Lecture 1

Question 1

What is the primary function of a DFE?

Answer 1

to evaluate the peripheral retina in search of “rhegmatogenous” conditions - prone to tearing

Question 2

what are 2 advantages of a BIO?

Answer 2

quick assessment of entire retina and vitreous and stereoscopic examination

Question 3

what are 3 disadvantages of a BIO?

Answer 3

lower magnification than SLEx and direct (3x), requires a dilated pupil, and light is very bright for patient

Question 4

what determines the magnification during BIO?

Answer 4

the power of the condensing lens (moving closer to the patient will not increase magnification)

Question 5

what are some indications for BIO?

Answer 5

every comprehensive exam, flashes/floaters, myopia > 4D, systemic diseases

Question 6

what is a contraindication for BIO?

Answer 6

narrow angles = angle closure secondary to pupil dilation

Question 7

which patients are sensitive to Tropicamide (use caution)?

Answer 7

Down’s syndrome patients (sensitive to anti-cholinergic effects)

Question 8

what is the pupil dilation protocol?

Answer 8

review hx, acuities OD/OS, pupils (EOMs), SLEx (VH), IOP, gonio (as needed), pt education (ask allergies) and instill drops

Question 9

what is vasovagal syncope?

Answer 9

sudden temporary loss of consciousness caused by transient cerebral hypoperfusion as a result of drop in HR and BP (vagus n)

Question 10

when can vasovagal syncope occur?

Answer 10

when body over-reacts to certain triggers = eye drops, tonometry, gonio, BIO, etc.

Question 11

what are some vasovagal syncope symptoms (warning signs)?

Answer 11

nausea, pale, light-headed, warm, clammy/sweaty

Question 12

what is the vasovagal syncope treatment?

Answer 12

recline patient and elevate feet, alternate (sit with knees up and head between knees), take BP and pulse, alert lab instructor - keep in position until BP and pulse increase to normal

Question 13

what is the patient education for BIO?

Answer 13

“I am going to use this bright light to get a good view of the back of your eye and make sure that it is healthy”

Question 14

what type of drug is Tropicamide?

Answer 14

anti-cholinergic drug which blocks the sphincter muscle of the iris and the ciliary muscle resulting in dilation and moderate cycloplegia

Question 15

what are the percentages for Tropicamide and when are each used?

Answer 15

1% = brown eyes 
0.5% = shallow angles (used alone) and blue/green eyes

Question 16

what type of drug is Phenylephrine?

Answer 16

sympathomimetic drug causing mydriasis - also acts as a vasoconstrictor

Question 17

what percentages does Phenylephrine come it and which is used?

Answer 17

2.5% and 10% (use 2.5% for dilation)

Question 18

what is the dilation “cocktail”?

Answer 18

anesthetic (proparacaine or fluress), 2.5% phenylephrine and tropicamide

Question 19

what is the purpose of the anesthetic in the dilation cocktail?

Answer 19

prevents burning and watering (which flush the drug out) and creates a more permeable corneal surface (loosens tight junctions)

Question 20

why is Phenylephrine not used alone to dilate?

Answer 20

doesn’t produce as much dilation as Tropicamide and doesn’t induce any blur (cycloplegic)

Question 21

what are the symptoms of an overdose of tropicamide?

Answer 21

headache, fast heartbeat, dry mouth and skin, unusual drowsiness, and warmth/redness of skin

Question 22

what are some side effects of phenylephrine?

Answer 22

dizziness, fast/irregular/pounding heartbeat, increased sweating, increase BP, paleness, and trembling

Question 23

what side effects should be explained to the patient before dilation?

Answer 23

blur near&raquo_space; distance for 2-6 hours, photophobia, may wish to have a driver and cycloplegia may wear off before dilation of pupil

Question 24

what should you record after dilating a patient?

Answer 24

which drop, how much, which eye(s), and what patient ed was given

Question 25

what happens when you increase the dioptric power of a condensing lens?

Answer 25

increased FOV, decreased magnification, and decreased working distance (the lower power lens = farther away from eye)

Question 26

which condensing lens gives the best balance between magnification and FOV?

Answer 26

20D

Question 27

which lens has a diameter and magnification similar to the 20D?

Answer 27

2.2 pan-retinal (25.5D)

Question 28

what is the working distance for the 20D lens, 2.2 pan-retinal and 28D lens?

Answer 28

``` 20D = 50mm 2.2 = 40mm 28D = 33mm ```

Question 29

what is the image magnification for the 15D, 20D, 30D and "2.2" lens?

Answer 29

``` 15D = 4x 20D = 3x 30D = 2x 2.2 = 2.5x ```

Question 30

what is the FOV with a 20D lens?

Answer 30

about 8 disc diameters (inversely related to magnification)

Question 31

how many disc diameters is the direct?

Answer 31

2 DD

Question 32

what is the distance from the optic nerve head to the macula?

Answer 32

2-3 DD

Question 33

which side of the lens faces the patient?

Answer 33

the side with the silver ring or the pointed side of the "V" on VOLK (open side faces you) = less convex surface towards patient

Question 34

what is it called when you pull the lens towards you until the entire lens fills with a view of the fundus?

Answer 34

tromboning

Question 35

what is the distance from lens to examiner for "tromboning"?

Answer 35

about 16-20 inches

Question 36

what 2 parts of the retina can you fill the entire lens with a view of the fundus?

Answer 36

posterior pole and mid-periphery

Question 37

how do you know if your optical bench is aligned?

Answer 37

the front and back surface reflections are aligned

Question 38

how do you know if you are at the correct "tromboned" distance?

Answer 38

there should be a pinpoint light on the cornea (center of pupil) and entire lens is filled

Question 39

what should you do each time you have the patient look in a different direction?

Answer 39

move yourself to maintain a position about 180 degrees from the patient's fixation

Question 40

what is the set-up for viewing the superior and inferior retina?

Answer 40

``` superior = examiner sitting inferior = examiner standing or seated with stool raised ```

Question 41

how many views are there for the periphery and how many for the pole/mid-periphery?

Answer 41

8 peripheral and 4 posterior pole/mid-periphery (overlap with scanning)

Question 42

what are the 8 peripheral views?

Answer 42

temporal, superior temporal, superior, superior nasal, nasal, inferior nasal, inferior, and inferior temporal

Question 43

what is the view within the condensing lens?

Answer 43

upside- down and reversed left to right

Question 44

how do you know what part of the retina you are studying?

Answer 44

where the patient is looking = retina you are studying

Question 45

if you are looking at superior retina and the vortex veins are centered in lens, which edge will the ora serrata be near?

Answer 45

near the edge by your thumb (equator will be near index finger)

Question 46

why might you see double with the BIO?

Answer 46

``` vertical = BIO is tilted on head horizontal = incorrect PD ```

Question 47

what is a major landmark for the equator?

Answer 47

ampulla (spider like)

Question 48

what two areas mark the periphery of the retina?

Answer 48

periphery = between ora serrata and equator

Question 49

what 4 things do you record if you see something in the retina?

Answer 49

which eye or both, anatomical location (use clock positions), size and shape (size in DD), and contour (flat or elevated)

Question 50

what do you record if everything looks normal in retina?

Answer 50

Record OD and OS separately (not OU) = flat and intact, no holes, no tears 360 degrees

Question 51

what type of lens is a condensing lens?

Answer 51

double aspheric with a multi-layered anti-reflective coating

Question 52

what do BIO's have that helps relax the accommodation of the examiner?

Answer 52

convex lenses built into the eyepieces (range from +1.75 to +2.50D)