Transcript FUNDUSCOPY - University of Missouri

What is funduscopy?
And…
Why is it important to you?
Web sites of interest:
Welch Alleyn
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www.panoptic.welchallyn.com
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http://www.welchallyn.com/medical/ go to
“optometry student” menu drop down
Red Atlas
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http://www.redatlas.com
Review of ocular anatomy
Retinal Layers
Optic Nerve Anatomy
Choroidal Vessels
Funduscopy
Techniques/instruments
Direct Ophthalmoscopy
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Fundus Contact Lens
Why do we dilate pupils?
Direct Ophthalmoscopy
Advantages
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Portable
Easy to use
Upright image
Magnification  15x
Can use w/o dilation
Disadvantages
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Small field of view
Lack of stereopsis
Media opacities can
degrade image
PanOptic Ophthalmoscope
Manufacturer: Welch Allyn
Increased field of view &
mag
Increased working distance
Hand held but less portable
www.panoptic.welchallyn.com
Indirect Ophthalmoscopy
Monocular or binocular
Advantages:
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Wide field of view
Binocular instruments
provide stereopsis
Disadvantages:
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Requires more skill
Decreased magnification
(3x)
Requires dilation
Inverted image
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Field of View & Mag:
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FOV <indirect but
>direct
varies w/lens & slit
lamp mag
Inverted image
Stereopsis
Dilated pupil
Requires skill
Fundus Biomicroscopy
Fundus Contact Lens
Requires physical
contact w/eye
Viewed
w/Biomicroscope
Advanced dx &
surgery
Field of view &
Mag vary w/lens
design
Direct Ophthalmoscopy:
Basic skills
Optics:
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Illumination system
Magnifier
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Hyperopes
myopes
Observation system
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Lens wheel
Apertures
Direct Ophthalmoscopy:
Basic skills
Viewing ocular
media
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Observe red reflex
Look for media
opacities
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Cataracts
Corneal scars
Large floaters
Direct Ophthalmoscopy:
Basic skills
Proper position for
central fundus
viewing
Right eye to right
eye
Left eye to left eye
Don’t rub noses…
Direct Ophthalmoscopy:
Basic skills
Proper position for
peripheral fundus
viewing
Direct Ophthalmoscopy:
Exam technique
Be systematic
Start at optic disc & work radially
Observe:
Optic disc: C/D ratio
 Vessels: course & caliber, AV ratio, light
reflex, crossings/banking
 Macula
 Peripheral fundus
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Direct Ophthalmoscopy:
Basic skills
Clinical pearls
FOV incr. when closer to Pt.
 Larger pupil increases FOV
 Contact lenses
 Check lens wheel– watch accommodation
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Normal Fundus
Viewing the Optic Nerve Head
Observe:
Size
 Shape
 Color
 Margins
 Cup to disc ratio (C/D) horiz & Vert
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Blood Vessel Evaluation
Observe:
Vessel diameter
 Shape/tortuosity
 Color
 Crossings
 Light reflex
 Artery/Vein (A/V) ratio: after 2nd bifurcation
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Hypertensive Retinopathy
Scheie classification:
I: Thinning of retinal arterioles relative to
veins
II: Obvious arteriolar narrowing w/focal areas
of attenuation
III: Stage II + cotton wool spots, exudates &
hemes
IV: Stage III + swollen optic disk (similar to
papilledema)
Vessel “Crossings”
Normal crossing
Direction change
“banking’” or “nipping”
Arteriolosclerosis
Increased light reflex (1/2)
“Copper wire” arterioles
“Silver wiring” arterioles
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whitish appearance w/continuing sclerosis
Increased A/V crossings
Macula
Lies about 2DD (disc diameters)
temporal to the optic disc
Should be avascular
May appear darker red than
surrounding retina
Should see bright foveal reflex on
younger pts