I could not live without…

The retinoscope

OutsideClinic’s professional services optometrist, Kamaljit Kalsi, discusses the importance of the retinoscope and the advances of technology in domiciliary care

Kamaljit Kalsi

Working in the domiciliary sector, I have always heavily relied upon the retinoscope, which I believe is a crucial piece of equipment. Whilst there have been many advances in technology, all of which contribute to efficiency and accuracy resulting in better patient care, this relatively ‘old fashioned’ piece of equipment is simple to use, being handheld, and still incredibly relevant to our profession. It is effective in various sectors, not least domiciliary, but also with children and infants. Critically, within my role, it helps with the type of patients I see – some of whom may have limited ability to communicate and may have recently become housebound due to a variety of conditions, including dementia, for example.

Often our patients’ needs are complex, and an appreciation of this is vital. Not all patients will be wearing their correct glasses, and sometimes they may have misplaced their prescription. Equally, with all patients, the retinoscope provides a rapid ‘insight’ (pardon the pun) into the patient’s eye health and prescription. I believe that it is always a helpful starting point. In many ways, it’s a ‘back to the basics’ approach and reminds me of my university days 25 years ago.

It is excellent for a preliminary review of the ocular media. I also find it very useful in determining how dense cataracts are by just looking at the light bouncing back from the retina at the outset of a consultation.

This relatively ‘old fashioned’ piece of equipment is simple to use, being handheld, and still incredibly relevant to our profession


Technological advances

Since I joined OutsideClinic some 20 years ago, I have seen a massive change in how technology has improved the service that we can offer patients and how the company has successfully adapted to embrace these.

I remember the days when we used paper records and an A to Z, whereas now we, of course, have a SatNav and an advanced, bespoke EYEris tablet programme. The tablet is another wonderful piece of equipment. It makes testing more efficient, and referring patients is as simple as a click of a button. Another advantage of this programme is that it allows you to add fundus photographs to patients’ data files, so when I need to review the last test records, an image is stored and can be easily referred to if needed. Moreover, the programme allows the submission of eGOS forms, which is more effortless and secure in terms of GDPR.

The retinoscope provides a rapid ‘insight’ (pardon the pun) into the patient’s eye health and prescription


The wireless age

Working in the domiciliary sector does, to some degree, restrict the equipment we can use due to the very nature of the role (hopefully, a portable OCT will be available in the not too distant future). Yet, I have always found it rewarding, and the choice of equipment available for me to use has hugely improved. Wireless/battery-powered equipment makes my tests run more efficiently. Sending ‘real time’ results to our head office whilst not worrying about patients tripping over cables when carrying out an eye examination is a simple example. Moreover, less time is needed to set up and more time can be spent focused on the patient’s needs. Further to these two great pieces of equipment, every optometrist is also equipped with a portable slit lamp, fundus camera, I-Care tonometer and a Welch Allen PanOptic ophthalmoscope.

The PanOptic ophthalmoscope, with a bespoke face screen designed within OutsideClinic, has been a great saviour during the COVID pandemic, enabling me to carry out a fundus examination with additional screen protection for the patients and me.

Despite all of these advances in mobile testing and even when working in practice, the retinoscope is my essential piece of equipment regardless of the testing environment. I first handled it in university, and it remains to be one thing I always rely on.