The document discusses the basics of ophthalmoscopy findings. It defines the fundus as the interior of the eye that can be seen with an ophthalmoscope. There are different types of fundi based on pigmentation, including dark, medium, light, tesselated, and albinotic. Key structures that can be examined include the optic disc, retinal blood vessels, macula, and peripheral retina. Features of these structures like size, shape, color, and abnormalities can provide clinical information. Direct and indirect ophthalmoscopy are described as methods to examine the interior of the eye.

1. BASIC
OPHTHALMOSCOPY
FINDINGS
Isha Dave B.Sc (Hons), M.C Optom (UK)
Practicing Optometrist and Educator
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2. The Normal Fundus
• Definition of Fundus:
– The interior of the globe as seen with an
opthalmoscope
– Limit is the orra serrata
– Direct ophthalmoscopy allows
visualisation of approx 60-70% of fundus
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4. Fundus Background
• What colour is the
retina????
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5. Fundus Background
• Orange/red background comes from:
– Light directly reflected from choroidal blood
vessels
– Light reflected from sclera and transmitted through
choroidal blood vessels
• Amount of light reflected depends on:
– Degree of pigmentation of retina
– Degree of pigmentation of choroid
• Most fundus layers are transparent and do
not contribute to appearance of fundus
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6. Types of fundus
1. Dark/Negroid
2. Medium/Caucasian
3. Light/Blonde
4. Tesselated
5. Albinotic
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7. 1. Dark/Negroid
• Heavily pigmented
RPE
• Heavily pigmented
choroid
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8. 2. Medium/Caucasian
• Normally
pigmented RPE
• Normally
pigmented choroid
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9. 3. Light/Blonde
• Lightly pigmented RPE
• Lightly pigmented choroid
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10. 4. Tessilated
• Lightly pigmented
RPE
• Normal/heavily
pigmented choroid
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11. 5. Albinotic
• Virtually no pigment
in RPE or choroid
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12. Why are some fundi more
pigmented than others?
• Age
• Race
• Hereditary
• Metabolism
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13. Optic Disc
• Definition:
– The ophthalmoscopic view of the optic nerve head
• Features:
– Size
– Shape
– Colour (NRR)
– Margins
– Cupping
– Vessels
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15. Optic Disc Cupping
• No detectable cup in 15% of eyes
• Can be measured by recording vertical
C/D ratio
• >0.2 difference between the eyes is
suspicious of glaucoma
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16. Optic Disc Vessels
• Central Retinal Artery
– Becomes and arteriole
after branching
• Central Retinal Vein
– Becomes a venule after
branching
• Cilio-retinal arteries
– Not branches of CRA,
derived from blood
vessels supplying the
choroid
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17. Optic Disc surroundings
• Elschnig’s scleral
ring
– RPE and choroid
stop short of the
disc
• Choroidal crescent
– RPE stops short of
the disc
• Peri-peripheral
pigment

18. Retinal Blood Vessels
• Two layers of capillaries:
– Superficial network in nerve fibre layer
– Deep network at junction of inner nuclear and
outer plexiform layer
– No capillaries at the fovea
• Walls of BVs are transparent
• Linear light reflex notable feature of arterioles
• Purpose of vessels
• Ocular vessel health reflects health of
circulation throughout body

19. A/V and V/A crossing
phenomena
• Generally arterioles
cross venules
• Venule dips to avoid
arteriole
• Disease induced
changes are most
noticeable at the
crossings
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20. Vessel Calibre
• Pathological changes cause arteriole
narrowing or venule thickening
• A/V ratio good indication of patholgy
– Normal = 2/3

21. Macula
• Macula is 1.5 to 2 disc
diameters temporal to
optic disc
• Horizontally oval
• Roughly same size as
the optic disc
• Foveal reflex
– Bright spot of light at
centre of macula
– Only real landmark on
healthy macula

22. Peripheral Retina

23. Peripheral Retina
• Peripheral retinal lesions:
– Size (in mm or DD)
– Location
– Shape
– Colour
– Flat/raised??
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24. Direct Vs. Indirect
Opthalmoscopy
• Direct
– Good magnification
– Good for macular
assessment
– V. useful is
assessment of media
opacities
– Real image – right
way up!
– Light and portable
• Indirect
– Stereopsis!!
– Good FOV
– Good for optic disc
and peripheral retina
assessment
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25. THANK YOU
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