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Tips and reassurance for colour vision deficient optometry students

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Dasun (R) looking through the slit lamp

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By Dasun Liyanapathirana
University of Melbourne (OD4) optometry student

When I first started optometry, I had no idea if being colour vision deficient (CVD) would impact my clinical competency.

However, it soon became apparent when performing the simplest of screening tests – Ishihara.

While I was guided to use memory and recall to overcome my CVD, University of Melbourne optometry lecturer Dr Kwang Cham, who was then the year one pre-clinical co-ordinator, rightfully advised me that later in the course differentiating between a haemorrhage and pigment would not be as easy as using the answers provided at the back of the Ishihara test.

During my final year clinical placement, I was flagged after missing two mid-periphery haemorrhages in an elderly stroke patient. On another occasion, I described a flame haemorrhage as a retinal pigment during a diabetic review.

I questioned whether it was because I did not do a thorough dilated retinal examination, or because I simply missed them because of my CVD.

My inability to detect haemorrhages and discern a retinal haemorrhage from pigment made me question my suitability as a future CVD-affected optometrist.

Dasun Liyanapathriana

Dasun Liyanapathirana

Doubts had started to set in and losing my self-confidence was neither ideal nor pleasant. 

Recognising that I needed to seek help and wanting someone to talk to, I turned to my advisor, who coincidentally was Kwang again. Knowing his ‘confrontational tough-love’ approach, I knew I needed to come up with some solutions before this meeting and find ways to address these deficits. Striving to be an independent, self-regulated and reflective learner, I could not possibly expect to be spoon-fed and reliant on someone else.

A quick literature search resulted in a commentary entitled Confessions of a colour blind optometrist in Clinical and Experimental Optometry that was written by the late Dr David M Cockburn, a renowned and pioneering Melbourne optometrist who is deuteranomalous.

A news article published by Optometry Australia in 2014 also showcased several optometrists with CVD including Dr Cockburn and Professor Anthony Adams.

These two articles provided valuable insights into optometrists with CVD.

The meeting with Kwang was enlightening. There was nothing new to learn at all; he merely reminded me of the discussions we used to have when I was learning fundus lens and binocular indirect ophthalmoscopy techniques. I had all the tips all along; I had just not adopted them routinely into my clinical practice.

Kwang asked me: ‘How do you expect patients to have trust in your care when you do not have any confidence at all?’

I had no time to waste and needed to pick myself up fast.

eye exam

Dasun (R) looking through the slit lamp

Critical strategies

Since then, I have incorporated two critical strategies that have made my consultations more efficient and effective. They are:

(1)    Red-free filter - It enhances the contrast between the retinal background and the area of interest. Haemorrhages tend to look darker with the red-free filter than pigment;

(2)    Siltlamp setup – I cannot emphasise enough that having a stereoscopic view, together with max intensity and magnification as high as possible, will greatly assist in detection and differentiation between a haemorrhage and pigment.

Though I still have my ups and downs in the clinic, I have learnt to be transformative resilient, and that being CVD is not an ‘excuse’ when I do not perform to expectations in clinic anymore.

By sharing my experiences, I hope this will reassure current and future CVD optometry students.

With Dr Kwang Cham
University of Melbourne optometry lecturer

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