Setting out into the world of work as a pre-reg optometrist requires a host of new personal and clinical skills. But what about the physical equipment you will need? Bill Harvey reports
In modern day optometry it is less about the equipment you have in your bag on your first day at the new practice and more about using what is provided. When I undertook my pre-reg year in a hospital many, many years ago, I was expected to own all of my own testing kit. This is rarely the case now, and it is fair to suggest most modern practices should offer all the required testing equipment you need. Be that as it may, there is much to be said for owning your own equipment, especially where you have chosen a particular apparatus that best suits your skills and requirements, for example a particular fundus viewing lens. Here are some points to consider:
- Owning your own trial frame is a good idea – you might be surprised to hear that even at stage two assessments, some people still seem unable to adjust their trial frame appropriately. Also, be aware that in the past year the College has specified that, even though use of a phoropter is fine in practice and at stage two, you must be able to demonstrate refraction using a trial frame and lenses at the stage one visit two assessment of routine eye examination.
- Have an occluder you are happy with – this may also allow you to measure pupil diameter or centration distances, or even have a pinhole. Some occluders are translucent and allow you to see what happens to the covered eye in, for example, phorias. Get hold of one you like and keep it – they go missing regularly.
- Equipment for assessing binocular status is often unavailable so I would suggest ensuring you have access to all you need at the start of the year. Something to assess fixation disparity, to support your observation of recovery on cover test, is important. Access to stereopsis tests, at least one, is important but make sure you know any limitations of what you have and what else is available. A prism bar helps you gauge eye movements on cover test and is a great way to improve your cover test skills.
- I hope you have access to an electronic test chart – if so, make sure you know how to randomise letters, change from Snellen to logMAR, and can offer targets of changing contrast. If stuck with an old projector system, remember that turning the lights off to improve visibility of the letters may reduce test accuracy.
- Make sure you know how to undertake both an Ishihara and a City colour test, when to use each and how to record and interpret results.
- Slit-lamps should be cleaned and focused before use, especially before an assessment. Make sure from day one you become adept at changing the magnification, light intensity and slit shape to optimise each view. Also, if you do not use a yellow absorption filter when looking for staining then I question your sanity – why not make things easier for yourself?
- You need to be good at both direct and indirect ophthalmoscopy. When buying your fundus viewing lenses, consider buying two – a higher powered one for large field views of, for example, diabetics, and a lower powered one for better imaging of the disc macula. Some of the cheaper acrylic lenses are excellent quality as long as you avoid scratching them
- Make sure you know all about your non-contact tonometer, for example how many times do you puff each eye, does this tally with guidelines, and how does the machine flag up outlier measurements? For contact tonometry, Goldmann is easier than Perkins. Also, try to use a disposable head that has an opaque carrier if possible as the view of the rings is easier for the learner. I think you should be using contact tonometry from day one if you want to make sure of passing visit 3 with no problems.
- You should have access to a fields machine, an Amsler book and have a gross perimetry stick. Make sure as a minimum you understand when a full threshold test is appropriate on your machine and how to undertake this. Remember to carefully label Amsler results. Remember that some patients unable to use the fields machine (severe learning impairment perhaps) are also people for whom fields is important – use your stick!
- If your practice has imaging (digital or OCT), being able to access these results for one of your patients is both impressive and the future. Do not be afraid to include such results in your selected records.