September 19, 2009 | POSTED BY | Articles, Clinical Optometry
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At SUNY Optometry part of our coursework is shadowing 3rd and 4th year students in the clinic. Keep in mind that the eye care clinic at SUNY Optometry (Optometric Center of New York) is THE LARGEST outpatient vision facility of its kind in the NATION! That means that this clinic sees over 80,000 patients annually. Individuals come from all over the United States to receive arguably the best eye care around.

On a side note, the doctors who run the clinic teach us everyday so I am proud to be learning from the best.

This week I was lucky enough to shadow a 4th year student on floor 7 of our building. This floor specializes in ocular diseases for the most part and is the place to go if you want to see patients with interesting cases. Our objective of the day was to take note of the “Chief Complaint” that the patient presented and to focus our thoughts and notes about how the exam revolves around this chief complaint.

A chief complaint is basically the patients reason for coming in to see the eye doctor and my patient had a very interesting chief complaint…

I walk into the exam room just as the exam begins. Sitting in the chair is an 70+ year old African American woman with her eyes squinting tightly, looking around the room in confusion wondering who the new footsteps belong to. The 4th year intern informs the patient that I am a first year student observing the exam today. As I take a seat I notice that this woman’s body language is indicating that she can barley see. She seems to be in pain and upset with the fact that the vision she once had seems to be slipping away from her.

The intern student tells me that she has LP 1 foot in both eyes. For pre-optometry students, LP 1ft. means that the patients visual acuity is measured by shining a light into the patients eye, and this light could only be recognized from 1 foot away. So this patient could not read any letters on the Snellen Chart what so ever and therefore their visual acuity had to be testing using light perception.

This is when I find out 4 key details that comprise the patients chief complaint. These are the 4 standard details that always comprise a chief complaint.

  1. Severity
  2. Onset
  3. Location
  4. Duration

This patient had glaucoma while living in Africa and upon her return to the U.S.A this glaucoma was so far advanced that bringing back her vision was not an option. Luckily, this patients left eye still had some life left in it. The patient had a cataract removed by an ophthalmologist 2 weeks prior yet came to SUNY shortly after because her eye was now extremely painful, blood red and was dripping tears.

This was the patients chief complaint and it was up to this SUNY 4th year to solve the problem. The student doctor took a patient history and revealed that the patient was still using eye drops for glaucoma and other conditions. These drops where Azopt, Combigan, Travatan, and Vigamox and if I was in my 2nd or 3rd year I would tell you ALL about them but unfortunately I am only a month and a half into my first year of optometry school.

After performing a detailed patient history and a full work up using the slit lamp, ophthalmascope, Goldman tonometer (OD 24 | OS 22) and other various tests, the student finally came to a personal conclusion. We left the room as she told me her thought process throughout the exam. This intern was trying to rule out infection such as a endophthalmitis; an infection/inflammation of the tissues eye that cause reduced vision, pain, redness and blurred vision. I was under the impression that the student was looking in the anterior chamber and in the vitreous for free floating cells that could indicate a bacterial or viral infection in the eyes tissues. The intern successfully ruled this out of the equation, and therefore would have the patient back the next day to see what progress the patient made within this 24 hour period.

The student and I reached the clinic meeting room where the doctors review all the cases that the interns are preforming via. computer as the exam is being preformed. The intern began talking with Dr. Dul as he evaluated his students interaction with the patient and began suggesting ideas. I was really happy because he focused his attention on me, asking me tons of questions about what I thought and really pushing me to use common sense to understand what was going on.

Dr. Dul, the intern student and myself went back into the exam room where Dr. Dul took control of the situation. He explained out loud the biology and chemistry that would be going on if an infection was present or not and we all learned so much great stuff, including the patient.

This was a great experience and regretfully there is much that I left out. Just imagine yourself in my shoes as this all went down and focus on what you would feel like inside when you saw this poor woman with an LP 1 ft looking around the room in hopes that her vision would come back to her spontaneously. All you want to do is help but you must first go through at least 3 years of optometry school until you can begin make a difference in 1 on 1 patient interactions.

Overall clinic is great and there is lots to be learned… Until next tuesday!

By: Matt Geller