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Welcome to question of the day #312

Eyetools question of the day #312

Several of my patients are anxious about having their eye health checked with direct ophthalmoscopy. Do you have any tips I how I can help them be less anxious?

Getting very close to people during direct ophthalmoscopy can make them anxious.

I try and keep this to an absolute minimum by advising them that this is the last part of the examination and that we are nearly finished. I carry out direct ophthalmoscopy as the last test in the examination.

I slowly move to pick up my direct ophthalmoscope which is always nearby and as I’m doing so this is what I say:

‘I’m going to have a look at the general health of your eyes now. This involves me getting very close and using a bright light but it won’t take long. I’m going to dim the lights now and ask you to look across the room into the mirror at the bright spotlight’.

I then move my hand across the spotlight, which I had switched on when I was picking up the ophthalmoscope, and make sure they can see it in the mirror.

I then say:

‘So, looking at the light I’m going to get close, blink whenever you need to and if my head gets in your way just pretend you can still see the light and look to where you think it is.’

I then focus on the external eye from around 10 cm and slowly move closer changing the focusing lens until I am focussed on the retina and at a distance of about 1 cm from the cornea. I then examine as much of the retina as possible along with the optic nerve. I tell the patient that they’ve done well and move to the other eye and repeat.

At the end, I tell the patient that I’m going to sit down and make a note of all the healthy things I’ve seen. I omit this part if I have seen an abnormality.

When my notes are complete, I summarise my findings for the whole examination.

Using this technique, I don’t get a sense that the patients I see are overly anxious during direct ophthalmoscopy.