Medical Eye Clinic Guidelines

General Information

• The Medical Eye Clinic (MEC) offers student interns clinical experience in ocular disease detection, diagnosis, and management. Student interns work with optometric and ophthalmologic specialists in ocular disease issues.
• Optometrists working the MEC are residency trained (or equivalent) with specialties in eye disease. Ophthalmologists are specialists in a sub-field of ophthalmology.
• Specific ophthalmologic sub-specialties include cataract surgery, glaucoma, retina, and cornea. Ocular disease detection, diagnosis, and management are taught through direct patient exposure and seminar programs.
• Student interns perform special examination procedures such as gonioscopy, binocular indirect ophthalmoscopy with scleral indentation, visual field testing and interpretation, and macular function testing.
• Minor surgical procedures such as eyelash epilation, ocular foreign body removal, and punctal plug insertion may be performed by student clinicians. Minor surgical procedures such as chalazion removal, laser treatments, and simple oculo-plastic procedures are routinely performed by our staff ophthalmologists and observed by student clinicians.

Patient Services

• The MEC is a referral clinic specializing in ocular health disorders.
• Referral sources include other UCBSO clinics, the UCBSO Tang Center satellite clinic, the University Health Services clinics, local private practice optometrists, and local non-ocular medical practitioners. Patients who call or present with a suspected ocular health concern may be placed in the MEC without professional referral.
• The MEC is responsible for emergency care and MEC faculty and/or residents answer a 24-hour ocular emergency phone line. Other patient services offered on-site include:
  • Anterior segment and fundus ocular photography – including 35mm slide and Polaroid.
  • Retinal nerve fiber layer analysis by retinal imaging.
  • Minor ocular surgical procedures.
  • Retinal fluorescein angiography.
  • Argon laser photocoagulation for various ocular disorders.
  • Pre-operative and post-operative management of laser refractive, SLT and Yag surgery patients.
  • Pre-operative and post-operative cataract surgery care. Cataract surgery may be performed by a MEC faculty member at an off-campus surgery center.

Referrals and Appointments

• In-house referral criterion. General criteria for patient referral to this service may include, but are not limited to, the following:
  • Patients with unexplained vision decrease.
  • Patients with ocular health-related anomalies requiring evaluation beyond the scope of a primary care examination.
  • Patients with symptoms suggesting an ocular health-related problem.
  • Patients with symptoms or history of non-ocular disease which may affect the eyes or vision.
  • Patients taking or having taken medications which may have adverse visual or ocular effects.
  • Any patient deemed suited to the MEC by a Clinical Instructor.
• For a same day referral:
  • The Student Clinician and/or the Clinical Instructor are asked to speak directly with a member of the MEC faculty.
  • A complete work up prior to referral is appreciated although at times this is not possible or prudent.
  • We encourage the referring Student Clinician and the Clinical Instructor to make a tentative diagnosis and treatment plan prior to consultation, but ask that discussion of these issues with the patient be limited.
  • After a brief discussion, the patient will be escorted to the MEC waiting area by the referring clinician.
  • All medical consultation, treatment, and follow-up will take place at this single location unless otherwise determined by MEC faculty.
• The MEC is also available for informal same-day consults and is available to give opinions on findings that may be unusual but not necessarily pathological.
• Most ocular photography or other special testing does not require a separate appointment and is performed after briefly discussing the case.
• Appointments:
  • To schedule MEC appointments for another day, please first discuss the case with a member of the MEC faculty prior to making an appointment. This will insure a timely examination and patient placement in the appropriate clinic.
  • Referring clinicians are encouraged to visit our clinic to observe their patient’s work up.
  • Appropriate introductions also help maintain the continuity of care.

Ocular Health Exam

• Patients seen in the MEC demonstrate a unique and often complex array of ocular health conditions; therefore, examination procedures are tailored to the particular patient.
• A problem-based examination style is required and a testing sequence determined after a thorough patient chart review.
• Refraction is typically not performed in this clinic unless necessary and time allows.
• Patients referred by local optometrists are not to be given spectacle or contact lens prescriptions.

Educational Objectives

• Develop a high level of clinical competency in the use and interpretation of various techniques for ocular disease detection and diagnosis.
• Develop a high level of technical competency and proficiency in the diagnostic evaluation of various ocular diseases and anomalies using available techniques of ocular disease evaluation.
• Develop proficiency in devising and applying logical and appropriate diagnostic strategies and using these strategies to arrive at an accurate diagnosis.
• Develop patient management and communication skills specific to ocular disease patients.
• Develop strong inter-professional and intra-professional communication skills as they relate to ocular disease conditions.
• Develop awareness and understanding of a wide variety of important ocular health conditions through direct patient exposure and a seminar program.
• Develop a working understanding of currently available topical and systemic medications used for the treatment of eye disease. This includes basic pharmacology, indications, contraindications, possible side effects, drug interactions, and alternative therapies.
• Develop an ability to appropriately manage ocular disease pharmacologically and otherwise.
• Develop an understanding of ophthalmologic and surgical treatment of eye disease that is beyond optometric scope of practice.

Faculty Responsibility

• Assist Student Clinicians in developing a diagnostic plan for evaluation of each individual patient, insuring that the rationale is understood and the specifics carried out.
• Provide guidance in areas or procedures where the Student Clinician expresses or demonstrates a need for assistance.
• Demonstrate certain diagnostic procedures and techniques that may be infrequently utilized by the Student Clinician.
• Repeat certain diagnostic tests pertinent to the evaluation and diagnosis to check clinical performance and insure high quality patient care.
• Discuss the case with the Student Clinician and assist in forming an accurate diagnosis, differential diagnosis list, and management plan.
• Actively participate in delivery of care and patient consultation thus ensuring high-level patient care and giving Student Clinicians the opportunity to learn by example.
• Review and sign each patient record after exam completion and assist Student Clinicians with proper medical record keeping.
• Accept professional responsibility for patients seen with a Student Clinician under said Faculty Member’s supervision. This may include communication with other health professionals, phone calls to patients, and occasional after-hours examinations.
• Provide time for consultation with other Faculty Members or Student Clinicians regarding evaluation, management, and related issues of patient care.
• Perform examinations on patients without the assistance of Student Clinicians when appropriate or for clinical educational purposes.