Presenter: Dr Guy Clare, RCVS Cert Ophthalmology, North Coast Veterinary Specialists (referrals), Sunshine Coast, Australia
In the practice where I work, I’m lucky enough to have a fifteen-minute consultation slot, but even in that time, performing a full eye examination is an almost impossible task. That was until I watched last week’s Platinum Members’ webinar led by Dr Guy Clare who explained that, as long as we follow ‘The Ten Commandments’ delivered within his webinar, then performing a thorough eye examination within a consult is possible. In fact, he is so confident, he believes it can be done in the more realistic consultation time of just seven and a half minutes.
Remembering some basic rules and principles of ophthalmology is an excellent base from which to perform this short eye examination. However, Guy advises it is important to accept that, in certain situations, a seven-and-a-half-minute consultation, although realistic in many cases, is sometimes just not long enough. Patients falling into this category are those that show signs of systemic illness alongside their ocular presentation. It is unrealistic to assess these patients fully in the space of a consultation, and in order to perform an adequate examination of both the eyes and the underlying systemic condition, these patients must be admitted.
However, if a patient is generally well, then ‘The Ten Commandments’ apply and consist of a list of assessments which need to be made in order to perform a full ophthalmic examination within a consultation. The Ten Commandments are as follows:
- Pupil assessment
- Internal eye examination
- External eye examination
- Schirmer Tear Test
- Intraocular pressure
- Fluorescein examination
Guy went through each of these assessments within the webinar offering practical and realistic advice. For example, when assessing the pupil, he discussed the technique involved for using distant direct ophthalmoscopy. The dial on the ophthalmoscope should be set at zero diopters and held at arm’s length to look at both pupils and the visual axis. By using distant direct ophthalmology both pupils can be assessed for size, shape, symmetry and pupil colour at the same time. The length of the visual axis can also be assessed and the structures being examined along this axis include the cornea, aqueous, lens and vitreous. If opacities are present, their position can be ascertained dependant on the direction they move in relation to the movement of the eye. For example, if the opacity is rostral to the centre of the eye, it will move in the same direction as the eye. If it is central, it won’t move at all and, if caudal, the opacity will move in the opposite direction to the eye.
Guy also offered an invaluable reminder about how to assess the first of The Ten Commandments; vision. Initially he advises always testing the menace response and if a patient is a non-responder to this test then visual tracking should be assessed by dropping cotton wool in front of the patient and checking for a response. If once again a patient is a non-responder, Guy advises setting up an obstacle course within a consulting room as a final check for vision. However, Guy reminded us that when checking for vision it is important to remember that the menace response is only present in puppies from 14-16 weeks of age as this is a learned response and not a reflex.
These snippets of information are just a taster of the offerings delivered by Guy for each of The Ten Commandments. He also cleverly used a number of mnemonics using several celebrities including Pamela Anderson, Calvin Klein and Brad Pitt which allows you to quickly remember and perform all the processes required to fulfil The Ten Commandments.
Celebrities have never, in my opinion, been put to such good use. If you are intrigued enough to find out more and also want to dramatically speed up your ophthalmic examination, then log into the webinar and check it out for yourself.
The Stethoscope (MRCVS)