hello there and welcome to the clinic where we're going to be looking inside your eyes today with a
new piece of ocular equipment but first i want to introduce the latest addition to the clinic
this is my new FlexiSpot E7 pro standing desk and with a simple press of the button
i can spend more time standing up rather than sitting down so as a medical professional that
makes my back much more happier so as i said as you're looking here this is the E7 pro
standing desk in a walnut finish there are a range of wonderful finishes available on the website.
I'm going to leave the link in the description to FlexiSpot where in April you can enjoy up to 30%
off your purchase but i've been very happy with this it's made life much more easier
when operating in the clinic where we have better access to the equipment
and as you can see here it comes with an inbuilt usb port for charging your phone
or my ocular equipment so please check out FlexiSpot using the link in the description
and thank you okay so let's have a brief look at the equipment we're going to be using today
okay so this charging up here in the usb port is the indirect binocular ophthalmoscope.
It is fully head mounted
we have the adjustable dials here for optimum practitioner fitting
this is the front part let's remove the cap here
okay we have the viewing portals here which are adjustable depending on the practitioner's
pupillary distance. You want to be achieving a binocular view okay and if we flip it out
so there is our green light source you'll be pleased to know there are three
settings here so we have our red free,
we have our white light and we have our cobalt blue apertures there
we can also adjust the aperture size large
medium and small here let's have a look at that so we have the largest medium
and smaller and we also have an intensity dial here for optimum comfort for the
patient if we give that a little turn, we can adjust the brightness there
so that's what we're going to be using to
look in the back of your eyes today, the head mounted indirect binocular ophthalmoscope
and just moving on we will need to use a particular lens for looking at the back of the eye
obviously I'll hold this in front of the eye, this is the 20 dioptre double aspheric lens
housed in this protective case here
so that is the lens we shall use to observe your fundus okay very simple to use
and as with any medical tests
we shall have to record the findings let's go a little bit higher here this is the
fundus chart recording pad, we can place your details here and the date
whether we're looking at the right eye or the left eye
this is where we will shall record our findings
we can obviously apply some written notes here if needed and we shall record the results like this
because when using the indirect ophthalmoscope the image is upside down and inverted and this will
be how things actually look inside your right or your left eye, that's the recording pad for today
now to achieve the best possible
view at the back of your eyes
we're going to need some eye drops so we're going to be blurring your vision, dilating the pupils
we shall use some tropicamide one percent one drop in each eye
and to aid dilation, I'll also be using another minim this is phenylephrine hydrochloride
one drop in each eye 2.5 percent
okay so that's all the equipment we're going to be using today
and we may pop some Fluorescein dye in the eyes as well just to check for any ocular staining okay so
now that you're ready we're going to be instilling
your eye drop. Remember we have two types of drop to dilate the pupils we have the Tropicamide
okay it does sting for a few seconds then it will ease off okay. It might be blurry for up to four
to six hours once you leave okay? so if you're ready, looking up for me let's place one drop
in the right, I'll give that a moment
okay try and look up again a little pop a drop in the left eye there
okay i'm just going to prepare the phenylephrine drops
okay when you're ready looking up again one drop in the right eye
okay looking up again one drop in the other eye
okay the stinging will ease off very quickly
now what we do need to do is we need to wait in the reception area for about 20 minutes
for the full effect of the drops to take place so if you can have a seat in the waiting area
I'll come and check on you shortly to see if the drops are working and then I'll call you through
hello there and welcome back to the clinics I'm going to set up the
indirect ophthalmoscope now to have a look at the fundus of the eye so just bear with me
so we want a nice secure fitting to ensure that we have a nice
binocular view there I want this to be sitting at the correct orientation
okay let's have a look adjusting to the white light
and the biggest aperture to begin with now that your pupils have dilated
a little look at the brightness setting here
okay i don't want it too bright i need to remain comfortable so let's go about halfway there
it's looking good
should be able to obtain we should be able to achieve a nice view there
we have the recording pad here let's pop your details in
today's date and we're starting off with the right eye
turn the image recording sheet upside down
okay now if you're ready just try and relax look over my right shoulder to the distance, I'm going
to hold the lens just in front of the eye there a little bit of movement in and out as we try to
obtain the best focus there, I'm just observing the optic nerve head there
the margins are nice and flat
just moving slightly this way to observe the macula I can see a nice bright foveal light
reflex there, Macula looks flat, there's no signs any oedema or haemorrhages there
and a little bit closer certainly no signs of any epiretinal membrane
excellent I'm just going to adjust the
aperture to the medium size there okay if you could look up to the ceiling
up and right
directly to the right
down and right
down to the floor
down and left
to your left side now
and up and left
okay just relax a second
okay now looking straight ahead we're just going to come back in with the green light assessment
I'm just looking at the nerve fibres
better viewed with the green light, I'm just going to look at the blood vessels
thank you look up look to the left
to the right
just down to the floor
lovely
okay so just record those results down for the right eye
no signs of any birthmarks or naevi at the back of the eyes,
fundus was completely clear, clear optic nerve head fine. Okay let's move on to the left eye now
okay just looking over my left shoulder
best you can
I'm tying to get the correct working distance there
about there good I'm just looking at the optic nerve of the left,
point four cupping approximately, no signs of any notching
or disc haemorrhages or pits and the vessels look fine at the crossings so nice and distinct
and there's no elevation of the neural retinal rim
normal looking lamina cribrosa there okay just looking up again
to your right
sorry up and right and down and right
down to the floor
and down and left
directly left
up and left
there we go
okay just relax again
just back in with the green light looking straight again
normal looking retinal nerve fibres there
vessels three to four
signs of any av nipping, okay looking up again right
left
down to the floor
excellent looking
okay so let's record those results for you
I'll make some written notes as well. This will be stored in your records
now we did say we were going to pop a little bit of orange dye into the eyes
just to check the anterior ocular surfaces so I have the dye here, slightly yellow
okay looking up to the ceiling please one drop it in the right
and one drop in the left just relax as I set up the blue light now
okay we need to switch to maximum brightness next,
there we go maximum brightness no lens required this time to come very close and check the
corneal staining there or absence of, lovely looking up I can get the inferior conjunctiva
now to the right
left for the temporal
that's looking grand and for the left eye, looking over my left shoulder again
okay might be a little bit of corneal staining in the superior zone the left cornea
okay looking to the right
looking to the left
and up and down through to the floor
looking great on the conjunctiva just some normal looking
ripple stains, no more than grade one there
just looks straight again let's recheck the left corner
excellent
so this concludes the ocular evaluation today just make a note of the corneal findings there
so right eye no staining, left superior corneal zone superficial punctate by the look of things
so that is everything thank you for coming into the clinic today and I'll see you again next time