What is funduscopy?

And…
Why is it important to you?
 Web sites of interest:
Welch Alleyn
 www.panoptic.welchallyn.com
 http://www.welchallyn.com/medical/ go to
“optometry student” menu drop down
Red Atlas
 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
 Portable
 Easy to use
 Upright image
 Magnification  15x
 Can use w/o dilation
Disadvantages
 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:
 Wide field of view
 Binocular instruments
provide stereopsis
Disadvantages:
 Requires more skill
 Decreased magnification
(3x)
 Requires dilation
 Inverted image
Indirect Ophthalmoscopy
Fundus Biomicroscopy
Field of View & Mag:
 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:
 Illumination system
 Magnifier
 Hyperopes
 myopes
 Observation system
 Lens wheel
 Apertures
 Direct Ophthalmoscopy:
Basic skills
Viewing ocular
media
 Observe red reflex
 Look for media
opacities
 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
 Direct Ophthalmoscopy:
Basic skills
Clinical pearls
 FOV incr. when closer to Pt.
 Larger pupil increases FOV

 Contact lenses

 Check lens wheel– watch accommodation

Normal Fundus
Viewing the Optic Nerve Head
Observe:
 Size
 Shape

 Color

 Margins

 Cup to disc ratio (C/D) horiz & Vert

 Blood Vessel Evaluation
Observe:
 Vessel diameter
 Shape/tortuosity

 Color

 Crossings

 Light reflex

 Artery/Vein (A/V) ratio: after 2nd bifurcation

 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
 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