Have you ever been frustrated by your inability to get a good funduscopic exam in your ED? In today’s times of hallway patients and double bunking, I think we’ve all been frustrated by lack of darkness. Also, the question of dilating everyone whose eyes you may wish to peer into can be an issue. So, what’s a pit doc to do?
Welch Allyn has tried to answer this question with the PanOptic Opthalmoscope. For those of us with a limited technical background, the basics are simple. This device just swivels onto the head of a regular WA light handle (either battery or wall powered) and emits a beam of polarized light towards the eye of your patient. The combination of the polarized light and its wider view allow you to see a lot of the retina - usually without dilating the pupil. The Welch Allyn PanOptic opthalmoscope has reopened my eyes to the eye. It’s comfortable to use, portable (in fact, they are well known to walk away from EDs), blacks out the ambient light to facilitate a good exam, and really lets you get the job done. Their product specs say it offers a 25 degree field of vision, compared with five degrees for a normal scope. The diopters are adjusted continuously by an easy to reach dial, and you can change light colors and apertures with a simple adjustment that is easily reached without “losing your spot.”
On my last shift I used it for several patients and saw much more of the fundus than I could see with a normal scope. Although I do take the 25 degree field of view claim with a grain of salt, I realistically get at least triple the field of view a normal scope would get. The only real issue I have is the “boot” that covers the patient’s eye. You have to clean it, and it can disappear. Even without the boot, the PanOptic is still far superior to a regular opthalmoscope. I had a second-year resident naive to the device use it recently, and his first quote was “awesome.” My informal house staff and medical student poll was all positive. The physical layout of the controls is nice and you can manipulate all of them without moving the patient’s head or interrupting your vision. I also like that it provides more physical distance between me and the patient. One can comfortably examine both of a patient’s eyes with a single eye. No more awkward leaning in, no more of the patient knowing I had a garlic bagel for breakfast.
We have been using the product in our ED for about three years now, and I consider it an essential part of our tool kit. It is not often that an emergency physician really needs to do a funduscopic examination, but when you do, you do. The PanOptic lets that happen in a hallway, curtained ward area, or a dark room. I sincerely believe that it is a quantum leap forward in our assessment capabilities. I have seen interesting findings that I rarely if ever saw before in a busy ED, and I can see them without dilating the pupils. At a cost of $600, I think it is worth the investment. Given their ability to walk away from a busy ED, I can say that someone else agrees with me. This is one of a rare few products that I unreservedly recommend.
The author has no financial relationship with Welch Allyn or any of their distributors.
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