Funduscopy

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

http://www.panoptic.welchallyn.com/

http://www.welchallyn.com/medical/

http://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


Monocular or binocularAdvantages: Wide field of view Binocular instruments

provide stereopsis

Disadvantages: Requires more skill Decreased magnification

(3x) Requires dilation Inverted image



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


Viewing ocular media Observe red reflex Look for media

opacities Cataracts Corneal scars Large floaters


Proper position for central fundus viewing

Right eye to right eye

Left eye to left eye

Don’t rub noses…


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


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

BINOCULAR INDIRECT

OPHTHALMOSCOPY

condenser

Inverted Fundus Image

Practitioner

Patient

PD Reduction System

Condenser

Aerial image

BIO PrinciplePage 14.3

Practitioner

Patient

PD Reduction System

Condenser

Aerial image

Practitioner

PatientCondenser

AerialImage

Light reflecting from retina gathered by condenser

Aerial (real) image formed between examiner and condenser

Aerial image becomes the object for the binocular indirect ophthalmoscope

BIO Condenser

Less curved surface toward patient’s eye

BIO condensing lenses are biconvex, aspheric designs with one surface more curved than the other

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BIO Condensers

With the less curved condenser surface facing the patient, spherical aberration is reduced and the size of the (interfering) reflected image of the source is smaller

Steeper mirror; smaller reflected images

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Note the “Reflexes” from the Condenser

http://www.mrcophth.com/retinacases/retinoschisis2.jpg

Retinoschisis

Using the BIO From Nova SO

Headset correctly positioned

Optimizing viewing distance

Using the BIO From Nova SO

Optimizing viewing distance

Start out with the condenser close to the patient’s eye

Keeping it normal to the patient’s eye, slowly move the condenser away from the patient

Initially, bright white reflexes are seen

As the condenser is moved further out to the correct distance, the reflexes soften and the aerial image fills the condenser

As the condenser is moved further out to the correct distance, the reflexes soften and the aerial image fills the condenser

Initially, bright white reflexes are seen

BIO Lenses

Heine

Keeler

WelchAllyn

Keeler Wireless BIOs

Slit-Lamp BIO

Slit Lamp BIO

BIO Summary

The BIO Condenser: illuminates the patient’s retina

forms an aerial (real, inverted) image of the patient’s fundus

makes both practitioner’s pupils conjugate to patient’s pupil

Choosing a higher power condenser: requires a shorter object and image distance

increases the illuminated region of the patient’s retina

decreases BIO magnification (mainly due to closer object distance)

increases BIO field of view (mainly due to closer object distance)

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Health & Medicine

Funduscopy