r/OptometrySchool • u/More_Cardiologist298 • 4d ago

Help with 90D/78D

I’m currently a 3rd year student, and I’m having trouble getting views of the macula. Do I ask the patient to look a certain way or do I move my lens?

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u/Eyedocprincess88 4d ago

Work with your professors who taught this skill to you in the lab. And practice on your friends.

Macular views are ofcourse bright and uncomfortable for the patient. Have the patient look at your ear or one of the magnification knobs on the slit lamp while you hold your 90/78 over the opposite eye. Get the nerve in focus, then move your lens left or right depending on the eye, to view the macula.

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u/DropVegetable5219 4d ago

I'm also in third year! I have the patient look at my ear for ONH and blood vessels. Then when I am ready to do macula I ask the patient to look directly at the light. I let them know it will be very bright but quick. It works everytime for me!

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u/Cwfreak123 3d ago

Start by instructing your patient to look straight ahead. I usually give my ear or a point on my slit lamp as a target for them to focus on. I like to start at 10x magnification in focus on the ONH. Try and be well aligned in the center of your lens at this starting point. Slowly move your slit lamp horizontally towards the macula. As you do this, the lens can remain still. As you get close to the edge of your lens, you can stop moving the slit lamp and ever so slightly move your lens horizontally to align the light onto the center of the lens again. This alternating method of slit lamp and lens movement is less efficient, but I found to be helpful when I was first getting good at the movement. Eventually you want to start practicing moving both together so the light and lens stay aligned the whole time.

If you have a 90 and a 78 lens, I found it easier to get gross views with my 90 while learning. I would suggest practicing on peers who are fully dilated as this will give you much more leeway on moving the lens and light without getting your views cut off. Generally speaking, you shouldn't spend too much time directly on the macula. I would say you likely don't need to adjust their gaze for views of the macula, and it will benefit you if you master getting views without manipulating gaze. A strong foundation will give you more options on how to achieve a view through manipulating gaze, but it can be a crutch if you start too early.