On page 26 of this week’s issue, you will see my review of a virtual reality slit lamp system that offers an exciting new way of teaching you how to use the slit lamp, both to view anterior structures as well as gonioscopy and slit lamp BIO with a fundus viewing lens.
Such systems are not new. Indeed, I reviewed a version of the same system aimed at teaching ophthalmologists how to use the head-set BIO way back in 2010. This latest system, however, reminded me of the somewhat haphazard way many of us were taught ocular examination techniques back in the 1980s, and how significantly things have moved on since then.
My initial training was mainly with direct ophthalmoscopy, the Volk lens only really taking over as the best way to view the fundus from the mid-1990s onwards. In hindsight, how we were expected to view those retinas of older people, the ones most likely to show disease, using direct ophthalmoscopy, is worrying indeed. Especially when we consider that dilation was often thought of as a ‘specialist’ extra, that views through any media opacity is limited with direct viewing, and that magnification/minification of the image due to refractive error was commonplace. Indirect BIO was, literally, an eye opener, though I still worry at the vast areas of un-viewed retina in parts of the UK outside Scotland; places where dilation of the over-60s is still not routine.
Even today, our fundus viewing skills are assessed in a somewhat Heath Robinson manner. As standardised as ping-pong balls with simulated retinas might be, surely the time has come for examination centres to consider a more realistic approach to assessing retinal viewing skills as is available now through virtual reality systems.
Finally, I noticed that this week scientists are concerned about a new virus that makes people sweat Marmite. It could easily spread.
Apologies.