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Welcome to question of the day #278

Eyetools question of the day #278

One of my patients told me she became very worried when I’d carried ophthalmoscopy and then sat down and made my notes. She thought I was writing down that she had a serious eye problem and was very relieved when I finally spoke and told her that her eyes were healthy. She did look very worried. How can I avoid this from happening?

This happened to me very early in my career as an eye specialist. I too conducted ophthalmoscopy and without saying anything I sat down and made my notes. When I looked at the patient he too looked very worried. When I told him his eyes were healthy he was very relieved and said he would have preferred to know that immediately after I’d finished looking at his eyes.

This made me think about the tests I do and the approach I use to tell patients what if anything I have found. Here is my approach.

Some patients become worried when they can read the 6/6 line of letters but not the 6/5 line. I let them know that the 6/6 line is the average or normal level of vision and any letters on the 6/5 line are a bonus.

When I complete the cover test I immediately let the patient know if the results are normal by saying ‘Your eye alignment is very good.’

When I complete pupil testing I immediately let the patient know if the results are normal by saying ‘Your pupils are working fine.’

When I complete the intraocular pressure on one eye I let the patient know if the results are normal by saying that the pressure is in the normal range. The same for the other eye.

When I complete ophthalmoscopy on one eye I let the patient know if the results are normal by saying that ‘The eye health looks good.’ The same for the other eye. Then I say ‘I’m going to write down all the healthy things I’ve seen.’

For children who haven’t needed glasses in the past and following my retinoscopy and/or subjective refraction still don’t need them I let the child and carer immediately I conclude that they don’t need them. Many children and carers are worried about having glasses.

At the end of an examination for a child, I summarise by saying ‘You need glasses for [visual task] or you don’t need glasses, your vision for far and near is very good, your 3D vision is good, your colour vision is good, your eyes are working well together as a team and your eyes are healthy. I advise another examination in xx months/years. Do you have any questions you would like to ask me?’

At the end of an examination for an adult, I summarise by saying ‘You need glasses for [visual task] or you don’t need glasses, your eye pressures are in the normal range and your eyes are healthy. I advise another examination in xx years. Do you have any questions you would like to ask me?’

I find that this approach leads to less worry for my patients. Some say they are grateful to know early on that their eyes are okay. A relaxed patient is usually a good patient. Many come back to me for eye examinations when they are next due.