PC - Fundus Lens - Week 1 Flashcards
When should the posterior eye always be examined?
As part of a routine eye exam.
Must patients always be dilated for a fundus lens exam?
No, undilated fundus lens should be attempted routinely on a patient not being dilated at the current visit, or when a DFE is contraindicated.
Consider a patient that has been dilated with no contraindications. Should you perform a fundus lens exam, or do a BIO exam?
Always perform both on a dilated patient.
Are cataracts an indication for a fundus lens exam?
Yes
Name 3 general indications for a fundus lens exam.
Indications for DFE
1st presentation
Reduced best corrected VA
Name 15 PC indications for a fundus lens exam.
Reported visual disturbance Photopsia Floaters Metamorphosia Metachromatopsia Shadows Veils Curtain of reduced vision Scotoma VF deficit HA Diplopia Ptosis Pupil abnormalities Trauma (hyphaema)
Name 5 GH indications for a fundus lens exam.
Diabetes Hypertension Cancer High cholesterol Lupus
Aside from general, PC, GH, and cataracts, name 4 indications for a fundus lens exam.
Known PVD
Previous RD
Retinal/choroidal lesion
Would suspicion of glaucoma be enough indication for a fundus lens exam?
Yes
Consider the power of a fundus lens. What do high and low powers mean for the field of view and magnification?
Low powers give higher magnification, but a lower field of view
High powers give low magnification, but a higher field of view
What light set up is ideal for a fundus lens setup?
Dim room lights
Consider a fundus lens exam on a patients right eye. What is an ideal fixation point? Name 3.
Your right ear, the dial, or a pixation light.
What is an ideal range of magnification to start a fundus lens exam with?
Start low, vary during examination
What height should the light beam be during a fundus lens exam?
Small, no bigger than the pupil
Where should 90D, and superfield lenses be held in relation to the eye vs 78D?
90D+ - close to the lashes
78D - 8mm from the eye
Where should the lens first be placed, and where would the top of the lens coincide with?
In front of the pupil
Top of the lens should be approximately at the brow
What can you do if you lose view of the fundus?
Try small movements of the lens, check recentration, and the light.
What can you use to check the stereo of your view?
Examining the NR/cup
What is the time limit on viewing a given fundus area on medium settings?
> 1 minute
What can you do to determine the conour of the fundus area you are examining?
Use a thin slit, and deviations will suggest a raised or depressed area.
Practise on the foveal pit.
How can floaters within the vitreous humour be brought into focus?
Pull the SL back, the retina will become out of focus, and the floater will appear, usually yellow.
Suppose you are looking at the optic disc and are satisfied. What should you do next?
Follow the major BV arcades from the disc in all quadrants.
Consider using a SL and a lens, which direction should it be moved in?
SL - moved in the opposite direction to retina examined
Lnes - same direction
Consider the following areas of the retina to be examined:
Superior
Inferior
Temporal
Nasal
What direction should the patient’s gaze be directed?
Superior - up
Inferior - down
Temporal - temporal
Nasal - nasal
Consider needing to estimate the distance of a site of interest from the peripheral retina to the optic disc. How can this be achieved if both structures cannot be viewed within a single field of view?
Direct small changes in gaze to the patient, and estimate disc diameters as you progress towards the disc.
Consider a situation where the patients gaze is directed in one of the following: Up Down Left Right
Up - inferior edge enwards
Down - superior edge inwards
Left - left edge inwards
Right - right edge inwards
What is the purpose of the red-free filter, and what is the light transmitted by it chiefly absorbed by?
Used to differentiate pigment from blood, and allows localisation of pigmentary lesions.
Absorbed by the RPE and Hb.
What can the red-free filter allow visualisation of?
The nerve fibre layer.
What ratio is the red-free filter used for?
C:D
Give a template of a recording for a fundus lens exam?
Undilated or dilated
Drops - %, type, dose, time, eye (R/L)
Findings - draw findings in correct sector
Hint - can turn paper upside down to help out, but write what the structures are when right way up.
