Fundus examination
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This document discusses different methods for examining the fundus of the eye, including direct ophthalmoscopy, indirect ophthalmoscopy, and indirect slit lamp biomicroscopy. It provides details on how each method works, including magnification, field of view, advantages, and disadvantages. Key structures that can be observed during fundus examination are also described, such as the optic disc, blood vessels, macula, and signs of common eye conditions like glaucoma, optic nerve diseases, retinal problems, and diabetes-related changes.
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Fundus examination
The document summarizes different techniques used to examine the fundus of the eye, including:
1. Direct ophthalmoscopy provides an upright 15x view of the posterior pole but no stereopsis. Indirect ophthalmoscopy uses lenses from 14-30D for an inverted 40-50 degree view with stereopsis.
2. Slit lamp biomicroscopy provides a 30-40 degree inverted view at higher magnifications up to 16x using a +78D lens.
3. A -55D lens provides a virtual upright view for examining the optic nerve and retina through dilated pupils. A contact lens combines high magnification and stereopsis for detailed macular exams.
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Visual Field Examination
- Visual field examination tests the peripheral sensitivity of the retina and visual pathways. It is important for assessing topographic sensitivity and detecting visual field defects.
- Automated perimetry provides standardized, quantitative tests to measure threshold sensitivity across the visual field. It allows for reliable long-term monitoring to detect glaucomatous progression.
- Interpretation of visual field tests involves analyzing parameters like total deviation plots, pattern deviation plots, and global indices to identify patterns indicative of glaucoma according to established criteria. Clinical correlation with optic nerve examination is also important.
Lenses in ophthalmology
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3. Lenses for indirect ophthalmoscopy include +30D, +20D, and +15D lenses, which provide different levels of magnification, stereopsis, and field of view.
4. Contact lenses for fundus examination include Modified Koeppe's lens and Goldmann's three mirror contact
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Clinical examination of squint
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Assessment of anterior chamber
Diagnosis and Assessment of anterior chamber of eye..
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Indirect ophthalmoscopy
Indirect ophthalmoscopy has evolved since its introduction in the 1850s to become an indispensable tool for examining the retina. It allows examination of the peripheral retina through the use of a condensing lens held close to the eye. The observer views an enlarged, inverted image of the retina. Several advantages include the ability to compensate for a patient's refractive error, good illumination, and use with scleral indentation to examine the far periphery. Adjustments of the lens diopter and observation distance allow viewing different areas of the retina with varying magnification and field of view. Proper technique involves adjusting the headband-mounted binocular scope and positioning the condensing lens.
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Fundus examination
The document summarizes different techniques used to examine the fundus of the eye, including:
1. Direct ophthalmoscopy provides an upright 15x view of the posterior pole but no stereopsis. Indirect ophthalmoscopy uses lenses from 14-30D for an inverted 40-50 degree view with stereopsis.
2. Slit lamp biomicroscopy provides a 30-40 degree inverted view at higher magnifications up to 16x using a +78D lens.
3. A -55D lens provides a virtual upright view for examining the optic nerve and retina through dilated pupils. A contact lens combines high magnification and stereopsis for detailed macular exams.
4. Wide
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Visual Field Examination
- Visual field examination tests the peripheral sensitivity of the retina and visual pathways. It is important for assessing topographic sensitivity and detecting visual field defects.
- Automated perimetry provides standardized, quantitative tests to measure threshold sensitivity across the visual field. It allows for reliable long-term monitoring to detect glaucomatous progression.
- Interpretation of visual field tests involves analyzing parameters like total deviation plots, pattern deviation plots, and global indices to identify patterns indicative of glaucoma according to established criteria. Clinical correlation with optic nerve examination is also important.
Lenses in ophthalmology
1. Dr. Reshma Peter discusses various lenses used in ophthalmology, including those for fundus examination, gonioscopy, and contact biomicroscopy of the fundus.
2. Indirect fundus biomicroscopy uses Volk lenses of +60D, +78D, and +90D attached to a slit lamp to provide an inverted and laterally reversed view of the retina.
3. Lenses for indirect ophthalmoscopy include +30D, +20D, and +15D lenses, which provide different levels of magnification, stereopsis, and field of view.
4. Contact lenses for fundus examination include Modified Koeppe's lens and Goldmann's three mirror contact
Clinical evaluation of optic disc changes
The document provides an overview of clinical evaluation of optic disc changes. It discusses examining the papillary changes including size, shape, neuroretinal rim, cupping and color. It also discusses vascular changes like nasalization of vessels and bayoneting of vessels. Peripapillary changes like RNFL defects, hemorrhages and gray crescent are also covered. The document outlines different staging systems to classify optic disc changes including the Disc Damage Likelihood Scale which quantifies glaucomatous damage based on rim width and disc size.
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Assessment of anterior chamber
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measurement of anterior chamber angle and anterior chamber depth.
Indirect ophthalmoscopy
Indirect ophthalmoscopy has evolved since its introduction in the 1850s to become an indispensable tool for examining the retina. It allows examination of the peripheral retina through the use of a condensing lens held close to the eye. The observer views an enlarged, inverted image of the retina. Several advantages include the ability to compensate for a patient's refractive error, good illumination, and use with scleral indentation to examine the far periphery. Adjustments of the lens diopter and observation distance allow viewing different areas of the retina with varying magnification and field of view. Proper technique involves adjusting the headband-mounted binocular scope and positioning the condensing lens.
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Aphakia
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- In aphakia, the eye becomes highly hyperopic, the anterior focal point moves forward, and the retinal image is magnified. This decreases visual acuity and field of view.
- Aphakia is treated with spectacles, contact lenses, or intraocular lenses. Spectacles cause issues like increased image size, ring scotomas, and reduced field of view. Contact lenses and IOLs provide better image quality but have risks of complications.
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To identify field defect
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- The optical principles behind how retinoscopy works to assess refractive error.
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- Strabismus is classified as apparent, latent, or manifest. Manifest strabismus is further divided into concomitant, where the deviation is the same in all gazes, and incomitant, where the deviation varies with gaze.
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fundusexamination-.pptx
eeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee
Errors 2
The document discusses assessment and correction of refractive errors. It provides information on objective refractive assessment tools like retinoscopy and autorefraction. It also discusses subjective refraction techniques and considerations for different patient types. Key points include using cycloplegic refraction for infants and uncooperative patients, adjusting IPD with the phoropter, and transposing cylinders to determine the spherical equivalent.
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Cycloplegic refraction involves temporarily paralyzing the ciliary muscle with eye drops in order to determine a person's full refractive error. This is important for children who accommodate too much. Common cycloplegic agents include atropine, homatropine, and cyclopentolate. Cyclopentolate is often the drug of choice due to its faster onset and shorter duration. A cycloplegic refraction allows an accurate assessment of refractive error, especially in children and other patients where accommodation can affect results.
Aphakia
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- In aphakia, the eye becomes highly hyperopic, the anterior focal point moves forward, and the retinal image is magnified. This decreases visual acuity and field of view.
- Aphakia is treated with spectacles, contact lenses, or intraocular lenses. Spectacles cause issues like increased image size, ring scotomas, and reduced field of view. Contact lenses and IOLs provide better image quality but have risks of complications.
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To know Humphrey visual field analyser
To know about various types of perimetry
To identify field defect
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- The optical principles behind how retinoscopy works to assess refractive error.
- Different techniques for performing retinoscopy, including static, dynamic, and near retinoscopy.
- Factors that can impact the results or make retinoscopy more difficult in some patients.
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Indirect ophthalmoscopy allows examination of the retina using an inverted magnified image. A strong convex lens is placed near the eye to make the eye highly myopic. This brings light from the retina to a focused real image between the lens and observer. The image size and position depends on the eye's refractive error - it is at the lens focus for emmetropia, in front for myopia, and behind for hyperopia. Indirect ophthalmoscopy provides a large field of view useful for retinal pathology assessment and laser treatment. Though difficult to learn, it allows examination of peripheral retina and is useful in media opacity.
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This document discusses ophthalmoscopy techniques for examining the interior of the eye. It begins with a brief history of ophthalmoscopy, including early inventors like Babbage and developments like binocular indirect ophthalmoscopy. The main methods covered are direct ophthalmoscopy, which allows examining the central retina but with limited view, and binocular indirect ophthalmoscopy, which provides a larger field of view, stereopsis, and ability to examine the periphery and vitreous. Both techniques are described in detail along with accessories that can be used. Indirect ophthalmoscopy is emphasized as the preferred method allowing the best examination of fundus details.
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This document provides guidance on properly measuring and prescribing glasses prescriptions. It emphasizes the importance of accurately measuring the pupilary distance (IPD) to avoid issues like decentration, tilt and induced astigmatism. It also discusses evaluating and correcting for accommodation, prescribing readers and bifocals, managing anisometropia and presbyopia, and using glasses to treat strabismus and amblyopia. Key points are measuring IPD before trials, testing reading function, and advising patients on minimizing decentration through small frames.
Bio optos-8-21-2011
Indirect ophthalmoscopy provides binocular visualization of the retina using an illuminated, inverted image located between the examiner and patient. There are two main types:
1. Binocular indirect ophthalmoscopy (BIO) allows for the best view of the retina through large fields of view and minimal refractive error effects. A condensing lens focuses light into the pupil and forms an aerial image magnified by the lens power.
2. Direct ophthalmoscopy provides a monocular view with high magnification but limited field of view and issues with reflections. It is better for viewing small pupils or the retinal nerve fiber layer.
Key factors that affect the view include the condensing lens power, examiner distance,
Trial box
The document describes the components and uses of a trial box, which is a set of lenses, frames, and accessories used to test vision. It contains trial frames that hold spherical, cylindrical, and prismatic lenses in various diopters for refraction testing. Accessories include occluders, filters, Maddox rods, and near charts for additional exams. The trial box is an essential tool for optometrists to objectively and subjectively refract patients and diagnose vision disorders.
Trial box
The document describes the components and uses of a trial box, which is a set of lenses, frames, and accessories used to test vision. It contains trial frames that hold spherical, cylindrical, and prismatic lenses in various diopters for refraction testing. Accessories include occluders, filters, charts, and tools like Maddox rods and cross cylinders. The trial box is used for objective and subjective refraction, diagnosing conditions like squint, and assessing binocular vision.
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Fundus examination
- 3. METHODS OF EXAMINATION DIRECT OPHTHALMOSCOPY INDIRECT OPHTHALMOSCOPY INDIRECT SLIT LAMP BIOMICROSCOPY
- 4. Why do we dilate pupils?
- 5. PUPILLARY DILATION Combination of phenylephrine [2.5 %] & tropicamide [1 %] then eyes closed Dilation attained = 15-30 min Normal reactivity = 4 - 8 hrs Conditions which to avoid : iris supported lens shallow AC
- 7. Viewing ocular media ◦ Observe red reflex ◦ Look for media opacities ◦ Cataracts ◦ Corneal scars ◦ Large floaters Right eye to right eye Left eye to left eye
- 9. •An erect upright virtual image •Magnification = 15 x •Field of view = 5 degrees •No stereoscopic view •Several plus and minus dial up lenses • Structures - optic nerve, blood vessels of posterior pole fovea
- 10. 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
- 11. - retinal arterioles - exudate retinal haemorrhage edema microaneurysm attached retina - vitreous opacity hole /break vitreous bleed - Retinal venules - pigmentation detached retina detached choroid outine of break - ora serrata /drusen hyperpigmentation Colour codes :
- 15. •An inverted reverse real image •Magnification = 2 to 4 X •Field of view = 40 to 50 degrees •Optimal working distance = 40 to 50 cms •Good illumination & stereopsis •Ease of use with scleral indentor •Lenses from 14 to 30 D range
- 17. Monocular or binocular Advantages: ◦ Wide field of view ◦ Binocular instruments provide stereopsis Disadvantages: ◦ Requires more skill ◦ Decreased magnification (3x) ◦ Requires dilation ◦ Inverted image
- 19. Indirect slit lamp biomicroscopy
- 20. •Field of View & Mag: • FOV <indirect but >direct • varies w/lens & slit lamp mag •Inverted image •Stereopsis •Dilated pupil •Requires skill
- 21. Slit-Lamp BIO An inverse real reversed image with hand held lenses Field of view = 30 to 40 degrees Lens power = + 78 or + 90 D , other lenses= + 60 to 132 D Magnifying knob to 10 X or 16 X
- 22. Optic disc DISC: DIAMETER – 1.5mm [1 disc diameter] COLOR – Pale pink SHAPE – Circular EDGES – Regular TERMINATION OF ALL LAYERS EXCEPT NFL CUP: C/D ratio – 0.3 to 0.4
- 23. Vessels RETINAL SYSTEM : CENTRAL RETINAL ARTERY AND CENTRAL RETINAL VEIN 4 major branches Arterioles, Venules Capillaries CILIARY SYSTEM : POST.CILIARY ARTERIES Choriocapillaries
- 24. MACULA Specialised region of retina Diameter – 5.5 mm Location – 2 DD - temporal margin of disc Color – Yellow; deep pigmented 4 zones : Foveola -0.35 mm Fovea -1.50 mm Parafovea Perifovea Retinal vessels Cilioretinal artery
- 26. Glaucoma
- 28. AION
- 31. RP
- 33. DR
- 36. HR
- 37. THANK YOU