Web sites of interest:
Welch Alleyn www.panoptic.welchallyn.com http://www.welchallyn.com/medical/ go to
“optometry student” menu drop down
Red Atlashttp://www.redatlas.com
Funduscopy Techniques/instruments
Direct Ophthalmoscopy
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Fundus Contact Lens
Direct OphthalmoscopyAdvantages Portable Easy to use Upright image Magnification 15x Can use w/o dilation
Disadvantages Small field of view Lack of stereopsis Media opacities can degrade
image
PanOptic Ophthalmoscope
Manufacturer: Welch Allyn
Increased field of view & mag
Increased working distance
Hand held but less portablewww.panoptic.welchallyn.com
Indirect Ophthalmoscopy
Monocular or binocularAdvantages: Wide field of view Binocular instruments
provide stereopsis
Disadvantages: Requires more skill Decreased magnification
(3x) Requires dilation Inverted image
Fundus Biomicroscopy
Field of View & Mag: FOV <indirect but
>direct varies w/lens & slit
lamp mag
Inverted imageStereopsisDilated pupilRequires skill
Fundus Contact LensRequires physical contact w/eye
Viewed w/Biomicroscope
Advanced dx & surgery
Field of view & Mag vary w/lens design
Direct Ophthalmoscopy: Basic skills
Optics: Illumination system Magnifier
Hyperopes myopes
Observation system Lens wheel Apertures
Direct Ophthalmoscopy: Basic skills
Viewing ocular media Observe red reflex Look for media
opacities Cataracts Corneal scars Large floaters
Direct Ophthalmoscopy: Basic skills
Proper position for central fundus viewing
Right eye to right eye
Left eye to left eye
Don’t rub noses…
Direct Ophthalmoscopy: Exam technique
Be systematicStart at optic disc & work radiallyObserve:Optic disc: C/D ratioVessels: course & caliber, AV ratio, light
reflex, crossings/bankingMaculaPeripheral fundus
Direct Ophthalmoscopy: Basic skills
Clinical pearlsFOV incr. when closer to Pt. Larger pupil increases FOV Contact lensesCheck lens wheel– watch accommodation
Blood Vessel Evaluation
Observe:Vessel diameterShape/tortuosityColorCrossingsLight reflexArtery/Vein (A/V) ratio: after 2nd bifurcation
Hypertensive Retinopathy
Scheie classification:I: Thinning of retinal arterioles relative
to veinsII: Obvious arteriolar narrowing w/focal areas
of attenuationIII: Stage II + cotton wool spots, exudates &
hemesIV: Stage III + swollen optic disk (similar to
papilledema)
Arteriolosclerosis
Increased light reflex (1/2)
“Copper wire” arterioles
“Silver wiring” arterioles whitish appearance w/continuing sclerosis
Increased A/V crossings
Top Related