general/referring level.

Leave a Reply

Your email address will not be published. Required fields are marked *

Author: admin