5 Eye Care Misconceptions Series- What to expect during an eye clinic visit
When you get the same question for the 15th time about a certain aspect of our clinic flow, then its time to write a misconception series on the topic. That tells me I am just going through the motions and doing a poor job relaying the message on why we do certain things in clinic. This is my attempt to explain the reasoning behind the apparent voodoo we do in clinic, and the usual order we do it in:
- Looking at a smaller line on the vision chart, “I can’t see, Doctor,” and after some encouragement being able to read the whole line and two lines below it. I can routinely get people to read 2-3 lines better on the vision chart by just encouraging them to guess on the letters. Many people are perfectionists and if they can’t see the letters clearly they prefer not to guess and blurt something out wrong. These letters on the chart get really small and it’s okay to guess on them. We realize that some letters look the same on the chart; For example E and F, so when a patient guesses either one, it is considered correct. It does not mean something is necessarily wrong with your vision.
- “I can’t stand those yellow drops.” The “yellow drops” are notoriously hated in every eye clinic in the US. It’s understandable- it stings, makes your eyes stain yellow like you have jaundice, and leaves you with a dry/heavy feeling for hours after the visit. These drops are a mixture of a dye/anesthetic that helps stain the eye to check for dryness/scratches/irregularities on the cornea and the white part of the eye. It also numbs the eye so we can check the eye pressure without you feeling any discomfort. Once people know the benefit of the yellow drop they are usually all on board with anything that numbs them from our prancing hands.
- “That eye pressure device is not going to touch my eye, is it?” There are a myriad of ways of checking eye pressure in the clinic. One such instrument is the patient favorite air puff that likely started off as a torture device in the middle ages. More commonly used devices make contact with your eye to measure the pressure. Now, while we can numb your eyes from feeling the tip of the device, we do not numb the eyelashes/eyelid. Thus, it’s common for a patient to feel the device when blinking, which commonly alerts people. I warn patients that they will feel something tickling against their eyelids/eyelashes which helps calm their nerves. Ideally we would like to measure pressure without opening your eyelids in order to get a more accurate pressure. This helps us avoid artificially elevating the pressure by placing weight on the eyelids with our fingers.
- “Do I have to be dilated today” or “I didn’t bring a driver, I can’t be dilated.” This is one of the most common concerns of patients in the clinic. I have heard every excuse in the book in a desperate attempt to avoid dilation. Almost every new patient to the eye clinic needs to be dilated (except for a few special conditions like closed angle glaucoma). Dilation gives us a clearer and wider view to the back of the eye where we monitor important eye landmarks. Darker eye colors tend to take longer to dilate, but 15-20 minutes is sufficient for dilation in most people. Otherwise, skipping dilation forces us to view the back of the eye through a little peep-hole. I can’t count the number of times I found disease in the back of the eye in a completely asymptomatic patient. Depending on iris color and age most patients will notice the dilation effects wear off in 6-8 hours. A dilated eye can more or less sees distance the same, however, with more light sensitivity. The big drop off is in the patients’ near vision. We have a majority of our patients drive home on their own with those cool plastic shades as a reward for completing the full exam. It is not mandatory that you bring a driver with you on those days unless you feel uncomfortable driving yourself.
5.“I have never seen so many testing machines in my life.” Ophthalmology is one of the most technology heavy fields in medicine. That translates to a myriad of tests that are available depending on the specific eye problem and how up to date the clinic is with their machinery. The annual large meeting in ophthalmology has football fields worth of technology available for the practitioner. Despite being able to find inconspicuous disease in the eye, these tests allow the ability to follow a diseases’ improvement/progress through long-term imaging. While nothing can replace a thorough history and exam, these tests are a great complement for a comprehensive visit.