I just wanted you all to know that right now I'm listening to a child screaming as they get their eyes examined....since when does the ophthalmologist cause as much terror as say.... a dentist?
also this is my 50th post, and i'm about to end my week of work!
Bart Smith, continuing to be awesome since 1982 so that you don't have to.
Love is a duet, each voice complementing each other and making them sound better than they would alone, each voice at times stepping back and letting the other shine. We've got a pretty good duet going Tina.
On April 28th, I'll be marrying my best friend. I can't wait!
Why can't parents give their kids a BIG spoonful of Vicks formula 44 an hour before the exam?? Oh yes, and have a couple spoons themselves while they're at it. :)
Oh yaa, congrats on the 50 milestone!
Last edited by FVCCHRIS; 07-31-2009 at 03:17 PM. Reason: content
I have known a few ophthalmologists with the good sense not to wear a white coat because they had found out that it frightens children. The child sees the white coat and thinks: "Shots!!!"
Chip
My oldest is profoundly autistic and mentally retarded. He saw an ophthamologist a few months ago, and did pretty well until he freaked out when they tried to do do the drops for dilation. The nurse tried a time or two, and then called the doctor back in. He tried once, and then called a halt to the whole thing before my son could work himself up into a meltdown. He said it's not worth giving him such a traumatic experience that he'll never cooperate at all ever again. He also misunderstood what I meant when I asked if it was really worth putting him in glasses considering his educational path and mental condition, and gave me an impassioned speech about how even someone with a disability deserves good vision.
I love that man.
As soon as the doc grabs that bottle of drops.Originally Posted by opticianbart
Our docs never dilate children unless by chance they are a high minus or have other symptoms. No puff tono either until they are 18 unless there is an extensive family history of glaucoma. Less trauma is a good thing. Mentally challenged childen especially. What I want to know is why the entire family (mom, dad, siblings) insist on sitting in the exam room while one child is getting an exam? Our older doc exited the exam room wild eyed the other day. I never even went into the dentist room with my kids.
All patients should be dilated as early as they can sit for it. Screening for a retinoblastoma is one really good reason to do it. We dilate every new patient older than 6 mos of age. For the most part, dilating yields more info on the high plus patients than the high minus patients. We give kids their drops with their eyes closed. No kidding. Lean them back and place the drop next to their nose - then tell them to open their eyes. Done. And the kids feel like they're heros.
Juvenile glaucoma is also very real and it makes sense to rule it out during all kids exams using an applanating tonometer. That's the test you'd want performed on your own emerging very high minus child. The 'air puff' is obsolete in isolating and managing any aspect of glaucoma. NCT is still be the minimum state standard but not the true standard of care.
Patients always comment on how much they prefer applanation tonometry compared to the 'air puff.' They hate the NCT and it's good practice management to eliminate it from the patient experience. It is a rare case where the patient will not permit applanation and will only sit for NCT.
That's just poor eye care. I'm sure there are many latent hyperopes who slip through at your office. No IOP check??? That won't fly with many insurances where it is required...
I always relate to the 5 year old hyperope who I dilated to rule out any latency...and far out in his peripheral retina, I found vessel telangectasia...ends up being Coat's Disease. The doc I worked for practiced like how you mentioned...and would have never have seen this and got the child the proper treatment he needed.
icare,
Thanks for echoing my thoughts exactly...and posting simultaneously...:cheers:
I should not have said "never". We have one young doc that recommends dilation to everyone but doesn't force it and an old school doc who will only do it on high minus or diabetics. The young doc also does IOPs but the old one not on kids. I think the young doc is trying to instill some changes but it's slow going. Hey, I just work there;)
Now think back, back in the days when O.D. couldn't use anesthesia, or mydriatics, most patients saw O.D.'s, got an exam without dillation, without contact pressure check. And not one of them felt obligated to tell the patient you should go to an O.M.D. for dillated exam or pressure check.
But now they must all have it reguardless of age. Are you sure that every patient must have it now. Did O.D.'s prior to getting legislation for drops just not care? Or was it just not really important since we couldn't do it? Do O.D.'s now insist on it now for the patient or insureance compensation?
Back before O.D.'s could dillate it certianly wasn't necessary that retinal photography be routine part of an exam on patient's deemed to not have a retinal problem. Surely we don't do this just for money.
Chip
Chip,
Back in the day whites and blacks had separate water fountains...you could smoke on airplanes...you could have unprotected sex and not worry about HIV...insurances didn't exist and patients were cash pay...books were printed in black and white...computer monitors were black and green or orange...
A change of the times I guess. I'm not an old OD, so I just try to do the best I can with each patient...and the way I was trained. It's a responsibility to the patient...not insurance. Treatments have changed. Research into the eye and vision has progressed. If these OD's aren't practicing like its almost 2010, then something is really wrong...
I feel for the young doc...I'm one too. I deal with this same sort of thing in the offices where I practice. The "slow going" is more like a "brick wall"...I'm not sure of the older mentality. I would recommend to you though, that if you think something is wrong with a patient, ask the patient to request the younger doctor...
20 years ago, there was an opthalmologist in our city.Daily OPD was abt 100+. Each patient accompanied by at least 2 family members. To control the anxity of 300+ people gathered and overflowing the clinic, there was a system to put distilled water drops and ask the trouble makers to keep the eyes shut untill their turn came !
I don't know if this has changed but the last time I asked (which admittedly was a very long time ago) most OMD's didn't check pressure on people under 35 (some set the mark at 40) unless there was either a family history of glaucoma or suspision of a problem. Maybe this has changed now that you don't have keep the little Goldman clean, sterile and available. This was also back when they had absolutely no faith in air tonometry.
I still don't know any that routinely take retinal photographs on a routine eye exam. Except in a retinal specialist office where the patient has a history of a retinal problem.
Chip
Chip,
Come on...please don't be so stuck in your ways...
I just had a 33 year old with moderate glaucoma this past Thursday. By the way, you do have to keep the Goldman tonometer sterile especially with HIV and hepatitis C...
But you knew all that...or some old OMD told you otherwise back in the 60's...
Number 1, or Number 2......
AHHHHHHHHHH!!! screams the child....
or every Dr's favorate...
Number 1, or Number 2?
They look the same.... lol :)
We already have that little system in place. Better than nothing I figure.
Every kid knows the difference between #1 and #2!! :shiner:
Texture, smell, consistency?
:bbg::bbg::bbg::bbg:LOL:bbg::bbg::bbg::bbg:
The docs I work for do retinal photos on as many patients as they can (children included) and test pressure on everyone. We have a GDX in-office 6 months out of the year (we share it with another office) and try to make sure that every patient eventually has it done. Change can be for the better and I am proud to work for ODs that have such a high standard of patient care.
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