2. INTRODUCTION:
IDO was introduced by Nagel in 1864
Examination of the posterior segment
Consists of headset with binocular
viewing system and adjustable lighting
system
Portable – rechargeable power packs/
spectacle mounted
Uses condensing lens(+14 to +30 D)
3. OPTICAL PRINCIPLE:
To make the eye highly myopic by placing a strong
convex lens in front of patient’s eye
Emergent rays from an area of fundus is brought to
focus as a Real, inverted image
4. OPTICAL SYSTEM
Binocularity is achieved by reducing the observer’s
interpupillary distance from about 60 mm to approx
15 mm by prisms/ mirrors.
6. IMAGE FORMATION IN EMMETROPIA
Emergent rays are parallel
Focus at its principal focus
Inverted image is formed between condensing lens
& observer
Size of the image remain same
7. IMAGE FORMATION IN HYPERMETROPIA:
Emergent rays are divergent
Condensing lens uses imaginary enlarged upright
image behind the eye
Final image is in front of principal focus
8. SIZE OF THE IMAGE:
Equal to an emmetropic eye if lens is held that
principal focus correspond to ant focus of eye
Larger than emmetropic eye if cond lens is held
at distance that principal focus is nearer than ant
focus of the eye
Smaller than emmetropic eye when cond lens is
farther away than ant focus of the eye
9. IMAGE FORMATION IN MYOPIA:
Emergent rays are convergent
Inverted image in front of the eye
Final image is within its own focal length
10. SIZE OF THE IMAGE:
Equal to an emmetropic eye, if cond lens –
principal focus corresponds to ant focus of the eye
Smaller than emmetropic eye, if cond lens -
principal focus is nearer than the ant focus of the
eye
Larger than emmetropic eye, principal focus of
cond lens is farther away from ant focus of the eye
12. IMAGE MAGNIFICATION:
Function of power of condensing lens
Power of patient’s eye ( 60 D)
Mag= power of eye
power of cond lens
Ex) 20 D lens- 60/20 = 3x lateral mag
30 D lens- 60/30= 2x lateral mag
13. Magnification:
- Diopteric power of the convex lens
- Position of the lens in relation to eyeball
- Refractive state of the eyeball
15. FIELD OF ILLUMINATION
Field of observation is larger than the field of
illumination
Field of observation is func of magnification and
condensing lens diameter
16. TECHNIQUE:
Procedure explained to pt
Light thrown into pt’s eye at arm’s distance
Keeping eye on that reflex, interpose condensing
lens in path of beam of light – slowly move the lens
away from the eye until image clearly seen
Examiner moves around the head of the patient
Examiner has to stand opposite the clock hour
position to be examined
17.
18.
19. SCLERAL DEPRESSION:
Depressor placed on pt’s lid
Examiner move depressor in a direction opposite to
that he/she wishes the depression to appear
Depressor rolled gently and tangentially over eye
surface
Most sensitive- superonasal quadrant
20.
21.
22. FUNDUS DRAWING:
Image – vertically inverted and laterally reversed
Top of retina chart placed towards foot end of the pt.
Made on special Amsler ‘s chart that has 12 clock hrs
marked and 3 concentric circles made on it.
Innermost circle- Equator
Middle circle-Ora serrata
Outermost circle-midpoint of pars plana
23.
24. NORMAL ANATOMICAL LANDMARKS:
Vortex veins ampulla- along the equator
Long ciliary vein- 3 o’ clock and 9 o’ clock position
Branching vessels marked to draw the pathology seen
25.
26. COLOUR CODE FOR FUNDUS DRAWING
COLOUR REPRESENTATION
Red Retinal arterioles
Attached retina
Retinal hemorrhage
Microaneursyms
Neovascularisation
Retinal break or hole
Blue Retinal venules
Detached retina
Outline of retinal break or hole
Yellow Exudate
Edema
Green Vitreous opacity
Brown Pigmentation
Detached choroid
Black Hyperpigmentation
Ora serrata
27. ADVANTAGES:
Larger field of retina is visible
Lesser distortion of image
Useful in hazy media because of bright light and
optical property
Can be used during retinal surgery as it preserve
sterile operative field
Laser energy can be directed thro IDO
28. DISADVANTAGE:
Less magnification( 5 times)
Impossible in very small pupil
Patient uncomfortable because of intense light of
IDO & scleral intentation
30. FEATURE DIRECT
OPHTHALMOSCOPY
INDIRECT
OPHTHALMOSCOPY
Examination thro hazy
media
Not possible Possible
Area of field in focus About 2 disc diopter About 8 disc diopter
Stereopsis Absent present
Accessible fundus
view
Beyond equator Upto ora serrata
Teaching mirror None Can be attached