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26/04/2010




 OPHTHALMOSCOPY

                                  Dr Frank FAMOSE
                            DVM, CES Ophtalmologie
                             Ekaterinburg May 2010




What is ophthalmoscopy ?
►Fundus examination           ►Direct
     Tapetum                  ophthalmoscopy
     Non-tapetal zone
     Vascularisation         ►Indirect
     Optic nerve papilla      ophthalmoscopy

                              ►Skiascopy




                                                             1
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Indications




► Diagnosis   ► Inherited ocular disease survey




DIRECT
OPHTHALMOSCOPY




                                                          2
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Principles of ophthalmoscopy




History

►1704 : First description of feline ocular fundus

►1846-1854 : Babbage-Wharton-Jones

►1858 : First use of direct ophthalmology in animals

►1892 : First atlas of veterinary ophthalmoscopy




                                                               3
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Material
►Handheld devices

►Low price




      Animal’s side   Operator’s side




Direct ophthalmoscopy : technical
aspects




                                                4
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What do you see ?
►Image size
   Magnification from x17 to x19
   Comparison to optic disc
    (vision field about 2-3 Odisc)

► Image position
   Real image
   Erect image




Practical realization
►Animal restraint

►Sedation




                                             5
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Practical realization
►Dilatation
   Tropicamide 0,5%
   1 drop ev. 5 min for
    20 min

►Dark room




Practical realization : step by step
►What to do ?                     ►How to do ?
 Place the ophthalmoscope on      Place it against your right brow
  your eye                          (for exam of right eye)
 Look for the Fundus reflexion    Look for it from a 0,5 to 0,75 m
  (green reflex)                    distance
 Get closer                       Till the Fundus is full field
 Follow eye movements
                                  ►Difficulties ?
                                   Keep both eyes opened
                                   Right for right, left for left
                                   Don’t lose fundus reflexion




                                                                               6
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Systematic examination of fundus

Tapetum


                                   Retinal
                                   Vessels




Non tapetal                         Optic
  Zone                              Disc




Systematic examination of fundus
         First          Second
       quadrant        quadrant




        Fourth           Third
       quadrant         quadrant




                                                     7
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Adjustements
►Rekoss disc
      Description
                                      -2
      Uses
►Light source size
►Light colour
►Grille
►Slit source


                                                        15




Pros and cons of direct
ophthalmoscopy
►Pros                      ►Cons
 Greater magnification     Small field of view
 Grid and slit             Short working distance
 Alteration of dioptric    Monocular vision
  power                     Bad vision of peripheral
 Lower cost                 retina
                            Greater distorsion if
                             opacities




                                                                     8
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INDIRECT
OPHTHALMOSCOPY




Principles of ophthalmoscopy




                                       9
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History

►1853 : Ruete

►1947 : Development in human medicine

►1960 : Veterinary use




Indirect ophthalmoscopy :
technical aspects




                                               10
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Equipment
►Light source
   Electric lamp
   Headband fit


►Optic system
   Converging lens
   Prisms




Equipment : digital fundus camera




                                           11
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Practical realization
►Animal restraint

►Sedation




Practical realization
►Dilatation
   Tropicamide 0,5%
   1 drop ev. 5 min for
    20 min

►Dark room




                                  12
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 Practical realization : step by step
 ►What to do ?                      ►How to do ?
 Place the ophthalmoscope on       Adjust pupillary space and
  your head                          direction of light source
 Look for the Fundus reflexion     Look for it from a 0,5 to 0,75 cm
  (green reflex)                     distance
 Place the lens 2-3 cm from the    Move it till the Fundus is full field
  eye
 Follow eye movements
                                    ►Difficulties ?
                                    Placement of lens
                                    Inversion of movements
                                    Don’t lose fundus reflexion




 Systematic examination of fundus

   Tapetum


                                                                 Retinal
                                                                 Vessels




   Non tapetal                                                     Optic
     Zone                                                          Disc




                                                                                    13
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 Systematic examination of fundus
             First       Second
           quadrant     quadrant




            Fourth        Third
           quadrant      quadrant




Normal fundus - Dog




                                           14
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Normal fundus - Dog




Normal fundus - Dog




                             15
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Normal fundus - Dog




Normal fundus - Dog




                             16
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Retinal degeneration - Cat




Central retinal atrophy - Dog




                                       17
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Retinal detachement - Dog




 Adjustements : lenses
 ►Plan-convex lens :
  converging effect

 ►Effect of power of
  lens
      On magnification
      On visual field




                            36




                                        18
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Pros and cons of indirect
ophthalmoscopy
►Pros                       ►Cons
 Larger field of view       Inversion of image
 Safer distance from the    Less magnification
  patient                    Technically more
 Binocular evaluation        difficult
                             More expensive




Conclusion

►Ophthalmoscopy : essential part of eye examination

►Direct and indirect complements each other

►Practice, practice, practice…




                                                   38




                                                               19

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Ophthalmoscopy

  • 1. 26/04/2010 OPHTHALMOSCOPY Dr Frank FAMOSE DVM, CES Ophtalmologie Ekaterinburg May 2010 What is ophthalmoscopy ? ►Fundus examination ►Direct  Tapetum ophthalmoscopy  Non-tapetal zone  Vascularisation ►Indirect  Optic nerve papilla ophthalmoscopy ►Skiascopy 1
  • 2. 26/04/2010 Indications ► Diagnosis ► Inherited ocular disease survey DIRECT OPHTHALMOSCOPY 2
  • 3. 26/04/2010 Principles of ophthalmoscopy History ►1704 : First description of feline ocular fundus ►1846-1854 : Babbage-Wharton-Jones ►1858 : First use of direct ophthalmology in animals ►1892 : First atlas of veterinary ophthalmoscopy 3
  • 4. 26/04/2010 Material ►Handheld devices ►Low price Animal’s side Operator’s side Direct ophthalmoscopy : technical aspects 4
  • 5. 26/04/2010 What do you see ? ►Image size  Magnification from x17 to x19  Comparison to optic disc (vision field about 2-3 Odisc) ► Image position  Real image  Erect image Practical realization ►Animal restraint ►Sedation 5
  • 6. 26/04/2010 Practical realization ►Dilatation  Tropicamide 0,5%  1 drop ev. 5 min for 20 min ►Dark room Practical realization : step by step ►What to do ? ►How to do ?  Place the ophthalmoscope on  Place it against your right brow your eye (for exam of right eye)  Look for the Fundus reflexion  Look for it from a 0,5 to 0,75 m (green reflex) distance  Get closer  Till the Fundus is full field  Follow eye movements ►Difficulties ?  Keep both eyes opened  Right for right, left for left  Don’t lose fundus reflexion 6
  • 7. 26/04/2010 Systematic examination of fundus Tapetum Retinal Vessels Non tapetal Optic Zone Disc Systematic examination of fundus First Second quadrant quadrant Fourth Third quadrant quadrant 7
  • 8. 26/04/2010 Adjustements ►Rekoss disc  Description -2  Uses ►Light source size ►Light colour ►Grille ►Slit source 15 Pros and cons of direct ophthalmoscopy ►Pros ►Cons  Greater magnification  Small field of view  Grid and slit  Short working distance  Alteration of dioptric  Monocular vision power  Bad vision of peripheral  Lower cost retina  Greater distorsion if opacities 8
  • 10. 26/04/2010 History ►1853 : Ruete ►1947 : Development in human medicine ►1960 : Veterinary use Indirect ophthalmoscopy : technical aspects 10
  • 11. 26/04/2010 Equipment ►Light source  Electric lamp  Headband fit ►Optic system  Converging lens  Prisms Equipment : digital fundus camera 11
  • 12. 26/04/2010 Practical realization ►Animal restraint ►Sedation Practical realization ►Dilatation  Tropicamide 0,5%  1 drop ev. 5 min for 20 min ►Dark room 12
  • 13. 26/04/2010 Practical realization : step by step ►What to do ? ►How to do ?  Place the ophthalmoscope on  Adjust pupillary space and your head direction of light source  Look for the Fundus reflexion  Look for it from a 0,5 to 0,75 cm (green reflex) distance  Place the lens 2-3 cm from the  Move it till the Fundus is full field eye  Follow eye movements ►Difficulties ?  Placement of lens  Inversion of movements  Don’t lose fundus reflexion Systematic examination of fundus Tapetum Retinal Vessels Non tapetal Optic Zone Disc 13
  • 14. 26/04/2010 Systematic examination of fundus First Second quadrant quadrant Fourth Third quadrant quadrant Normal fundus - Dog 14
  • 15. 26/04/2010 Normal fundus - Dog Normal fundus - Dog 15
  • 16. 26/04/2010 Normal fundus - Dog Normal fundus - Dog 16
  • 17. 26/04/2010 Retinal degeneration - Cat Central retinal atrophy - Dog 17
  • 18. 26/04/2010 Retinal detachement - Dog Adjustements : lenses ►Plan-convex lens : converging effect ►Effect of power of lens  On magnification  On visual field 36 18
  • 19. 26/04/2010 Pros and cons of indirect ophthalmoscopy ►Pros ►Cons  Larger field of view  Inversion of image  Safer distance from the  Less magnification patient  Technically more  Binocular evaluation difficult  More expensive Conclusion ►Ophthalmoscopy : essential part of eye examination ►Direct and indirect complements each other ►Practice, practice, practice… 38 19