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  • Building a Top-Notch Ophthalmology Consult Fanny Pack


    Picture this: You’re strutting through the hospital corridors, fanny pack slung stylishly around your waist like a seasoned ophthalmology detective.

    With each step, you feel the weight of responsibility (and your lens box and eye drop or two) around your waist. But fear not! Your trusty fanny pack is packed to the brim with all the eye-examining goodies you need to dazzle your patients and colleagues alike.

    All right. Maybe “dazzle” is a bit much. But, hey, a little flair never hurt anyone, especially when it comes to peering into peepers! So, let’s embark on a journey through the must-haves for crafting a top-notch ophthalmology consult fanny pack.

    Because who said saving sight couldn’t be stylishly hands-free?

      • Fanny pack. Perhaps it goes without saying, but the fanny pack is an essential component here. With your equipment always at the ready and providing hands-free convenience, the fanny pack is a solid choice for any consult resident. Depending on the style, you can also express your personality! Cotopaxi hip packs are a vibrant and unique choice for the fashionable ophthalmology trainee.
      • Smartphone. Keeping a well-charged cell phone with you that’s loaded with handy apps can replace the need for lots of bulky equipment:
        • The light can serve to check pupils in lieu of a pen light.
        • The Eye Handbook app can be used to check color vision and visual acuity.
        • Some electronic medical records are accessible from phones or apps.
        • The camera can document pathology.
        • EyeWiki on your browser can serve as your “eye dictionary.”
        • And OE Acronyms can keep you up to date with all the complex acronyms in our field!
      • Reading glasses or +2.50 free lens. Checking visual acuity can be one of the most crucial parts of the eye exam. But for patients over the age of 40, presbyopia can make bedside vision exams a nightmare. Pro tip: Purchase a cheap pair of reading glasses at the dollar store or a +2.50D trial rim lens that can be placed over each eye during the visual acuity assessment. You’ll never again have to wonder if the patient is losing vision or just needed a pair of readers!
    Isaac Bleicher, MD, chief resident at Massachusetts Eye and Ear
    Left: Isaac Bleicher, MD, chief resident at Massachusetts Eye and Ear and director of the ocular trauma service, sports a colorful consult fanny pack. Right: The contents of Dr. Bleicher’s all-star consult fanny pack. Pack anything you might need for your next inpatient or emergency room consult.
    • Eyedrops. Keep a fresh bottle of proparacaine and a set of dilating drops at the ready for bedside exams. Intraocular pressure testing and dilated fundus exams are a staple of most inpatient consults. Proparacaine is also a great way to determine surface pain (which resolves with drops) from other sources of eye pain (e.g., intraocular pressure or uveitis). Pro tip: If patients need frequent retinal exams, atropine can keep the eye dilated in preparation for their next consult exam.
    • Fluorescein strips. Eye pain, red eyes, blurry vision … many of these consult questions can be solved with the use of fluorescein dye. Keep a few fluorescein strips nearby to help check for dendrites, keratopathy and corneal abrasions.
    • Tonometer. Many options exist for checking intraocular pressure while on consults. Common tools include tonopens and iCare tonometers. The convenience of having these tools on hand for consults can’t be understated, as performing Goldmann tonometry in the inpatient setting is often difficult or impossible. However, these tools are sensitive to damage and expensive! Tonopens should always have a protective tip in place to prevent debris and trauma. Make sure to bring extra tonopen covers!
    • Fundoscopic lenses. Is an eye doctor even an eye doctor without their lens set? Keep your personal lens set handy to perform dilated eye exams. The 20D lens can also serve as a magnifying glass to check for corneal and eyelid pathology bedside.
    • Scleral depressor. Don’t let flashes and floaters get you down. Checking the peripheral retina is important in any patient with a concern for retinal pathology. A scleral depressor is key to add to your kit, though cotton-tipped applicators often serve as a ready stand-in.
    • Desmarres. Consult for a facial burn? For trauma with periorbital ecchymosis and edema? For an intubated patient? Examining the eye can be difficult in these cases, but Desmarres lid retractors can be your best friend in visualizing the eye without putting pressure on the globe or causing patient discomfort.
    • Snellen and pediatric eye chart. If you’re worried about your phone losing charge, keeping a Snellen eye chart in your fanny pack is an easy way to check visual acuity bedside. Some Snellen eye charts also come with a handy-dandy pupil gauge to assess pupil diameter with increased accuracy. Pediatric handheld vision tools can also be great for entertaining and checking vision in children.
    • Pen light. Here’s another backup for the cellphone: a pen light. Checking pupils is crucial, and a penlight will allow the bedside assessment to happen with ease. Pro tip: You can also use the light on an indirect ophthalmoscope in the same way.
    • Notebook and pen. Finally, don’t forget to pack a small notebook and pen to record your findings and document patient consultations. Once you’ve seen a few patients, the findings can all start to blur together. You can even map out a retinal drawing in the notebook and document items to study up on later.

    And there you have it! Your fanny pack is now primed and ready to accompany you on your ophthalmic adventures. Remember, when it comes to eye care, a little laughter and a well-equipped fanny pack can go a long way. Now, strut your stuff with confidence because with this arsenal at your hip, you’ll be ready to tackle any eye-related challenge that comes your way.


    Grayson W. Armstrong, MD, MPHGrayson W. Armstrong, MD, MPH, is Associate Director of Medical Student Education, Harvard Medical School, and Medical Director of Ophthalmology Emergency Services at Massachusetts Eye and Ear. A 2023 recipient of the Academy’s Artemis Award, he joined the Academy in 2016.