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PPO5 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

what are 3 pupil dilation contraindications?

A

anterior chamber IOL, narrow angles from gonio, and plateau iris

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2
Q

what are the 2 diagnostic codes for a DFE?

A 
92004 = new patient
92014 = established patient
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3
Q

what are 2 exceptions for when a dilated exam is part of a comprehensive exam?

A

patient refuses and medically contraindicated

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4
Q

what should you do if your patient refuses dilation at their comprehensive exam?

A

you still must assess the fundus - undilated 90D and/or direct scope (pt ed on importance of DFE and reschedule within 1-2 weeks)

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5
Q

what instruments/tools give a direct view of the retina? which give indirect?

A 
direct = direct ophthalmoscope and goldmann 3 mirror 
indirect = condensing lenses and BIO
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6
Q

what is the difference between a direct and indirect image?

A 
direct = upright image (directly on observer's retina)
indirect = inverted/reversed, aerial image located between examiner's eye and condensing lens
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7
Q

what is the clinical standard for posterior pole examination?

A

using a high plus condensing lens and the slit lamp biomicroscope (dilated or un-dilated)

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8
Q

what are 2 reasons why fundus biomicroscopy is advantageous over direct ophthalmoscopy?

A

stereoscopic views and variable magnification and FOV

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9
Q

what is the FOV and working distance for the 90D lens?

A

FOV = 30-40 degrees and 7mm working distance

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10
Q

what is the FOV and working distance for the 78D lens?

A

FOV > 90D and working distance is 8mm

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11
Q

which lens has more magnification, 78D or 90D?

A

78D

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12
Q

when do you use the 90D vs. the 78D?

A 
90D = preferred lens for undilated views and periphery 
78D = preferred lens for glaucoma suspects and diabetic retinopathy
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13
Q

what happens to the magnification as the power of the condensing lens decreases?

A

increases

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14
Q

what happens to the FOV as the power of the condensing lens decreases?

A

decreases

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15
Q

what is the “super 90” lens?

A

superfield lens, diameter > 90, designed to provide same mag as 90 with > FOV and 7mm working distance

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16
Q

what is the “super 66”?

A

designed for high resolution of posterior pole, diameter > 78, mag >78D but same FOV and 11mm working distance

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17
Q

what is the digital high mag lens?

A

ideal for posterior pole = diameter and FOV similar to 78, more mag than 78 and 13mm working distance

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18
Q

what is the digital wide field lens?

A

“ultimate 90” - similar mag but larger FOV, 5-6mm working distance

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19
Q

what does the proper working distance of a condensing lens allow for?

A

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

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20
Q

what is the set-up for 90D or 78D?

A

medium-high illumination in click position, 10x (can move to 16x with 90D), parallelepiped beam height 5-6mm and with camera use polaroid filter and 1-3 aperture size

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21
Q

what are the steps to 90D/78D after the slit lamp is set up?

A

give patient proper target (aperture knob), center beam in red reflex of pupil (cornea in focus), hold lens at 45-60 degree angle close to eye, and pull slit lamp towards you until image is in focus

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22
Q

what is the order for scanning the posterior pole with 90/78D?

A

start with optic nerve, scan away from disc to inferior arcades, then down to superior arcades, scan nasal retina and then macula

23
Q

you are examining OS superior/temporal arcades, the view is lost as you reach the outer limit of the 90D, which way should you move to keep scanning?

A

move lens to lens to examiner’s left (direction you are scanning) - works because the views are inverted and reversed

24
Q

which vessels, temporal or nasal arc around the fovea?

A

temporal (nasal vessels radiate straight from disc to equator)

25
Q

which way should you hold your 90D lens if the patient looks up to examine superior retina?

A

you need to tilt the bottom of the lens closer to patient and top towards you

26
Q

which way should you hold your 90D lens if the patient looks down to examine inferior retina?

A

tilt the bottom of the lens away from patient (towards you) and top towards the patient

27
Q

which way should you hold your 90D lens if the patient looks left or right?

A

tilt the lens IN the direction of the patient’s gaze (pt looks right = tilt lens to your right)

28
Q

it is important to keep your views centered in the 90D lens - where do you have the patient look?

A

ask patient to look into the direction you want the image to move (ex: want ONH to move to your left, ask patient to look to their right)

29
Q

what are the horizontal meridian landmarks that divide the retina into superior and inferior?

A

long posterior ciliary nerves at 3 and 9 o’clock

30
Q

what are the vertical meridian landmarks that divide the retina into nasal and temporal?

A

short ciliary nerves at 10 and 2 and 4 and 6 o’clock positions

31
Q

what divides the anterior and posterior retina?

A

the equator (vortex ampulla mark this spot)

32
Q

how many vortex ampulla are there and where are they located?

A

at least 4-6 = located at 1,5,7,11 o’clock meridians

33
Q

what is the ora serrata?

A

junction between retina and ciliary body (nasal appears serrated - dentate processes are more easily seen nasally)

34
Q

what are the different FOV (degrees) for the mirrors on the 3-mirror?

A 
D-shaped = 60 
rectangular = 66
trapezoid = 76
35
Q

what are 4 indications for the 3-mirror fundus examination?

A

stereoscopic exam of retina, stable view of posterior pole, magnified view of peripheral retina, and performed after BIO

36
Q

what are 3 contraindications of using the 3-mirror?

A

severe corneal surface disease, recent eye surgery, trauma (hyphema, corneal laceration, and globe perforation)

37
Q

what view does the contact hruby lens provide?

A

a direct upright view (larger FOV than with direct scope)

38
Q

what areas of the retina are seen with the trapezoid, rectangular and d-shaped mirrors?

A 
trapezoid = equator to PP (mid-periphery)
rectangular = equator to ora (periphery)
d-shaped = CB and pars plana
39
Q

what is the set up for the 3-mirror fundus exam?

A

same as gonio and 78/90D - place mirror 180 from retina in question, move light into mirror and push IN with scope (not pull back)

40
Q

what are the boundaries for the mid-periphery and the periphery?

A 
mid-periphery = everything posterior of equator
periphery = between the ora and equator
41
Q

what 5 things do you asses for the optic nerve?

A

disc size/shape, margins, contour of neuroretinal rim tissue, C/D ratio and rim tissue/NFL

42
Q

what 4 things do you examine during fundus biomicroscopy?

A

optic nerve, vessels, posterior pole retina and macula and peripheral retina

43
Q

what are you looking at when you evaluate the optic nerve head?

A

physiological cupping of the optic nerve (looking at the overall size of the disc to estimate the expected physiologic cup size)

44
Q

how do you know if the disc size is smaller or larger than average?

A

use medium aperture spot on direct scope:
smaller = disc falls within spot
larger = disc falls outside spot

45
Q

what is the average size of the ON?

A

disc diameter is about 1500 micrometers

46
Q

how do you measure the ON with a slit lamp?

A

use narrow beam in click with 78/90D, adjust vertical height beam across the vertical optic disc inner edge and read scale

47
Q

what are the conversion factors for 78 and 90D lenses?

A 
78D = 1.2x conversion
90D = 1.33x conversion
48
Q

what is the order from smallest to largest optic disc size with race?

A

caucasians - hispanics - asians - african americans (largest)

49
Q

how does the optic disc size change for myopia and hyperopia?

A

greater for high myopia (>5D) and smaller for high hyperopia (>5D)

50
Q

what is the cup to disc ratio?

A

the ratio of the physiological cup of the optic nerve to the overall diameter (divided into tenths) - estimated and recorded for horizontal and vertical ratios (record horizontal first)

51
Q

what are the 5 “R” rules for optic nerve evaluation?

A

scleral “ring” for ON diameter, “rim” size and color, “retinal” nerve fiber layer, “region” of the peripapillary for atopy (PPA) and “retinal” and/or optic nerve hemorrhages

52
Q

what is venous pulsation?

A

an observed pulsation of the venous arcades as they pass over the rim of the cup or at the central bifurcation

53
Q

what is a scleral crescent?

A

“white stuff” - or direct visualization of the sclera around the ONH

54
Q

what is a pigment crescent?

A

“dark stuff” - direct visualization of the RPE and choroid

PPO5 (5 decks)

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