Guidelines For General Examination

Hi guys, I think the general feedback(correct me if I am wrong) I get so far is that most of you are really very stress and tense in clinic for a few reasons:

Ret --- if not accurate -- minus marks.

Silt lamp -- if I miss something--minus marks

Ophthalmoscopy -- miss something or wrong estimation of C/D ratio -- minus marks

Overall --- minus here, minus there, alamak!!!! Sure to fail!

RELAX!

TIPS

Ret --

1. Correct working lens or working distance,
2. Correct fogging lens.
3. Always tell patient to relax! Explain to patient what you are doing
4. Continuous constriction and dilation of pupil size( esp young patients). May indicate fluctuatng accomodation
5. Inform patient to look at the distance target. If patient is looking at you it induces accomodation
6. When you think you have achieved end point. Move forward slightly, you should see a with movement

Silt Lamp--

1. Always have a system of check anterior health.
2. If patient does not have any symptoms or complaints,then no need to flip lids
3. Try not to over rely on the green stain. As this will help tain yourself to be more observant.

Eg. First check the lid and lashes, then continue to central cornea, then nasal and temporal bulbar conjuctiva, superior cornea, inferior cornea, so on so forth.

Ophthalmoscopy--

1. For an increase field of view, go very very close to your patient. It really helps
2. To have a better field of view for the superior retina you can ask patient to look up, for nsal retina ask paient to look towards the nose and so on so forth
3. C/D ratio, try to judge by the blood vessels instead of the colour.

All in all, just like everything, it comes with practice. It took me 3 - 4 years to get better and more confident in Ret and ophthalmoscopy. In fact everything.

Patience is a virtue! Don't expect yourself to be excellent in everything within 1 - 2 weeks. Afterall, Rome was not built in a day right?

Do let your clinicians know if you really don't feel comfortable in a particular technique.

Don't be afraid to ask or make mistakes. Because if you don't ask and make mistakes, how are you ever going to learn right?

Hope this helps.