Preliminary Testing

Perform Amsler grid testing with near correction

Amsler grid testing should be performed with the patient’s near correction in place.  Limit questions to two:  “Are all the lines straight?” and “Are any boxes missing?”  Make sure you perform it at 12” to 14”, and watch to ensure that they are fixating on the central target during testing.  If not, repeat test instructions and start again.  If there are wavy lines or missing boxes, record that in Compulink by drawing it in the system.

Cover test on a visually confirmed trope (i.e., you can see the trope when you walk in the room) doesn’t elicit a trope.

You know which eye is the fixating eye.  When you cover the fixating eye, the non-fixating eye (the troping eye) should move to fixate.  If you don’t see that, make them fixate; i.e. “Look at the letter”.  Also, make sure that you are aware of alternating v. constant.

Perform EOM testing slowly, but steadily

EOM testing as taught has two components:  EOMs, and tracking.  If the patient doesn’t track well, place a target in each of the cardinal gaze positions to see if their EOMs are capable of moving their eyes to each of those positions.

Use a 20D lens to evaluate pupil responses in small or minimally reactive pupils

The 20D lens serves to magnify the pupil.  Use a BIO turned to high as a light source.  In extreme cases, you may have to revert to the slit lamp to evaluate pupil responses.