I’ve had a really amazing first summer in Boston; I’ve been able to relax, see the city, and visit my hometown, while still gaining some valuable work experience. As I mentioned in my previous posts, I’ve been working at New England Eye over the summer, specifically for the On-Sight Mobile Clinic. Mainly, I’ve been working in the office, performing tasks such as recording the results of eye exams, sending the results of children’s eye exams to their parents, analyzing data from hundreds of eye exams the van has performed, and calling patients to ask them about their eye health. But in the past few weeks, I had the opportunity to go on the On-Sight van to both pediatric and adult sites.
During the year, the van mainly travels to schools and Head Start programs on pediatric days, but during the summer it stops at daycare centers and day camps as well. I was able to perform vision testing on four- and five-year-olds at a day camp when I went on the pediatric van, and was introduced to some of the challenges inherent in performing eye exams on younger children. My previous clinical experiences through NECO have all been vision screenings at schools, which enabled me to work with children from ages three to thirteen, but usually the children are older and interested enough in what we are doing to cooperate well with the procedures. I learned that this can be very different with children that are not only younger, but are not as receptive to having their eyes checked once they realize that someone is going to put drops into their eyes.
I was able to check the children’s visual acuity, stereopsis, eye movements, and pupils, and perform cover tests, realizing that it is much easier to do so when you can keep the child entertained. One of the nice things about working on the On-Sight van was that they have a program that projects a VA chart onto a screen, with letter size decreasing as you control it with a remote, and when you aren’t checking VA you can play short movies for the children to focus on when you need them to look at a distance target. However, the difficulty starts when you try to bring eye drops into the equation. I learned from my preceptor that it’s much easier to get drops into a child’s eyes if they don’t know they’re coming; it’s important to be quick and decisive, before the child has time to get apprehensive or feel a slight sting from the first drop. If a child is smart and sees you with the eyedropper, or has heard about getting eye drops from his or her friends, then he or she is extremely resistant to the idea. I also learned that children tend to have very short memories when it comes to eye exams; a minute or so after getting the eye drops and being assured that they did a very good job, the children are perfectly happy to go watch Rio in the waiting area of the van. In addition to several children who tested normally, I was able to see one patient who had a large alternating tropia and appeared to also have divergence excess, since the tropia was larger at distance than near. It was really great getting more experience working with children; I hope that in clinic this year I’ll be able to work more with kids as well.
When I went on the adult van, we travelled to a facility for adults with neurodegenerative disorders like MS and ALS. I was able to observe fourth-year NECO students performing eye exams on the patients there, and also observe patients receiving OCT scans. I learned that optic disc atrophy is common in these patients, and in addition to seeing this on the OCT scans, I examined a few of the patients with an ophthalmoscope to see this for myself. My experience on the adult van showed me that although there are challenges to working with patients who aren’t as mobile, it is still extremely possible and rewarding.
Working at New England Eye this summer enabled me to get experience working with many different aspects of the vision care process: seeing patients, following up with patients and their parents, ordering glasses and mailing them out to patients, and analyzing data from the hundreds of eye exams that the van has performed. It gave me a deeper understanding of how an eye clinic is structured and is able to function, and I will be able to apply that information to my clinical work this year and later in my career.
Looking ahead, I’m excited about starting my second year at NECO, but also apprehensive—I’ve been told by nearly every upperclassman that I’ve talked to that second year is the most difficult. Once you reach your third year, I’ve been told, it gets a bit easier because you have fewer classes and start devoting about half of your time to clinic. Despite the difficulty, I’m really looking forward to starting second year, for several reasons. Completing my first year means completing my foundational coursework for optometry, like anatomy, physiology, and cell biology, and also my beginning coursework in vision and optometric care. This year, I will be able to complete more specialized coursework in areas like binocular vision and ocular disease, and learn how to perform more complex procedures on patients, like slit lamp examinations and BIO, or binocular indirect ophthalmoscope examinations. I’m also really looking forward to starting clinic; we have our white coat ceremony in September, after which we begin working in clinic sites around Boston and practicing on patients other than each other and children at vision screenings. I’ll be writing more about second year in a few weeks; until then, I hope everyone enjoys the rest of their summer!