Lec 2: Fundus BIO Flashcards
Dilated exam IS part of a comprehensive exam in order to bill what two codes?
92004 (new)
92014 (established)
Refraction and binocular assessment alone does not complete a comprehensive eye examination. The patient MUST have a fundus assessment. This can be done dilated or not, with the preference of dilation. (T/F)
true
whats the difference b/w direct and indirect ophthalmoscopy?
direct: upright, non inverted image
indirect; anatomically in correct position
indirect: inverted, aerial image b/w examiner’s eye and condensing lens
techniques using direct views
goldmann 3 mirror with Hruby lens
direct ophthalmoscope
technique using indirect view
hand held condensing lens (inverted and reversed)
Preferred technique of posterior pole examination
fundus biomicroscopy
! Lens diameter > 90D
! Magnification >90D
! FOV <90D
! 8mm working distance
78 D
! Good with small pupil
! Small, ring design
! Fov ~30 – 40 degrees
! 7mm working distance
90 D
! Good “work horse” lens for biomicroscopy
! Preferred lens for undilated views
90D
! Preferred lens for glaucoma suspects and diabetic retinopathy
78D
! Small, diameter, >90D
! Designed to provide same mag as the 90D with >fov
! 7mm working distance
super 90
- specially designed for high res of posterior pole
- lens diamter > 78D
- Mag > 78D but designd to give same fov as 78D
- 11mm wd
super 66
pt with deep set eye
what lens should u use?
78D b/c it has a longer wd (super 66 would be great too)
! Ideal for posterior pole
! Diameter similar to 78D
! Fov similar to 78D with more mag than 78D
! 13mm working distance
digital high mag
! “Ultimate” 90, similar mag and much wider filed of view
! Working distance VERY SHORT at 5-6mm
digital wide field
The proper _____________ allows the back focus of the lens to be fixed right at the pupil, permitting the examiner to move the joystick and effectively scan the full field the lens provides
working distance
condensing lens
SET-UP:
! Medium - High illumination in click position
! 10x
Using 90D or Superfield start with 10x-16x
Using 78D stay 10x
! Parallelepiped beam height 5-6mm
! For HS BQ900 use Polaroid filter ON and aperture 1-3
- Focus on pupil (iris in focus)
- Put lens in place holding it perpendicular to light
- From outside of scope SEE the light go thru the pupil
- While looking thru oculars pull the scope back [holding hand very still] until see image
- Continue to pull back until image in focus
musts for how to fundus biomicrosopy
You are examining OS and superior-temporal arcades. The view is lost as you reach the outer limit of the 90D lens. Your corrective maneuver is to move where?
examiner’s left
Why does this work?
Ans: your views are inverted and reversed
o Macula and optic nerve
o Superior and inferior vessel arcades
o Temporal vessels arc around the fovea on their way to the periphery
o Nasal vessels radiate straight from the disc to equator
posterior pole
It is important to keep your views CENTERED in the lens. Accomplish this by doing what?
moving your lens and/or asking the patient to make slight fixation adjustments
if you want optic nerve to move to your left, where do we tell the patient to look?
slightly to their right
If you are scanning across and reach the outer limit of your lens diameter, the corrective maneuver is to do waht?
move your lens IN the direction of your scans
o Long posterior ciliary nerves at 3 & 9 o’clock represent the anatomical horizontal meridians
o Divides the retina into superior/inferior
horizontal meridian
o Short ciliary nerves seen between 10 and 2 as well as 4 and 6 o’clock represent the anatomical verHcal meridians
o Divides the retina into nasal/temporal
vertical meridian
– Vortex ampulla are located just posterior (~3mm) to the
ORA
– There are at least 4 to 6 vortex veins (ampulla) – Located in the 1, 5, 7, 11 o’clock meridians
anterior/posterior retina
anterior/posterior retina is divided by what?
the equator
– The junction between the retina and ciliary body – Nasal ora appears “serrated”
ora serrata
layers towards the choroid/sclera
outer
layers towards the vitreous
inner
near the front of eye, closer to ora serrata
anterior
near the back of eye, closer to posterior pole
posterior
if pt looks up, where do we tilt lens?
bottom of lens towards pt
All views are inverted and represent the view of an angle or area of retina 180 degrees away
all mirrors in 3 mirror goldmann (not Hruby lens)
- stereoscopic exam of retina
- stable view of post pole
- magnified view of peripheral ret
- performed AFTER PERIPH RET EXAM WITH BIO
3 MIRROR fundus indications
! Severe corneal surface disease
! Recent eye surgery
! Complications of trauma
◦ Hyphema
◦ Corneal Laceration
◦ Globe perforationcontraindications of 3 mirror
posterior pole (PP) views
central lens (hruby)
equator to PP (“mid-periphery”)
trapezoid
equator to ora (‘Periphery”)
rectangle
CB, pars plana
gonio mirror
The D-shaped/thumbnail mirror may be used to view what?
pars plana with widely dilated pupils
- Focus on iris around pupil
- Move light into mirror of interest
- find orange glow
- push in and scope v. pull back
slit lamp set up same as gonio and 78/90D
