HOW TO CHART THE SCLERA
Before putting ink to paper, there are a number of considerations we must discuss. So, just read these simple instructions and you will be able to draw an accurate chart!
1. PERSONAL HYGIENE
Wash your hands thoroughly before touching another person's eyelids.
2. LIGHTING
The best light for charting is NATURAL DAYLIGHT.
Cloudy days and rainy days are fine for charting. It's the quality of light that's important. Artificial lighting distorts the reading because it will bring old lines out more prominently thus making them look more relevant.
"Bringing old lines out," means the lines deeper in the layers of the sclera (which are not of current concern) will show up more, and the Sclerologist will become involved with conditions that body has already healed. [Lines which have "faded" have actually recessed into the deeper layers of the sclera.]
Some Sclerologists will chart at night under full spectrum lightning and try to compensate for the lack of natural light by careful observation. Obviously it's the practitioner's choice.
Most Sclerologists prefer to sit in front of a window with their backs to the window. This way there is a good supply of indirect, natural light.
Some Sclerologists use a little magnifying glass with a built in light to read the sclera. This can be helpful in a low light situation such as a rainy day. Some like to wear reading glasses that magnify thus making the sclera an even larger surface to view. The Sclerologist can look at the eye in natural light and compare it with the lighted magnifying glass if so desired. I natural daylight, the lighted magnifier does not alter the reading.
3. SEATING ARRANGEMENT
Charting is a simple procedure. The client can stand, sit on an examination table, or sit. Most Sclerologists have their clients sit as it is more relaxed and it creates a lap, which can be useful for holding various papers (agreement, lab reports, questionnaires, etc.).
It is important to be level (see eye to eye) with the client. This helps get the lines plotted in the right zone. The client's head should be straight, not tilted. The Sclerologist may change the angle of observation by adjusting his or her body in order to see higher up into the head quadrant. Usually a seated position helps the practitioner's and client's eyes level out.
If the practitioner is right handed, the client should sit facing the practitioner and to the left.
If the practitioner is left handed, the client should sit facing the practitioner and to the right. This allows the proper hand to be free to draw the lines while the other hand lifts the patient's lid or hold a clipboard with the chart. (This is demonstrated on the video portion of the ISI Certification Course.)
To be sure this is communicated well, if you sit directly in front of a person, your knees will touch. Thus you move your knees past the person to sit closer. A right-handed practitioner will have the client on the left and thus be on the right side of the client. A 45º rotation of both the practitioner's and the patient's hips will put the two people face to face, close, without the knees bumping. Once face to face, and eye to eye, an accurate chart can be quickly drawn.
Arrange the chairs so the indirect light source is behind the practitioner's back. There should not be a light shining in the client's face.
4. GET THE "ANGLES" STRAIGHT
Sit close so you can see "eye to eye" straight on, not at an angle. The practitioner will be off to one side to be closer rather than "knee to knee". But turn to look straight on at the client. This helps prevent misplacing the lines and getting the in the wrong zone.
Since the eyeball is a sphere, lines can be placed in the wrong zone if the client is looking askew. Think how the globe of the world looks different when spread out flat on a wall map. The practitioner must be aware of the angle in which the patient is looking. It is best to have the patient look up perfectly at 12 o'clock to chart the abdominal quadrants; directly at 3 o'clock and then 9o'clock to chart the opposite chest or neck quadrants, and exactly at 6 o'clock to chart the head zones.
It is easy for the client to look askew. If the client looks up at 1 o'clock instead of 12 o'clock, the lines can be improperly placed resulting in poor understanding of the client's case. Some Sclerologists have colored dots strategically placed on the ceiling and walls. Others will hold their charting pen in the air in the location where they want the client to look to provide them a target. Once the eye is in the proper position, it is simple to chart accurately.
5. CHART POSITION
Put a chart on a clipboard so there's a strong back for writing. Position the chart one of two ways:
1) Have the client hold the clipboard in front or on the lap. Usually holding the chart with two hands in front of the chest works well.
2) Some practitioners prefer to hold the chart in their own lap or with their non-writing hand. Whatever works for you. Note: be sure the client's name and the date are written on the chart.
6. COMMUNICATE YOUR INTENT
Inform the client that you (or the client) will be lifting the eyelids and that he or she will be looking where you designate. Other points to cover include: 1) It's OK to wear contact lenses, they won't hide any information or get knocked off. 2) It's OK to blink, 3) hold the vision steady by focusing on some distant object so the eye does not wander, 4) it won't take long, and, 5) whatever else is pertinent.
Many Sclerologists will rest a finger or a thumb on the client's cheek or temple as an anchor for steadiness as well as a sensory stimulus that takes the mystery out of "where is this person's hand near my eye." Thus it can bring reassurance to the client that the eye will not be poked, and relaxation regarding that. Now you're ready to chart.
7. CHARTING PROCEDURE
Most Sclerologist simply chart "around the clock". They lift the eyelid of either eye and have the client look straight down.
It's important to watch the iris as the client look straight down to verify that the eye is indeed STRAIGHT DOWN. Some people look off to the side when you say, "straight down". If this occurs, give them something to look at such as a paper on your lap or the cap of your pen so they are looking straight down. This ensures that twelve o'clock in the sclera is twelve o'clock on your chart and your lines are drawn in the right zone.
Chart the lines in that quadrant according to their "o' clock" points of origination and termination.
Then have the client look straight up ensuring the six o' clock sclera area is exposed directly at the bottom of the eye. Chart the lines in that quadrant.
Then have the client look straight left and straight right and chart the lines in those quadrants for each eye.
Occasionally you'll need to verify a line that falls in between the quadrants (i.e. 2:00, 4:00, 8:00, 10:00). Just hold your pen up where you want the client to look and keep looking while you verify a line or chart its actual pathway.
WITH AN ACCURATE CHART, A SCLEROLOGIST CAN PROVIDE AN INTERPRETATION AND INSIGHTS ON HOW TO IMPROVE HEALTH.
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