Author: Linda Lam
25% of the population manifests anisocoria as a normal, routine examination finding. The hallmark sign in lesions of the pupillary efferent pathways is anisocoria.
Changing consulting room illumination helps to differentiate between physiological and pathological cases.
Always test both light and near reflexes and test for a relative afferent pupil defect (RAPD). If an RAPD is present it indicates a problem with the optic nerve.
A quick refresher on some differentials to consider when it comes to pupil reaction:
Pupils are quick and easy to assess and should be done routinely. A thorough case history is also vital in determining acute or chronic cases, especially if the patient has had head trauma in the past.
Join us in welcoming Lucia to the Young Optometrists NSW/ACT Subcommittee! Lucia graduated from UNSW in 2012 and has experience in both regional and metropolitan practices. Keep an eye out for her.
Read on for our Q&A with Lucia.
Tell us a little about yourself?
I graduated from UNSW in 2012 and since then I’ve worked in both regional and metropolitan practices, as well as a short stint in London, taking advantage of the Youth Mobility Scheme to work and travel around Europe. I’m currently working part time in Western Sydney due to recently starting a family and deciding to undertake further studies in optometry.
How did you end up in optometry as a career?
Optometry appealed to me because it is a stable and fulfilling job, which allows me to help people by resolving their visual concerns and also work with other healthcare professionals. I’m now also beginning to appreciate the flexibility, good work-life balance and various opportunities in career development.
What are you most passionate about outside of optometry?
I enjoy running as it really helps to clear my mind and relieve stress. I also like it for the way it challenges my mental toughness as ultimately, I choose when to stop. I love watching sports, especially basketball; and spending time outdoors, exploring new places.
What inspired you to join YO as a subcommittee member?
I’ve really enjoyed reading the YO blog posts (Unconventional Optometrist and Real Talk) and have found them to be very informative and relevant. I was then compelled to join YO and assist in furthering the goals of facilitating career development and networking opportunities for young optometrists.
How would you spend your free time?
I’ve started to read a lot more this year, trying to maximize the little “me time” I have outside of looking after a toddler. I also enjoy journaling, travelling and playing board games with my friends.
If you had one superpower, what would it be?
Being able to speak the language of whichever country I find myself in.
Our 'Unconventional Optometrist' column is where we chat to optometrists who are a bit out of the ordinary! Do you know anyone who we should feature? Let us know!
My name is Sujan Hong and I am a Korean-Kiwi-American... and soon to become an Australian. I have identity crisis when I have to cheer for sports teams... haha.
What can I tell you about myself?
1. I have 6/6 vision and hadn’t been to an optometrist before studying optometry at university.
2. The primary reason for choosing optometry was because I wanted a respectable degree as a back-up to figure out what I really wanted to do with my life.
3. I graduated with a BOptom, University of Auckland and practised in Auckland, New Zealand as an optometrist for a few years before leaving.
4. Music has always been a big part of my life! I never considered music as a career, but I was fortunate enough to have met a very inspiring music teacher during my high school years who helped me to discover my talent and “almost inspired” me to take up music professionally.
5. I have ABRSM, Royal School of Music for Piano Performance and AmusTCL, Trinity College London for Music Theory. Teaching music could also be a backup career if I really want a career change (!) - although I feel a bit rusty now. I also played timpani with various youth and community orchestra.
6. After optometry, I wanted to travel the world and decided to study Computer Programming. I hated Programming, but landed an amazing opportunity to work as a project manager for a software company.
7. Working in a start-up environment was great experience - it means you have to be really flexible and willing to learn something new - all the time.
8. I briefly worked for a Product Development and Design team with Benefit Cosmetics in San Francisco.
9. I was involved with multiple non-profit organisations in San Francisco and also had my own personal social organisations with over 2000 members (between the two groups)
10. I had a brief appearance in The Five-Year Engagement starring Jason Segel, and played “That Korean Girlfriend”.
11. I worked as a relief optometrist around NSW with OPSM for a few years.
12. I currently work as Professional Affairs associate with Alcon. I am loving every minute of my job! Please note that the roles of Professional Affairs and Business Development Manager (AKA BDM or rep) are different, and shouldn’t be confused.
13. I don’t really think I knew such a role (Professional Affairs) existed before joining Alcon – so now I make a point of letting optoms know the roles that we each play in helping you grow as an optometrist and as a business.
How did you become involved in helping in a restaurant? How long have you been at it for? Where can we visit your restaurant?
I am a big foodie. I have eaten at many different places around the world and in my hometown, and I also enjoy cooking (I probably have every imaginable kitchen gadget in my kitchen except for Sous-vide which is next on my list).
I have always been interested in learning something new and helping others, and I ended up helping some friends set up their new restaurant business. The restaurant, Yuzu Dining is located in North Strathfield, which is about 30 mins drive from Sydney CBD.
Tell us about your typical day/week at work
What I love about my job is that there is no typical day / week at work. Even when I was working as a relief optometrist for OPSM in NSW, there was no typical day and week - as I was in a different practice working with different people every day / week.
Currently, my week may look like:
Monday: Presenting - Deliver an educational talk to optometrists about how to manage dry eye patients with Alcon’s range of products.
Tuesday:University - Teaching final year students how to fit multifocal contact lenses easily and successfully.
Wednesday: In office prepping follow-up for Monday’s presentation and university teaching session; respond to key questions from client groups and return emails to stakeholders. Set up key meetings for next week and identify what resources are needed. Book flight to next month’s Optometry conference.
Thursday: Liaise with major conference (on Friday) and finalise Agenda and key speaking points. Send through PPT presentation slides and add in 30 sec video to support presentation. Confirm travel and accommodation for next month’s educational roadshow.
Friday: Major Optometric Conference – Introduce a speaker to educate the attendees on how Alcon’s technologies can be used in everyday optometric practice.
The highlight of my role so far is probably attending the 2019 Asia Pacific Optometric Congress in Manila last month. Seeing the scope of optometry in the APAC region was phenomenal, and optometrists in Australia and New Zealand are so fortunate to be able to practice with such a big scope.
How did you get into this unique area of optometry?
LinkedIn! I was contacted by a recruiter and after several rounds of interviews, got into the business. I wasn’t actively looking for a new opportunity, but sometimes they come knocking at your door. I feel so proud to be working for a company with integrity and huge focus on R&D and feel fortunate to work with so many other smart people and learning something new all the time.
How do you keep up with the optometry world?
Through YOU! I get to meet a lot of optometrists as part of my job. Whilst I may be the one training optometrists, I also learn a lot from the way you all practice. I love being able to share what I learn from different optometrists – such as tips and tricks of the trade – and bringing these back to you so that you can all be the best at what you do. This cycle of listening, participating and sharing back is how I can give back to our society – practising optometry vicariously through you!
Do you have any goals for your optometry career?
In the past, I was fulfilled through providing the best clinical advice and service to each individual patient that I saw. Since working in my new role with Alcon, I’ve realised that I could have been even better as an optometrist had I known even half the things I have learnt since joining the company. Because of this, I’m always eager to share as much as I can with every optometrist I meet and in the future, I’d like to bring together optometrists so we can work together to make the industry stronger. I also wish I could incorporate the scope of optometry in the Asia Pacific region and create stronger alignments with what we do in Australia and New Zealand somehow. Australian optometrists are very fortunate to have Optometry Australia working continuously to keep our industry strong. Some optometrists choose not to become OA members because of cost involved (myself included!) but Tim Grant, who is the Head of Asia Professional Affairs for Alcon and is also like a godfather figure when it comes to silicone hydrogel contact lenses (he was part of the team that launched first ever silicone hydrogel contact lenses in the WORLD with CIBA vision) said something very poignant. He said “We pay forward with our fees to OA. The fees paid by previous members are why we are in a strong clinical position, same for us to pay forward for future development even if we do not receive the benefit.” I couldn’t agree more and was again grateful to work with and to learn from a great leader in the industry. (and I will be joining OA for this reason!)
What keeps you sane outside of your work life? Do you have any hobbies or passions you pursue?
I love to eat! But in order to eat, I have to exercise! One thing I miss due to my travel and work is being able to do a daily workout. I used to cover K-Pop and upload to my personal YouTube channel. I also used to transcribe music for subscribers, so they could play what I play by ear but I don’t really have time to listen to or play piano either. If I had the time, I would love to learn the guitar and the violin (since they are both more portable than a piano!). If I had more time, I would brush up on languages learnt and learn a new language – if I can speak Japanese, Chinese, Spanish and French enough to have a conversation - I would be happy! Other than that, I love all living things and enjoy planting and seeing my compost worms eat and reproduce.
It's easy to get stuck in the bubble of Optometry. What's something that you wish optometrists knew about other industries?
I think for most people, once they get into a certain industry, they stay in it for the long haul for various reasons. Sometimes you may want a career change, but the industry may not be willing to take on someone mature even if you are willing to start from an entry level position. Alternately, it may be hard to let go of what you already have and to start afresh.
I think being a specialist in one industry has its merits - but I think it’s important to know whether you want to be a specialist in that one industry. You may not know until you have had exposure to a wide variety of industries whether your passion lies in that industry, or if in fact you want to be elsewhere. When I started out, I never had the mindset of being in optometry for the long haul, so that’s maybe why I ended up exploring other options.
Following the various experiences I have had and growth in understanding of myself, I’ve identified that my core professional motivation was to work in an industry where I can make a genuine difference in the quality of life of people. To me, this narrowed my focus to the healthcare industry, but I don’t think I would have come to that conclusion if I had stayed in Optometry for 10 years.
From my perspective, if you want to explore other options, put 200% into whatever industry you settle on, and give yourself a decent time period to get invested and explore where you and the industry fit before evaluating whether to stay or go – I recommend this as what you experience and learn within 3 months is very different to what you’re capable of learning over 3 years.
What advice would you give to other optometrists who also wish to pursue this type of optometry?
I think being an optometrist is a wonderful and rewarding career even though it can be disheartening for some with the current direction of the industry. If we continue to provide our patients with what we have signed up for when we started our degrees – that is, providing primary eye care and making a difference in the quality of our patients’ lives with passion and empathy – then we’ll have the impact we seek. I hope over time people will appreciate and see the important role that optometrists play in this society.
Having optometry background also doesn’t limit you to consult rooms either. There are professional affairs / services roles with various optical and medical device companies where your role is to educate other eye care professionals on how to most effectively use their products to provide best eye care. You can also head non-profit organisations such as Eyes4Everest or Glaucoma Australia to provide eye care for people with limited access to such services; and to raise awareness about certain medical conditions that maybe affecting the eye.
Or maybe you can simply go into a totally different industry! What you learn at university is only a foundation for what you need in your life. I think what you truly learn at university is discipline (studying for all those exams) and working with others (teamwork) which form a crucial basis for everything that you do in life.
For anyone wanting to ask any questions about my job(s), or just how to navigate through life as young optometry graduate – you can reach out to me via LinkedIn: https://au.linkedin.com/in/sujanhong.
The Young Optometrists NSW/ACT networking event saw over 130 optometrists, optometry students and key industry professionals gather under one roof at the Doltone House on 13th July 2019.
This event was an invaluable opportunity for individuals within the industry to gain insight into the various facets of the industry, to facilitate discussions and mingle with one another. Optometry students were also given the opportunity to network with key members within the profession for career advice and new opportunities.A final year optometry student commented “I love the idea of the networking night and making it less intimidating for us to talk to older and more experienced optometrists”.
The night opened with an address from Acting Chairperson of Young Optometrists NSW/ACT, Wilson Luu. He explained the event was conceived to break down the silos that occur in the Australian optometric industry and hoped the night would facilitate genuine discussions between all those present.
“ We want to break down the silos that occur in the industry and tonight brings a great opportunity to network amongst our peers” - Wilson Luu, Acting Chairperson of Young Optometrists NSW/ACT
The event attracted optometrists from not only Sydney but also regional NSW and guests from Melbourne. The venue was packed throughout the night with plenty of fruitful conversations and new connections forged. An optometrist attendee commented that they enjoyed “professional engagement with younger year optometrists”.
The Young Optometrists NSW/ACT team with the sponsors of the night. Left to right: Corinne Lam (YO), Sarah Tait (YO), Kelvin Bartholomew (Provision), Megan Tu (YO), Wilson Luu (YO), Joe Tanner (Coopervision), Elizabeth Kodari (Luxottica), Abdul Hamidi (YO), Raj Sundarjee (Specsavers) Jordan Olsen (Specsavers), Celine Zhang (YO)
Young Optometrists NSW/ACT (YO)'s mission is to support recently graduated optometrists and optometry students by providing a dynamic and progressive environment to advance the profession. YO aims to continue doing so by providing further platforms for members of the industry to interact with one another in the future.
Young Optometrists thanks their generous sponsors Coopervision (Platinum Sponsor), Specsavers (Gold Sponsor), Luxottica (Silver Sponsor),and Provision (Silver Sponsor), for making the networking event possible.
Causes of diplopia or double vision can be a challenge for eye care practitioners to diagnose as they can be benign but also can be life and sight threatening. Is the cause of your patient’s diplopia merely uncorrected astigmatism or could it be a sign of a possible brain tumour?
We first need to determine whether the diplopia is monocular or binocular. Generally, if the diplopia goes away when one eye is closed, this means that the patient is experiencing binocular diplopia, whereas if the diplopia persists, this indicates that the patient is experiencing monocular diplopia. In most cases, monocular diplopia does not warrant a neurological evaluation and treatment involves addressing the underlying cause.
Some examples of causes of monocular diplopia include:
There are many different presentations and causes of binocular diplopia and in the worse case scenario, a life or sight threatening cause may be underlying.
Knowing the direction (vertical vs horizontal), onset (sudden vs long standing), and committance (comitant vs non comitant) of the diplopia can guide our clinical diagnosis.
We need to evaluate the motility of the eyes individually and together. Ocular alignment should be evaluated in all gazes and at both distance and near.
Some examples of causes of binocular diplopia include:
Red flags for urgent referral in association with bilateral diplopia include:
The main treatment objective in patients with binocular diplopia is to create the largest, most central area of single binocular vision, however this may not be achievable in all fields of gaze. Patients may adopt an abnormal head position in order to overcome their diplopia.
Conservative approaches to managing binocular diplopia include occlusion of the vision in one eye, vision therapy and refractive correction including the use of prisms. Less conservative options include surgery, in cases where the strabismus is stable.
As millennials, we are exposed to unprecedented quantities of information through the advent of social media and the internet. The internet is full of traps: rich Nigerian princes, being the millionth visitor to a website, hexed downloads, pyramid schemes and the like. The ability to distinguish between true information and misinformation is vital due to the sheer volume of content we are consuming. “Fake news” has become a common term in our vernacular.
Critical thinking is the skillful analysis and evaluation of an issue to form a judgement. It something we use daily in our clinical decision-making – we relate scientific concepts to clinical application. When we are presented with new information, we have been taught to evaluate its relevance to evidence-based optometric practice.
Critical thinking should also occur outside the safety of our consultation room. Whether it’s navigating a job contract or evaluating a new lens design, diagnostic equipment or clinical procedure, we should always have our critical thinking caps on.
Consider the following...
Be skeptical: Approach what you see and hear rationally and critically. Does the proposal make sense (a distortion-free multifocal anti-scratch, uber thin, unbreakable, feather light lens, anyone?)? Why are they posing this to me? Is it trying to persuade me of a certain viewpoint? Who else are they offering this to?
Is the offer too good to be true?: A salary of $200k a year with full benefits should ring some alarm bells (after the initial “wow!”). Is this a sign that the job is having difficulty retaining applicants due to job conditions? Or do they really value you as an optometrist?
Verbal commitment to actual commitments: You should never walk away from a verbal commitment without solidifying it as a written one. It can be as simple as a quick email saying, “It was great meeting you, thank you for your generous offer of 60% off this product”. It is easy to renege on a verbal agreement as there is no physical evidence to follow through on. ‘Let’s shake on it”, they say. In a week’s time it can become forgotten promises.
Pick your sources: If it seems improbable, do some research. Consider the credibility of the source of the information – is the company/person who is presenting the information have suitable expertise and reputation? Is there more information available to you?
The ability to think critically is the ability to weigh the merits of contrasting arguments.
When you hear something, don’t just take the information at face value. Stop and wonder whether what is posed to you seems correct. Take the time to consider both sides of the story and think critically.
Tis the season for dry hands! Heaters are a crackling, our dry hands are a cracking. The winter chill brings lower humidity in the air and room heaters aren’t helping this.
With the non-stop handwashing, alcohol swab and hand sanitizer use, our hands are taking a beating this winter. The constant wetting and drying removes protective substances from the skin making it less pliable and more prone to cracks and fissures. When soap/cleansing agents are added, these agents act as secondary irritants, resulting in a change in the pH of the skin and removal of protective lipids from the skin.
Here are some tips to keeping your hands healthy:
Thoroughly rinse off your (gentle) soap
Use a gentle hand soap to wash your hands. Gentle cleansers that contain moisturisers can help retain the moisture on your skin. A foaming soap base is easier to rinse off. The skin on the palm side of your hands is thicker than that on the back of your hands. Unless you’ve been in contact with germs with the back of your hand, try to avoid lathering this thinner skin. Rinsing is another important step. Soap that stays on your skin will pull out the natural oils from your skin. Pay attention to the space between your fingers where soap residue can accumulate.
Best time to moisturise is right after you wash your hands
The best time to moisturise your skin is straight after you dry off your hands from washing or a hot shower. It is the best time to trap moisture into the skin. As optometrists, we want something that is safe and non-greasy for contact lens handling. The most effective non-greasy hydrating ingredients are glycerin and lanolin
Apply moisturisers overnight for severely chapped skin
One of the best remedies for dry hands is to soak them in warm water for 5 mins to start the hydration process, then slather then at bedtime with a thick moisturiser, then cover your hands with soft gloves. Trapping the moisturiser will help it absorb more into your skin
If your hands are extremely irritated, you may have to consider wearing non-latex gloves as a protective barrier. The use of gloves does not allow one to avoid washing their hands completely. Gloves provide an imperfect barrier to infectious material. Once gloves are removed, hand washing is imperative.
Is it more than just dry hands?
If you have scaly and inflamed skin, deep and painful cracks and thick scaly skin, it may be more than just ‘dry hands’. You may have a form of hand eczema. There are many things that can cause hand eczema - latex gloves, chemicals, water, the list goes on! Please seek the professional advice of a dermatologist to get to the root of the issue.
We want to get the most out of every slit-lamp examination. You can’t diagnose or treat a problem with your therapeutic skills if you can’t identify it!
Filters, filters, filters!
We use filters in our social media lives to highlight detail and make things really ‘pop’.
The neutral density filter is a drastically underused part of the slit lamp. Without its use, finer detail can be missed. The neutral density filter (symbol is usually circle with hashed lines) modifies all wavelengths of light and avoids under and overexposure. In image A, the blood vessels of the conjunctiva cannot be seen due to overexposure; in image B, the addition of a neutral density filter enables the conjunctival blood vessels to be visualised.
We all know the benefit of the red free (green) filter for posterior eye examination - it allows us to visualise RNFL defects and pigmented lesions of the retina. The red-free filter obscures anything red so blood vessels and haemmorhages appear black. In the anterior eye, it can be used to highlight the path and pattern of inflamed blood vessels. It is also great for highlighting the presence of a Fleischer ring.
The Wratten filter bolsters contrast when used with the cobalt blue filter. Most slit-lamps have a Wratten filter built in so remember to flip it on when you use the cobalt blue filter. It make examination with fluorescein much simpler.
2. The Basics: Alignment and PD
There is a human on the other side of the slit-lamp. Make sure the patient is aligned well with the canthus mark with their forehead resting on the plastic band and chair at a comfortable height. Make sure you’re also comfortable with your alignment with the oculars and the PD adjusted accordingly to ensure a stereoscopic view. Never duck or tilt your head - remember your personal ergonomics also. Rest your elbow on your lens case or foam discs for comfort when you’re using your diagnostic lenses.
3. Turn up the rheostat!
The anterior chamber and the anterior vitreous is very tricky to visualise without adjusting the brightness. Turn up the light when examining these structures. A stray cell or anterior vitreous detachment is easily missed if the brightness of the slit-lamp is too low. While amping up the intensity of the light may improve your ability to see, it will be uncomfortable for the patient. If you must increase the intensity of the light, let your patient know and keep it as brief as possible. The general rule of thumb is to lower the beam width and/or height as you increase the brightness of the slit lamp.
Mimi Nguyen Ly is a young optometrist who has made the leap to full-time journalism. She is truly a unique soul and a joy to interview, with an interesting journey from full-time optometry to journalism. Mimi strives to provide a voice to issues for the public good above all else.
Tell us a little bit about yourself
I came from Vietnam to Australia when I was 7. I’m an only child but grew up with my aunt and uncle, and two cousins who I consider sisters. My parents eventually permanently moved to Australia later. I completed UNSW Optometry in early 2015. I chose optometry because I was raised in a family that valued healthcare. My cousins are doctors and dentists and I’m the only optometrist in the family.
How did you get into the world of journalism? How long have you been at it for?
I joined the Epoch Times because I was inspired by the paper’s mission—to report true, uncensored news. At the time, only news filtered by state run media were being reported out of China. I care about China because I saw there were a lot of human rights issues that were not being reported about. Epoch Times, on the other hand, was the first to report on things like the SARS outbreak when it was initially censored by state-run media. The paper later won an award for its thorough investigative reporting on organ harvesting in China’s state-run hospitals, at a time when the regime thoroughly denied the practice and when no other medias were covering the story.
I joined as a volunteer contributor in 2011 (second year university) because I wanted to be able to help in some way. The general news I was writing helped to support the work of other investigative journalists on the front line. Over time I saw that the paper was also reporting on other issues in other parts of the world that were being avoided or overlooked by other medias. We could report on these things because we are independent and not guided by profit or other interests. Our mission as a media has since evolved to “Truth and tradition.” I believe that people have a right to be informed, especially about the world’s most critical issues.Responsible journalism benefits society by empowering people with knowledge so they can make the best decisions for themselves and their communities. I came to realised that, even today, there is a void and a need for more news outlets to take on this role. I wanted to help fill that void.
I started to do journalism full time since April last year, but I’m still keeping up with optometry, in a locum role.
Tell us about your typical day at work
I’m currently on the web news team, which means we cover breaking news and trending news. While getting ready for and driving to work, I’m listening to the radio to get updated from what I missed out while asleep. At work I browse for news topics and help assign topics to writers. I’m also writing news pieces for the day; basically, my role is to constantly update the world on what’s happening. Sometimes I will call potential sources to ask questions or to ask for a short face to face interview with them. Generally for now, I’m working on the web news.
How do you keep up with the optometry world?
I am doing locum optometry. On my free days, or in the evenings, I may be attending CPD evens. I’m keeping updated with the news in the optometry world generally through browsing insight and mivision magazines, and other outlets via social media.
Children’s vision has always interested me. My current goal is to learn more about children’s vision and related issues such as vision training. In the long term, I aim to continue to practice as an optometrist in any capacity I can.
It's easy to get stuck in the bubble of Optometry. What's something that you wish people knew about journalism?
Anyone, including you, can be a journalist. You don’t have to be working for a media company to be one. If you care enough about an issue you can report on it. What will make it a journalistic work is the intent and how you gather your information. Being a journalist means that you place the public good above all else (instead of your own assumptions or self interests) and that you are adhering to journalistic standards when you gather and report information (eg seeking out multiple witnesses/voices, telling as much as possible about your sources, and asking different sides for comment are some such standards). It’s what differentiates it from propaganda, advertising, fiction or entertainment—in the current media landscape the lines can blur between these. I’ve come to realise that some media companies, even some major ones, don’t serve people in this way anymore. So when we consume the news, we should all be vigilant and discerning.
What's some advice you would impart on a Young Optometrist seeking a career change?
There is so much you can do to help others with optometry, from solving their vision issue to simply bringing a smile to others every day through your sincerity and care, and that’s special, never forget that. If you can see how special this is you may even consider staying with optometry. Every job will have the fun aspects, but also will have the challenges and the mundane—are you mentally prepared to endure what’s to come? Don’t think the grass is always greener on the other side. Reflect deeply on what truly inspires you to leave to seek another path—if it still drives you, and you’re very clear and solid, go do it. If you really want to do it you will figure out a way, others will see your sincere passion, and doors will naturally open.
Otherwise, stay in optometry and do the best you can to benefit the world with your already acquired knowledge.
Where can we follow your work?
You can follow me on Twitter @miminguyenly
Cycloplegic drops have two main benefits in optometric practice. Firstly, cycloplegic is a useful tool in assessment of refractive error. Cycloplegia inhibits the accommodative power of the eye by blocking the action of the ciliary muscle, allowing the static or objective refractive error of the eye to be measured. Two main cycloplegia drugs are used in practice: atropine and Cyclopentolate. These drugs are called anticholinergic because they block the muscarinic action of acetylcholine. This action inhibits cholinergic stimulation of the iris sphincter and ciliary muscle, which results in mydriasis and cycloplegia. Secondly, as it dilates the pupil it allows for ophthalmoscope examination.
Cycloplegic retinoscopy and refraction helps determine full hyperopia in patients with accommodative esotropia and prevents overcorrection in myopic patients, making it a great tool, especially when testing children. It is also useful in prescribing correction in patients with limited cooperation during subjective refraction and amblyopic patients.
In practice, cyclopentolate hydrochloride 1% is the cycloplegic agent of choice. It has a faster onset of effect and reaches peak effect after 30-45minutes, its effect also washes out after 4-8 hours. Contradictions for cycloplegic drops is in patients with: closed-angle glaucoma, Down’s Syndrome, seizures, in pregnancy or breast feeding patients its effect is still unknown. Hypersensitivity to atropine is also not uncommon.
Here are some of our top tips for instilling eye drops in children:
If the situation allows, let the parents and child know that the eye drops cause a stinging sensation: doing so is important as it builds trust.
Show the child what the container of eye drops/ointment looks like. Put some on the back of the child's hand so he or she knows what it feels like.
Work as quickly and calmly as you can - this minimises the child's distress.
Recline the patient backwards or leaning into the chair comfortable, have them look up to the ceiling (have a picture or object for them to look at to distract them) and instill into nasal canthus. Or they can keep their eyes closed as you attempt to pull down their lower eyelid and instil it into their conjunctival sac.
Blinking exposes the eye to air and causes an increased stinging sensation. After the drop is in, ask child to keep their eyes closed and count to the highest number they know. Make it a silly competition. “1, 2, 3,...685,...ten billion”.
Praise, praise, praise! Let the child know they’ve done a great job. A little reward such as a sticker or jellybean goes a long way.
If your patient is nervous or afraid, often demonstrating on yourself or their parent (with a substituted lubricant) can help relax and calm them as they can see what would happen. If they are still nervous you can have them practice at home with lubricants before returning for their cycloplegic examination.