What is funduscopy? And

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• What is funduscopy?AndWhy is it important to
  you?

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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

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Review of ocular anatomy
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Retinal Layers
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Optic Nerve Anatomy
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Choroidal Vessels
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Funduscopy Techniques/instruments

• Direct Ophthalmoscopy
• Indirect Ophthalmoscopy
• Fundus Biomicroscopy
• Fundus Contact Lens

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Why do we dilate pupils?
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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

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PanOptic Ophthalmoscope

• Manufacturer Welch Allyn
• Increased field of view mag
• Increased working distance
• Hand held but less portable
• www.panoptic.welchallyn.com

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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

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Indirect Ophthalmoscopy
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Fundus Biomicroscopy

• Field of View Mag
• FOV ltindirect but gtdirect
• varies w/lens slit lamp mag
• Inverted image
• Stereopsis
• Dilated pupil
• Requires skill

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Fundus Biomicroscopy
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Fundus Contact Lens

• Requires physical contact w/eye
• Viewed w/Biomicroscope
• Advanced dx surgery
• Field of view Mag vary w/lens design

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Direct Ophthalmoscopy Basic skills

• Optics
• Illumination system
• Magnifier
• Hyperopes
• myopes
• Observation system
• Lens wheel
• Apertures

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Direct Ophthalmoscopy Basic skills

• Viewing ocular media
• Observe red reflex
• Look for media opacities
• Cataracts
• Corneal scars
• Large floaters

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Direct Ophthalmoscopy Basic skills

• Proper position for central fundus viewing
• Right eye to right eye
• Left eye to left eye
• Dont rub noses

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Direct Ophthalmoscopy Basic skills

• Proper position for peripheral fundus viewing

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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
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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)

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Vessel Crossings

Normal crossing
Direction change
banking or nipping
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Arteriolosclerosis

• Increased light reflex (1/2)
• Copper wire arterioles
• Silver wiring arterioles
• whitish appearance w/continuing sclerosis
• Increased A/V crossings

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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