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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
BINOCULAR INDIRECT

OPHTHALMOSCOPY
condenser

Inverted
Fundus Image
BIO Principle
Page 14.3

Practitioner
Aerial
image

Patient

Condenser

PD Reduction System
Practitioner
Practitioner

Aerial
image

Patient

Condenser

PD Reduction System
Aerial
Image

Condenser

Patient
Aerial (real) image
formed between
examiner and
condenser

Aerial image becomes the
object for the binocular
indirect ophthalmoscope

Light reflecting
from retina
gathered by
condenser
BIO Condenser

Page 14.1

BIO condensing
lenses are biconvex,
aspheric designs with
one surface more
curved than the other

Less curved
surface toward
patient’s eye
Steeper mirror; smaller
reflected images

BIO Condensers
With the less curved
condenser surface
facing the
patient, spherical
aberration is reduced
and the size of the
(interfering) reflected
image of the source is
smaller

Page 14.1
Note the “Reflexes” from the Condenser

Retinoschisis

http://www.mrcophth.com/retinacases/retinoschisis2.jpg
Using the BIO

Headset correctly
positioned

From Nova SO

Optimizing viewing
distance
Using the BIO

From Nova SO

 Start out with the condenser close
to the patient’s eye

 Keeping it normal to the patient’s
eye, slowly move the condenser
away from the patient
 Initially, bright white reflexes are
seen
 As the condenser is moved further
out to the correct distance, the
reflexes soften and the aerial image
Optimizing viewing
fills the condenser

distance
Initially, bright white
reflexes are seen

 As the condenser is moved
further out to the correct
distance, the reflexes soften
and the aerial image fills the
condenser
BIO Lenses
Keeler

Heine

Welch
Allyn
Keeler Wireless BIOs
Slit-Lamp BIO
Slit Lamp BIO
BIO Summary

Page 14.1

The BIO Condenser:
 illuminates the patient’s retina

 forms an aerial (real, inverted) image of the patient’s fundus
 makes both practitioner’s pupils conjugate to patient’s pupil

Choosing a higher power condenser:
 requires a shorter object and image distance
 increases the illuminated region of the patient’s retina
 decreases BIO magnification (mainly due to closer object distance)
 increases BIO field of view (mainly due to closer object distance)

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