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Global Ophthalmology ( GO ) Guide, Third World, American, Yag Iridotomy, Repair of Broken Slit Lamp, Cigarette Lighter for Cautery, Pupillary Ruff


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     I would recommend the Global Ophthalmology ( GO ) Guide website < www.aao.org/GOGuide >: topics concerning developing world ophthalmic issues, Vision 2020, developing world ophthalmic epidemiology, volunteer opportunities, presentations, and much more. Check it out.
     My suggestion is don't say "Third World ". The term is actually a left over from the cold war era. First world was the States and its allies ( NATO, etc. ). The second world was the Soviet Union and its allies ( Warsaw Pact, etc. ). Everyone else was lumped into the "Third World". Some folks in the developing world ( middle-income and low-income ) resent the term. If you use the term "third world ", you might unintentionally be sending a message about yourself.
      My suggestion also is don't say " I'm from America". I suppose it doesn't matter if you are in Europe, Africa, or Asia but if you say that in Latin America, you might be turning someone off. Many, many years ago when I was living in Guatemala distributing Ivermectin for Onchoceriasis control, I was invited to the home of the CEO of a local ophthalmic NGO.  She brought up the subject and pointed out to me she was also American -- just not North American but Central American. Perhaps it's no longer an issue but I try not to use it.
       If you are using a Yag  laser to do an iridotomy, pupilloplasty, etc. be sure to set the Yag at zero defocus. If you are trying to blast through an iris crypt, you don't want the laser defocused. Don't forget the pilocarpine 2-4 % x 3 pre-laser.
        Can use a cigarette lighter to heat up a muscle hook to obtain hemostasis for lid procedures, etc. Better than a candle which leaves a carbon deposit ( film ).
        Often a good way to examine a pupil is by looking with a slit lamp. Have the slit light focused on the lateral limbus and quickly bring the light into the visual axis pupil area. If you have a sluggish response on one side and a brisk response with the other pupil then probably you will also have a RAPD. Can also just have the slit lamp totally off and then switch on the light already focused on the visual axis area of the pupil. Compare to the other pupil. Often you get a better look at the pupil and the response looking with a slit lamp rather than just an external exam.
         The pupillary ruff should be equal on both sides. There is a lot of variation in the appearance / prominence of the pupillary ruff but it should be fairly symmetrical. About the same  amount of clumps / lumps of the posterior pigmented layer on both pupillary margins. An atrophic / absent pupillary ruff strongly suggests that eye had a previous problem - acute IOP spike (  ? glaukomflecken ), iritis ( ? retroillumination defect ), trauma (  ? mydriasis / pigment dispersion ), etc. Often subtle but can be helpful with the diagnosis.
          If you find a slit lamp not working in the developing world often you can just take the top portion back to the States for repair. If the problem is related to the wideth or length of the slit light ( beam ) or if you are just getting a blue light but not the white light then unscrew the top ( see photo ) and you can have it repaired in the States and later send it back overseas. Save the two screws.

                                                                                                                                               Peace, Baxter
Baxter McLendon
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