Ophthalmoscopy

Question 1

Ophthalmoscopy

Answer 1

a way to look inside the eye

Question 2

Types of Ophthalmoscopy

Answer 2

Direct Ophthalmoscopy ( FOCUS ON THIS THAT IS THE ONE WE WILL BE USING IN LAB)
• hand-held instrument providing magnified monocular view inside eye
• limited field of view
Indirect Ophthalmoscopy
monocular indirect (MIO)
• better field of view than direct (works well with smaller pupils)
• less magnification than direct
binocular indirect (BIO)
• allows wide field of view and stereoscopic fundus evaluation
• best used with dilated pupil

Question 3

What does direct Ophthalmoscopy means?

Answer 3

It means that you have to shine the light direct into the pt eyes

Question 4

Fundus Biomicroscopy

NOTE: CHECKING THE BACK OF THE EYE IS VERY IMPORTANT BECAUSE IT CAN EVEN DETECT TUMORS

Answer 4

Refers to the use of lenses in conjunction with a biomicroscope (slitlamp) to view the fundus.
-ANOTHER WAY TO GET AT THE PTS EYES
-CHECKS THE BACK OF THE EYE (THAT IS WHAT FONDUS MEAN)
Types:
• Hruby lens
• fundus contact lenses
• non-contact condensing lenses

Question 5

Dilation: what, why, and when?
NOTE: IF THE PT DO NOT WANT DILATION AND YOU RECOMMENDED JUST DOCUMENT IT (PT SHOULD SIGN A REFUSE FORM). ALSO, DOCUMENT WHEN THE PT IS DONE DILATION MAKING SURE YOU TOLD THEM THE PROBLEMS IT CAUSES WHEN IT COMES TO BLUR VISION, CANT DRIVE, ECT.

Answer 5

• Pharmacologic enlargement of pupil via eye drops
• Allows much better view into the eye
• Integral part of any truly “comprehensive” eye care
Some patients/practices resistant:
Many patients simply don’t understand the advantages.
Perceived disadvantages:
• blurred vision (unable to drive)
• light sensitivity (uncomfortable)
• long-duration

Question 6

Direct Ophthalmoscopy
1- Advantages
2- Disadvantages

Answer 6

1- • Easier to do than BIO or fundus biomicroscopy
• Provides good magnification
• Ability to adjust focus (cornea to retina)
2- • Limited field of view
• Does not allow stereoscopic viewing (no depth perception)
• Relatively dimmer image limits resolution

Question 7

Direct Ophthalmoscopy: Clinical Procedure

Answer 7

• Patient seated just below your eye level
• Room lights dimmed
• Patient views large distant target
• Stand to side of eye to be examined
• Ophthalmoscope held in same had as eye to be examined
• Using spot beam, look through scope from about 40 cm in front of patient
(just temporal to their line of sight) and focus on iris
• Observe retinal reflex, looking for media opacities
• Slowly move closer to patient’s eye (to just in front of eyelashes), while
adjusting focus until fundus structures come into clear view.

Question 8

Fovea is

Answer 8

The MOST sensitive part of the eye and is located in the Macula

Question 9

Optic cup is like a cup inside

Answer 9

the optic disk

Question 10

When looking at the back of the eye we noticed that the arteries are_______ in color than the veins. Arteries passes_______ the veins.

Answer 10

lighter, above

Question 11

Optic nerve is about_____ in a normal eye

Answer 11

0.5 mm

Question 12

In Direct Ophthalmoscope we encounter

Answer 12

a lot of magnification, but very limited field of view

Question 13

Direct Ophthalmoscopy: Clinical Procedure

Answer 13

• Locate the optic nerve head
• Examine the disc noting it’s appearance
• Examine the area adjacent to the disc
• Examine the area further out into all quadrants
• Lastly, move into line of sight to examine macula
• Switch sides (hands) and repeat on other eye

Question 14

Little tips from the video on Direct Ophthalmoscopy: Clinical Procedure

Answer 14

• The large playing disk is the one you want to see at first

- dim room illumination to make sure pt is fine

Question 15

What to record:

Answer 15

Optic nerve:
• cup-to-disc (C/D) ratio
• rim color
• margins
• spontaneous venous pulsation (SVP)?
Blood vessels:
• arteriovenous (AV) ratio and any AV crossing changes
Macula:
• Does it have homogenous color?, a foveal reflex?
* above is only a guideline… Anything abnormal!

Question 16

Recording cup-to-disc (C/D) ratio:

Answer 16

• The ratio of optic nerve cup diameter to total optic nerve diameter
• Cup can be oval (different horizontal and vertical dimensions) and may be decentered.
• Recorded as a decimal for both horizontal and vertical dimensions,
with horizontal first: H/V
C/D ratio: 0.3/0.2

Question 17

You get a larger C/D ratio in

Answer 17

Glaucoma

Question 18

Optic nerve rim color

Answer 18

• For a normal eye the rim color is like a little opaque with pinkish color
• For abnormal eye the rim color will be really bright and yellow

Question 19

Optic nerve margins ( edge of the optic nerve as a whole)

Answer 19

• For a normal eye the margin will be really defined and smaller compared to the the margins of abnormal eye
• For abnormal eye other that the margin will be bigger than the margin for the normal eye it also will look like more disperse and undifined (the limits of the margin are not very well seen)

Question 20

spontaneous venous pulsation (SVP)

Answer 20

Venous vessels that comes back to the heart (See the videos and rest of ppnt in these topics)

Question 21

Summary

Answer 21

Direct ophthalmoscopy is insufficient as a single or stand-alone procedure for ocular fundus examination.
• Supplanted in large measure by stereoscopic ophthalmoscopy (BIO)
and biomicroscopy (slit-lamp) for comprehensive fundus evaluation.
• Still important because easiest method of fundus evaluation to learn, and may be used to supplement other procedures.
• Ease of use and high magnification are main advantages, while limited field of view and lack of stereopsis are disadvantages.