What is funduscopy?And…
Why is it important to you?
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
Review of ocular anatomy
Retinal Layers
Optic Nerve Anatomy
Choroidal Vessels
Funduscopy Techniques/instruments
Direct Ophthalmoscopy
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Fundus Contact Lens
Why do we dilate pupils?
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
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Field of View & Mag: FOV <indirect but
>direct varies w/lens & slit
lamp mag
Inverted imageStereopsisDilated pupilRequires skill
Fundus Biomicroscopy
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: Basic skills
Proper position for peripheral fundus viewing
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
Normal Fundus
Viewing the Optic Nerve Head
Observe:SizeShapeColorMarginsCup to disc ratio (C/D) horiz & Vert
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)
Vessel “Crossings”
Normal crossing
Direction change
“banking’” or “nipping”
Arteriolosclerosis
Increased light reflex (1/2)
“Copper wire” arterioles
“Silver wiring” arterioles whitish appearance w/continuing sclerosis
Increased A/V crossings
Macula
Lies about 2DD (disc diameters) temporal to the optic disc
Should be avascular
May appear darker red than surrounding retina
Should see bright foveal reflex on younger pts
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