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Methods III - Block 10 > Binocular Indirect Ophthalmoscopy- lecture 1 > Flashcards

Binocular Indirect Ophthalmoscopy- lecture 1 Flashcards

1
Q

Indirect ophthalmoscopy involves making the eye highly _____ by placing a ____ power ____ lens where in accordance to the eye?

A

-myopic
-high
-convex (+13D to +30D)
In front of the eye

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2
Q

Indirect ophthalmoscopy creates what kind of image in front of the lens?

A

Real, inverted, and laterally reversed

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3
Q

Why is the technique called indirect?

A

B/c the fundus is seen through a condensing lens

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4
Q

Where is the image formed when performing indirect ophthalmoscopy?

A

Close to the principle focus of the lens, between the lens and the observer

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5
Q

Preliminary step when you perform BIO

A

Explain procedure to patient

Wash your hands

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6
Q

How should the headband fit for BIO?

A

Comfortably without undue tightness

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7
Q

Where should oculars be with the BIO on?

A

Straight and level

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8
Q

How do you want the eyepieces adjusted on BIO for maximum field of view?

A

As close to the eyes as possible, with a slight pantascopic tilt; avoid resting on bridge of nose

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9
Q

When you turn your BIO on, what do you want your rheostat at?

A

To about 50%

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10
Q

When you turn your BIO on, what size do you want your aperture set to?

A

Largest size

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11
Q

When you turn your BIO on, what filters do you want in place?

A

None

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12
Q

When you turn your BIO on, what do you want to set the mydriatic pupil setting to?

A

Maximum dilated

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13
Q

What adjustment knobs are on the right of your BIO?

A

Clear, red-free, yellow and blue filters

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14
Q

What adjustment knobs are on the left of your BIO?

A

3 aperture sizes plus diffuser

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15
Q

What do you view when adjusting your interpupillary distance on BIO?

A

View wall or other object (your thumb) at roughly 40 cm

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16
Q

How do you adjust interpupillary distance for BIO?

A
  • view obj at 40 cm
  • monocularly for each eye until the object is centered in the field of view
  • with both eyes open, a single clear binocular image of the object should be obtained
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17
Q

If diplopia is encountered, what do you do to adjust the BIO?

A

Make further adjustments to the PD until a fused img is achieved

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18
Q

How do you adjust the mirror height?

A

Adjust light vertically using the mirror until it occupies the upper half of the field of view

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19
Q

Available powers of condensing lenses

A

14D to 40D

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20
Q

Power of lens that is a good balance b/w magnification and field of view

A

20D

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21
Q

What general power of lenses offer a greater FOV and can aid with examination through small pupils?

A

Higher power lenses

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22
Q

The power of the condensing lens determines these 3 things:

A

Working distance
Magnification
Field of view

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23
Q

As the power of the condensing lens decreases, what happens to the field of view, working distance, and magnification?

A

FOV dec
WD inc
Mag inc

24
Q

A +30 lens power has what magnification?

A

2x

25
Q

A +30 lens power has what FOV?

A

60 degree

26
Q

A +30 lens power has what stereopsis?

A

1/2

27
Q

A +30 lens power has what working distance from cornea

A

26 mm

28
Q

A +20 lens power has what magnification?

A

3.25x

29
Q

A +20 lens power has what FOV?

A

40 degrees

30
Q

A +20 lens power has what stereopsis?

A

3/4

31
Q

A +20 lens power has what working distance from cornea?

A

47 mm

32
Q

A +14/+15 lens power has what magnification?

A

4.17x

33
Q

A +14/+15 lens power has what FOV?

A

30 degree

34
Q

A +14/+15 lens power has what stereopsis?

A

1

35
Q

A +14/+15 lens power has what working distance from cornea?

A

72 mm

36
Q

What power of lens is used to obtain a panoramic view when detail and stereopsis are not as important, and used with a small pupil?

A

30D

37
Q

Is your working distance less or more with a 30D condensing lens?

A

Less

38
Q

What power of lens is most widely used, since it provides an adequate field of view, stereopsis and magnification?

A

20D

39
Q

What power of condensing lens is most useful for detailed view of the macula or optic disc or for determining elevation of the retina in shallow retinal detachment?

A

15D

40
Q

3 important patient preparations for performing BIO, after washing your hands and explaining the test to the pt?

A
  • dilation of eyes
  • dark room when possible
  • have pt chair fully reclined, enabling practitioner to move around the pt and hence gaining a full 360 degree traverse of the fundus
41
Q

If you are looking at the super quadrant, where should you be looking from?

A

180 degrees in the opposite direction (inferiorly to the pt)

42
Q

What position do you recline you patient to?

A

Supine position (or in upright seated position) with the height to about waist high or slightly lower

43
Q

How do you hold the condensing lens?

A
  • grasped b/w tip of flexed index finger and ball of thumb
  • extended 3rd finger holds pt’s lid (thumb of opposite hand is used to retract the lid not held by the 3rd finger)
  • -3rd finger acts as a pivot that enables the observer to tilt the lens in all planes merely by rocking the forearm on the tip of the finger
44
Q

How do you obtain a view of the fundus with the lens?

A
  • Place lens close to eye to that lids, conj, and iris may be seen
  • Center pupil in lens
  • Gradually move lens away from pt, making pupil magnified until it fills the entire area of the lens
45
Q

If the img of the fundus does not fully fill the lens, what should you do?

A
  • move the condensing lens closer to the eye, recenter the pupil, then lift it again
  • adjust your head tilt to better distribute the light entering the patient’s eye
  • adjust the ophthalmoscope mirror up/down
  • adjust condensing lens laterally
  • adjust tilt of condensing lens
  • check for bino vision; readjust if necessary
46
Q

In which directions do you adjust the ophthalmoscope mirror and condensing lens if the img of the fundus does not fully fill the lens?

A

Mirror: up/down
Lens: laterally

47
Q

Where must the pupil be located in order to maintain a clear view of the fundus?

A

Pupil must be kept centered in lens at all times or fundus view is lost

48
Q

What do slight movements of the eye or hand off the pupil cause when observing the fundus?

A

Distortion, shadows, or complete loss of view

49
Q

How do you want your arm and head when observing the fundus?

A

Keep arm extended and head at arms length from the lens

50
Q

What can slight adjustments in working distance effect?

A

Changes in magnification, but larger changes will produce difficulties with accommodation, convergence, and possibly diplopia

51
Q

Slight tilting of the lens will displace reflections. What will excessive tilting of the lens induce?

A

Astigmatism that will distort the fundus img

52
Q

Light intensity that’s adequate for most needs?

A

Moderate light intensity

53
Q

Limit exposure to BIO light to how many seconds at a given time?

A

30 seconds or less

54
Q

2 options you can give the pt to refresh their tear film

A
  • give pt a chance to blink to refresh tear film

- use artificial tears to aid in comfort (mostly for elderly patients)

55
Q

Proper room lighting for BIO?

A

Dark enough for you to achieve sufficient contrast

-avoid too much ambient light

56
Q

What light intensity do you start with when using BIO?

A

Don’t begin with the brightest light; once the pt is accustomed to the light, you can gradually turn it up to double-check a selected area

Methods III - Block 10 (3 decks)

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