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Slit Lamp Biomicroscopy &

Volk Lens Binocular Indirect

Ophthalmoscopy

Competency Lecture for

Scottish Eye Examination (Updated 2015)

New Contract for Scotland

in 2006

Significant changes to the Scottish Eye

Examination GOS regulations

GOS

regulations

(as at 07/12/15)

New Contract for Scotland

in 2006

External examination of the eye using slit lamp

microscopy and appropriate diagnostic agents

Fluorescein sodium

Rose bengal

GOS

regulations

(as at 07/12/15)

GOS

regulations

(as at 07/12/15)

GOS

regulations

(as at 07/12/15)

Why?

Magnification can be varied

Condensing lens power

Slit lamp control

Binocular view aids diagnosis

Power of slit lamp illumination aids viewing of

fundus image in the less optically clear eye

What about the younger

patients? Direct ophthalmoscopy is acceptable

Slit lamp BIO is possible with a 3mm pupil

Binocular viewing requires a minimum of 5mm

High powered condensing lens will work more readily

with small pupils

Undilated examination is possible with younger

patients

Pupil dilation

Tropicamide 0.5%, 1%

Blocks sphincter muscle

Phenylephrine%, 2.5%

Stimulates dilator muscle

Not usually adequate as sole drug for slit lamp BIO

Explanation and advice to

patients

A record of all drugs administered to the patient

should be included in the patient notes

Ideally an information sheet should be handed to the

patient when they leave the practice. It should include

information about the normal to be expected and the

length of time these may last

College of Optometrists

Advice for good practice

Publications/Other guidance and advice/installation of

eyedrops

Includes advice notes to be given to patients following

drop installation

www.college-optometrists.org members area

College of Optometrists

guidance

College of Optometrists

guidance

Record keeping

standards are

essential – you may

have to rely upon

them in any dispute.

College advice and

literature in

members only area

Slit lamp BIO procedure

Low mag around 10x initially

Narrow slit – approx 2mm wide

Illumination and observation axis at 90 degrees to

corneal apex

Focus on corneal apex

Add condensing lens close to cornea- stabilise on

brow with fingers

Pull slit lamp back observing for red reflex

Focus image of fundus by moving slit lamp

Slit lamp BIO procedure

•The image is formed between the observer and the

condensing lens

•This image is both inverted and reversed

Slit lamp BIO procedure

Slit lamp BIO procedure RE

Mid peripheral retinal

viewing

As per direct ophthalmoscopy

The same patch of retina is illuminated in BIO

as in direct ophthalmoscopy

BUT you view this patch of retina as an

inverted reversed image

Condensing lenses

Availability and choice

Retinal view

Approximation of view with

90D condensing lens and 10x

slit lamp mag

Approximation of view with

60D condensing lens and 10x

slit lamp mag

Condensing lenses

wide field low magnification lenses; generally more

suitable for small pupil exam

90D classic

Superfield

Super Vitreofundus

Superpupil XL

Digital Widefield

Condensing lenses

reduced field higher magnification lenses; generally

more suitable for detailed exam, particularly of disc

and macula

60D classic

78D classic

Super 66 Stereo Fundus lens

Digital 1x Imaging Lens

Practice makes perfect!

Select condensing lens appropriate to the task

- best to have 2 lenses: 1 x low mag

1 x high mag

Go for it – it will become quick and easy with

practice!!

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