Fourth year clinical rotations are the pinnacle of optometry school that all students are anxious for. It’s a time of freedom, learning, and exposure to parts of optometry you may never see in the school clinic. Or is it?
My name is Lawrence Yu, and I’ve started my clinical rotations as a fourth year student at the Southern California College of Optometry at Marshall B. Ketchum University. Through this blog, I will chronicle and share my rotations experience throughout the year at my four different sites. Join me as I leave the safety of the school clinic and enter the real world of optometry. Learn with me as I see some crazy eye diseases. Suffer with me as I endure moving every 2.5 months. Follow me and prepare yourself for your last year of optometry school.
Second Rotation: Month 1 at a Low Vision Clinic
Low vision was something that I never considered as wanting to pursue. Part of that was because of the lack of clinical exposure in my third year at school, and the other part was because of its “slow vision” nickname. However, I took a gamble with my second rotation selection and picked a clinical site that sees only low vision patients. The Center for the Partially Sighted (CPS) is an independent organization that provides specialized care for low vision patients to put them on the path to independence. The clinic is located near Los Angeles, California, and I was dreading the move from beautiful San Diego to smoggy L.A.
My perspective on low vision completely changed after my first month at CPS. I used to think that low vision was just poor VAs fixed with magnifiers, but we saw an enormous variety of patients with reduced visual fields, poor contrast, or high light sensitivity. I used to think that trial frame refraction was convoluted, but it was very logical with clear end-points. I used to think that low vision was slow vision, and yes, it still was slow vision. However, the fulfillment that I felt after changing my patient’s life was completely worth the time and effort.
The biggest change for me at my second rotation was doing retinoscopy on every patient. My low vision master/staff doctor taught me that autorefractor readings on low vision patients are unreliable due to many factors, such as poor fixation or eccentric viewing. Because of this, we did retinoscopy in the patient’s best field as a starting point for refraction. In the naval hospital for my first rotation, speed and efficiency were key, and technicians already had autorefractor measurements ready before I saw any of my patients. It was a big but worthwhile change since I now feel immensely more comfortable with retinoscopy after doing it on many small pupils, nystagmic eyes, and odd corneas.
Even something as standard as measuring VAs was different for every patient with low vision. At school, I used electronic VA charts with a computer monitor. At CPS, I learned that the illuminated white screen with black text can overestimate VA because of the high contrast. When I switched to the Feinbloom chart, the measured VA was more similar to real life acuity because of its printed background and possible glare from the room lights. Some patients were so light sensitive that the computer monitor was too bright for the patient to look at comfortably. With so much individualized care in measuring VAs for a patient, you can imagine how much thought goes into the rest of the eye exam!
For my next article, I’ll be talking about the emotional satisfaction in low vision. I looked forward to being able to legitimately change lives every day. Stay tuned!