204: Tortuous blood vessels
I have taken some retinal photographs of one of my patients. He is 59 and looks to be overweight but tells me he...
203: How to pass exams
I’m starting a course as an eye specialist. It’s my first time at college and I’m worried that I won’t be able to cope...
201: Powerpoint slides are not enough for good learning
I’ve just started as a lecturer on an eye programme. One of the experienced members of the faculty has advised me not...
201: How to study.
I am studying for a qualification in eye care. I read all of the copies of slides the lecturers give me but nothing...
200: I would like to do a Masters degree in eye care but I work full-time and am worried I won’t be able to make the time for it. What should I do?
I have two Batchelor of Science degrees, two Masters, two diplomas and a PhD. For all but one of the Batchelors I was...
199: There is an OCT machine being delivered to the practice tomorrow. I know that it can be used to scan the retina and provide detailed images and that it will have the ability to provide images of the anterior chamber angle but I’m worried that I won’t be able to learn how to use it properly. I graduated 20 years ago and struggle to learn new things. What can I do?
When I worked in practice there were three types of practitioners I worked with. Those who knew they didn’t know...
198: A longstanding patient came into my practice yesterday complaining of something being in her eye for the last hour. It was a windy day and something had blown into her right eye. She tried blinking it out but the eye became very uncomfortable, red and watery. She wanted my advice. What should I have done?
Over my career, I’ve had about six people present in practice complaining of an eye being uncomfortable with a feeling...
197: A patient of mine phoned yesterday having being splashed with a chemical in her face some of which went into her eyes. She was in a panic and I didn’t know what to say. I advised her to go to an accident and emergency department at one of the local hospitals. Could I have done anything else?
Over my career, I’ve had two people run into my practice having had chemicals splash into their eyes. Of course, the...
196: What’s a good way of identifying which of my patients are at risk of ocular trauma?
I recently read an article about optometrists triaging and treating patients with ocular trauma in accident and...
195: Many of my patients work in the construction industry. I’m thinking of offering polycarbonate lenses instead of CR39 to those at risk of ocular trauma. Is this a good idea?
I think that is a very good idea. Polycarbonate lens along with another material called Trivex has many advantages...
194: One of my patients has recently attended eye emergency. He was hitting a metal bolt with a metal hammer and something hit him in his right eye. He has been told by a hospital doctor that he has suffered corneal damage and the vision in that eye will not return to normal levels. What can I do to prevent this from happening to other patients?
One of my patients has recently attended eye emergency. He was hitting a metal bolt with a metal hammer and something...
193: I have just examined an eight-year-old girl. She complains of blurred vision when reading books and also when looking at the board at school. Her parents that her reading and writing skills are poorer than they expect from her advanced spoken language abilities. She is R 6/9, L 6/6, 6/6-2 with both eyes (BE) together. My refraction shows right plano/-0.50 x 45 and left plano/-0.25 x 135. This gives R 6/6, L 6/6/ and BE 6/6. Her parents asked whether glasses are necessary since she could see the same with BE with and without the refractive correction. What should I do?
Small amounts of uncorrected astigmatism especially when oblique can have marked effects on clarity at distance and...
192: I have just examined a ten-year-old boy complaining of occasional headaches and eye ache when reading. His schoolwork is not going well and his reading ability is that of an 8-year old. He has a refractive error of +0.50 DS in each eye. His accommodative amplitude is 18 dioptres in each eye and 20 with both eyes together. Without refractive correction, he has a very small esophoria and with refractive correction, he is orthophoric at near. His parents are keen for him to have glasses. What should I do?
This is a difficult clinical dilemma. One that I faced a lot in clinical practice as I had a reputation for helping...
191: I have just examined a ten-year-old boy complaining of occasional problems with reading the board at school and some other distance tasks that are part of his daily routine. My examination reveals -0.50 DS in each eye. His father does not want the boy to have glasses as he thinks that glasses will make his eyes weaker if he wears them. What should I do?
In my clinical experience being the first to discover myopia in a child often leads to problems convincing one or more...
190: I’m just starting out in my first job having just qualified. I know it is important to be able to evaluate the anterior chamber depth but I never mastered this technique when at college. What should I do?
Examination of the anterior chamber is an important technique to master. It is particularly useful in the differential...
189: I have just received a letter from a patient. He has asked me why I didn’t refer him at his last eye examination with me a year ago. He went to another eye specialist and has been diagnosed with primary open-angle glaucoma. He has been told that he has had glaucoma for around two years. I’ve looked in his clinical records and there is a copy of a referral letter but I can’t remember if I told him I was referring him as a glaucoma suspect. What should I do?
Two of my current medico-legal cases involve claims by patients that they weren’t told by their eye specialist that...
188: One of my male patients has just presented complaining of no vision in his right eye. He noticed it about an hour ago when he woke up but is not sure if it has been there longer. This is the first time he has experienced this. He is 66 years old, overweight and is taking medicine for high blood pressure. His left visual acuity is ‘perception of light’. What is going on?
This sounds very much like a right central retinal vein occlusion. The most common cause is a blood clot, which...
187: One of my male patients has just presented complaining of a darkening of his vision in one eye for a few seconds. This is the first time he has experienced this. He is 45 years old and overweight but denies and other health problems and taking medication. What is going on?
Your patient’s transient darkening of vision in one eye sounds like amaurosis fugax. ‘Amaurosis’ is Greek for...
186: I’ve started at a new practice and at the end of my first week the practice owner who is also an eye specialist told me to keep my consulting tidy. What difference does this make?
Patients assume that all eye specialists have a similar level of knowledge and that this is of a high level and up to...
185: I own a practice but don’t like working there. The staff are very negative and are often arguing and gossiping. I don’t have the energy to hire new staff. What can I do?
I’m sorry to hear about your difficult working situation. It must be very hard for you. As you are the boss you are in...
184: One of my patients has a white ring around his corneal limbus on each eye. He is 35-years-old and denies any health problems and using any medication. What is going on?
This sounds like corneal arcus. There are two types; arcus senilis for people over the age of 40 and arcus juvenilis...
183: I’m starting my first practice and I want to know which is the best colour vision test to use.
Throughout the World, the most common colour vision test is the Ishihara Pseudoisochromatic Plates Colour Vision...
182: I have just examined a new patient in my practice. She is 45-years-old and denied any health problems or medication. I noticed she had yellow marking on her eyelids on both eyes. What is going on?
This sounds like xanthelasma. They are yellow deposits of cholesterol underneath the skin usually on or around the...
181: I was carrying out an examination of my 65-year-old patient’s retina and saw a small shiny yellow piece of debris in one of the retinal arteries. What should I do?
It sounds to me that you have seen a Hollenhorst plaque. According to some textbooks, this is a common finding in...
180: I’ve just started my first position as an eye specialist in an eye practice in a shopping mall. I saw a 20-year-old female with a long history of type 1 diabetes. She told me she has two reviews with her general practitioner per year and the last one was one month ago when her blood sugar levels were in the normal range. When I examined her retinas both had what looked like soft exudates. There was no one else in the practice to ask for advice. She is coming back next week for a review when a more experienced specialist will be in the practice. The image shows her right retina. The left was the same. What is going on?
I have looked at the image and to me, it looks the ‘soft exudates’ are actually a reflection of the light from your...
179: I’ve just started a 7-year-old child who has -5.00 DS in each eye on myopia management dual focus contact lenses. She has been wearing them for two weeks and complains of headaches and eye aches when she is reading and doing close schoolwork. She wears her contact lenses all waking hours. What is going on?
It sounds like the change from glasses to contact lenses has caused a decompensating exophoria. It is important to...
178: I have read that young people with low amounts of myopia and a near esophoria are at greater risk of myopic progression. Is this correct?
It has been suggested that near esophoria is associated with more rapid myopia progression than for people with...
177: Are there any links between binocular vision anomalies and myopia management?
My favourite topic in eye care is binocular vision. My new interest is myopia management so I’m very pleased that...
176: Get some sleep
I work in a practice in a shopping mall. I start work at 9 am and work until 9 pm for six days a week and sometimes...
How to perform the Brückner test.
This test is used to assess the symmetry of binocular fixation by comparing the brightness of the red reflex in each...
How does B-scan ocular ultrasound work?
One type of ocular ultrasound is B-scan. It is a quick, non-invasive test used to assess the structural integrity of...
Measuring eye pressure without using drops or a puff of air-rebound tonometry.
iCare tonometers are easy-to-use, hand-held, battery-operated devices that require only minimal training. All iCare...
How do I examine the structures of the anterior chamber angle?
Gonioscopy is a technique that allows accurate evaluation of the width of the anterior chamber angle and detailed...
How can I examine the mid- and far retina?
Negative powered diagnostic contact lenses in conjunction with the slit-lamp biomicroscope can be used to view the...
How does OCT work?
OCT is short for Optical Coherence Tomography. The concept is quite simple. This technology involves directing light...
175: Dealing with different sized pupils
I’ve been told by a hospital-based eye specialist that I am over referring patients with anisocoria. All the patients...
174: Dispensing opticians are very important
I work in a practice where I conduct eye examinations and the dispensing of glasses. During the dispensing process, I...
173: How to write a good referral letter
My boss in the practice who is also an eye specialist has conducted a review of some of my clinical records. She has...
172: Sport and contact lenses
One of my patients has a son who is very keen on football and plays in goal. He is almost 12 years old. He plays...
171: First day in a new practice
Next week I’m starting my first job as an eye specialist following completion of my college course. I’m worried I...
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