In practice we can accommodate a vast range of patients with a breadth of clinical needs. Many tests are successfully performed with patient co-operation after the practitioner explains the purpose and mature of the test, and advises the patient where to look and how to respond. However, in some cases, communication is more challenging. This could be with infants, individuals with learning difficulties or people with dementia.
It is likely that we have all experienced a baby or a toddler who arrives for their appointment already offering justification for the phrase ‘terrible twos.’ The crescendo of cries gives an indication that they are on route to your consulting room, while you’re rapidly searching the cupboards to locate any toys or sources of possible entertainment.
“Instinctively, infants slowly reopen their eyes with curiosity at the sound of their favourite theme music and after a few moments of assessing the room and the situation, they start to become captivated by the video”
In some cases, the time taken for history and symptoms may calm the infant once they see their parent engaging with and placing trust in the practitioner. In other cases, it may not.
Despite all of the encouragement you can give, the peculiar sounds that you can make, the bribery their parents attempt, and even after you’ve covered them from head to toe in stickers, some young ones may still not event open their eyes.
When patients aged two years or under present for an eye exam, it is often because a parent or guardian has a concern that required through investigation. For example, it is essential that reliable clinical results be obtained so an informed decision is made regarding their management.
In these situations, I find it invaluable to use my dual monitors as a source of distraction. Many consulting rooms have a desktop computer on which the practitioner records their findings, and a second monitor positioned above the patient chair. This monitor displays the logMAR chart, which is reflected through the mirror on the opposite wall and into the patient’s line of sight. A dual-monitor display allows content to be shared or moved from the desktop screen to the second monitor with the cursor.
“Paediatric eye care is fascinating and I really enjoy communicating with and examining children”
Dual monitor, dual use
When examining infants who are upset, or if it is challenging to achieve steady fixation, I ask the parent what the child enjoys listening to or watching at home, their favourite song, show or video, for example. I then use YouTube to access this content and move the internet tab across from the desktop screen to the second monitor in order for it to be seen through the mirror.
Instinctively, infants slowly reopen their eyes with curiosity at the sound of their favourite theme music and, after a few moments of assessing the room and the situation, they start to become captivated by the video. This enables both the parent and child to relax and the experience becomes far more comfortable and enjoyable for all parties.
One difficulty is that some children discover they can gain a much better view of the entertainment on the monitor by turning their head to look behind them. To avert this, it is useful for the practitioner to only look or point to the mirror whenever they direct the child’s attention to the monitor.
Paediatric eye care is fascinating and I really enjoy communicating with and examining children, who offer a fresh perspective in a busy day. It is in our best interest to provide patients with a comfortable and welcoming environment in our consulting rooms. For children and individuals with learning difficulties, having a visual and audio stimulus similar to what they experience at home may create this. It allows them to make an association between the eye exam and home comforts, which is immediately reassuring when they are in unfamiliar clinical surroundings.
Furthermore, using the second monitor to display this content results in steady patient fixation at a target six metres away, allowing you to perform the clinical tests you require and to achieve more accurate results for retinoscopy and direct ophthalmoscopy.