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