Bad Eyes?

Explaining an eye exam to the youngest patients.

By Gale S. Pollock, Major General (Ret), CRNA, FACHE, FAAN

As our young patients come in for care, they are often afraid—but not willing to initially admit or discuss it. They think they are the only ones nervous about having their eyes examined or what it will mean.  In this short story, a young boy learns a few details about his eye and eye exams; this allays his anxiety.  Print and provide this story to your patients before their exam.  Show them a picture in the exam room of the eye so they can see that you have that information there for them as well.  A cooperative patient allows you to do the best evaluation possible for them—help them to help you.

Joan arrived at her best friend Mike’s house early that morning. They were hoping his Dad would drop them at the skate park again on his way to work that morning. It had been their habit since school let out for the summer to get there early. They enjoyed being there before the park was crowded and before it was miserably hot. But Mike was sitting, head in hand, looking worried.

“What’s wrong?” asked Joan, as she sat down beside him on the step.

“I can’t go skate tomorrow,” Mike said. “I have to go to the eye doctor. I heard my Dad say that maybe the reason I fall so often when I skate is that my eyes are bad. How can an eye be bad? I know I can be bad, but my eyes?”

Joan laughed and tried to cheer him up. “Did you try telling him you fall because you are a horrible skater? Or that I fall more often than you? Anyhow, I don’t think you should worry. My sister is an eye doctor. They are called ‘ophthalmologists’ because they study the eye. Let’s go talk to her; she came over this morning to talk with my Mom! Bring your board. We’ll skate on the streets if we can’t go to the park!”

After blasting down the streets over to Joan’s, they found her Mom and sister in the kitchen talking.

“Katrina, you need to help us,” Joan said to her sister. “Mike has to go to the eye doctor tomorrow. His Dad is worried that he falls a lot when we skate.” Rolling her eyes, Joan continued, “Mike didn’t tell his Dad he is just a crappy skater!”

Katrina smiled. “Of course I can talk about your eyes,” she said. “I love helping people understand how important the eye is for each of us. Mike, how old are you?”

“I’ll be eleven on my next birthday, in October.”

“Usually, when a boy your age is having trouble with his eyes—or his parents or teachers think he is—it is easy for us to help him,” Katrina said. “Most important for you to know is that the eye exam will not hurt. Your eye doctor will use different types of lights and computers to examine your eyes and will ask you questions about which picture, letters, or numbers look best to you. They will use your answers to help them understand what your eye is seeing or not seeing so well. Depending on what they learn, they will make some recommendations to help you to see better.

Figure 1. Simple eye schematic.

“Do you two know the eye has lots of parts?” she continued. “If any of those parts are not working right, the eye does not see correctly. But most of the problems are easy to fix for someone your age, Mike.”

Katrina got out a piece of paper and started drawing. “OK, first we have the entire eyeball,” she said after a moment. “The eyeball itself is a like a balloon. Air or water can fill a balloon, but a special substance that looks like soft Jell-O fills the eye. It is called the vitreous.

“The front of the eye has an area that acts like a clear protective shield; that is called the cornea.

“Behind the cornea is a part we can see on other people, or on ourselves in the mirror, called the pupil. That is the black spot that gets larger or smaller depending on how much light there is (Figure 1). When there is a lot of light, the pupil gets smaller: It constricts. If the light is weak, like at dusk when the sun is very low in the sky, the pupil opens to allow more light into the eye.

“Another part of the eye that we can see in the mirror or by looking at someone else is called the iris. Mike, your iris is brown, and Joan’s is green. The iris controls the size of the pupil (Figure 2). The white portion of the eye that you can also see on one another is the sclera.

Figure 2. Photos of pupil, dilated (A) and constricted (B).

“Behind the pupil and iris is the lens of the eye. That allows us to focus on different things; it changes shape so we can focus on objects up close or far away. Almost at the back of the eye is an area called the retina. It is tissue that is very sensitive to light, and people say it acts like film in a camera.”

Joan and Mike both laughed. “We use our phones as cameras. There’s no film in them!”

Katrina laughed, too, and said, “Explaining cameras might have to wait for another day. Let’s focus on the eye today! In the center of the retina is a gathering point for the images that is called the macula.

“Then, at the very back, the eye has what looks like a tail,” she went on. “That tail is called the optic nerve. The optic nerve is what sends the image or picture of what we see to our brain, to a special area called the visual cortex. This information is then processed by our brain and helps us make decisions. For instance, if you saw someone speeding toward you in the skate park, you would quickly move away so they would not run into you!”

Finally, Katrina said, “Since your visit to the eye doctor is tomorrow, why don’t I come over after work, and we can talk about what tests you had done. Then, if they made a recommendation because there is a problem with your eyes, I can help you understand that.”

“Deal,” said Mike. “Thanks so much for helping me to understand some things about my eyes. I bet I have questions tomorrow. Today I want to skate and think about … the cornea, the iris, the pupil, the lens, the retina, the macula, and the optic nerve.”

“What about the vitreous?” Joan said, laughing. “If it’s like soft Jell-O, you should remember that. You are always hungry!”

“Thanks, Katrina,” Mike said. “See you tomorrow. Let’s go, Joan!” n

Gale S. Pollock, Major General (Ret), CRNA, FACHE, FAAN
• Advanced Leadership Fellow at Harvard University, 2011
• Representative for United States and Canada for Impactwear International
• Independent Associate, Viridian
• (703) 969-3383