Retina examination what and when to order what is really necessary, avoiding excessive work up.

1. HUDSON DE CARVALHO NAKAMURA,
MD, CBO
FUNDAÇÃO BANCO DE OLHOS DE GOIÁS
GOIÂNIA, BRAZIL
www.fubog.org

3. 4 HELPING
DIAGNOSIS
4 MONEY
4 TRAINING
4 CATCHING UP
PATIENTS
 4 HELPING
DIAGNOSIS, BUT NOT
ALWAYS
BAD

4. APPERANCE : Uniform red
Punctate stippling-periphery
Varies-color of individual
Normal choroidal vessels,invisible
PARTS : DISC
VESSELS
MACULA
PERIPHERY

7. RED EYE
LOW VISION
OCULAR PAIN
FLOATERS & FLASHES
METAMORPHOPSIAS
SCOTOMAS
MICROPSIAS
IMAGE DISTORTION
DIPLOPIA – MONOCULAR AND BINOCULAR

8. NORMAL VARIANTS

10. Why it is performed:
It can detect some signs & physiological effects of
various circulatory, metabolic and neurological
disorders.
Routinely used to assess and diagnose vitro-retinal
diseases (such as Diabetic retinopathy, retinal tear
and detachment, macular hole, retinal haemorrhage,
retinal artery and vein occlusion, choroidal tumor, or
macular edema), optic nerve defects, and hereditary
diseases.

13. Fundus examination is used to:
Identify and locate vitro-retinal and optical
nerve defects caused by eye diseases or
trauma.
Examine the extent of the defects or
abnormalities to plan a proper treatment.
Evaluate the success of treatment.

14. DIRECT OPHTHALMOSCOPY
RED REFLEX
INDIRECT OPHTHALMOSCOPY
AMSLER GRID TESTING
WATZKE ALLEN TEST
EYE TEST FOR ROP SCREENING

15. METHODS OF EXAMINATION
DIRECT OPHTHALMOSCOPY
INDIRECT OPHTHALMOSCOPY
INDIRECT SLIT LAMP BIOMICROSCOPY

16. DIRECT OPHTHALMOSCOPY

17. DIRECT OPTHALMOSCOPE

20. INDIRECT OPHTHALMOSCOPE

21. Indirect ophthalmoscopy

22. LOOK FOR DISTORTIONS, CROOKED LINES, SCOTOMAS,
OTHER IRREGULARITIES

24. SPECIALLY 4 MAC HOLES

26. - 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

27.  Vitreoretinal chart Optic Disc drawing

28. ERM – CME – CNM – ME – CSME – POST-UVEITIS – POST
INJECTIONS – MAC HOLES – PSEUDO MAC HOLES

29. -Thimble scleral
depressor
-Pencil type depressor
-Cotton tipped applicator
To examine periphery between equator and ora
serrata by creating a mound to view.
Start superonasal superior ,superotemporal,
Inferotemporal, inferior, inferonasal

35. ERM – CME – CNM – ME – CSME – POST-UVEITIS – POST
INJECTIONS – MAC HOLES – PSEUDO MAC HOLES – PVD IN
THE X-LATERAL EYE 4 MAC HOLE PREVENTION

36. ERM – CME – CNM – ME – CSME – POST-UVEITIS – POST
INJECTIONS – MAC HOLES – PSEUDO MAC HOLES

42. CME
NON CME, DIABETIC
OTHERS

44. MEDIA OPACITY - PVD – UVEITIS – HYALOID ASTERITIS –
IOFB – LENS & IOL DISLOCATIONS

45. B-scan ultrasound is most useful when direct
visualization of intraocular structures is
difficult or impossible. Situations that
prevent normal examination include lid
problems (eg, severe edema, partial or total
tarsorrhaphy), keratoprosthesis, corneal
opacities (eg, scars, severe edema), hyphema,
hypopyon, miosis, pupillary membranes,
dense cataracts, or vitreous opacities (eg,
hemorrhage, inflammatory debris).

46. NO MEDIA OPACITY – WHAT FOR?

47. In such cases, diagnostic B-scan ultrasound can accurately
image intraocular structures and give valuable information
on the status of the lens, vitreous, retina, choroid, and
sclera. However, in many instances, ultrasound is used for
diagnostic purposes even though pathology is clinically
visible. Such instances include differentiating iris or
ciliary body lesions; ruling out ciliary body detachments; and di
intraocular tumors, serous versus hemorrhagic
choroidal detachments, rhegmatogenous versus
exudative retinal detachments, and disc drusen versus
papilledema.

49. VISUAL EVOKED
POTENTIAL - VEP
 The visually evoked potential (VEP)
measures the electrical response of
the brain's primary visual cortex to
a visual stimulus.
NEURO-OPHTH DISORDERS
OPTIC PATHWAY DISORDERS
EXCLUDING CRITERIA
MEDICAL LEGAL
OTHERS

56. Preemie Eye test (ROP)...
how bad is it?
I made the mistake of
reading up about the
ROP eye test that they
are giving my baby early
next week. It sounds
absolutely terrible. How
did your babies do
afterwards? The nurses
have warned that he may
not eat well that day.

58. Your Baby’s Eye Test
Why your baby needs an eye test
All babies on the neonatal unit are screened for an
eye condition called retinopathy of prematurity
(ROP) if they are born before 32 weeks of
pregnancy or if they weighed 1500 grams or less
at birth.

60. ERM – CME – CNM – ME – CSME – POST-UVEITIS – POST
INJECTIONS – MAC HOLES – PSEUDO MAC HOLES

62. NO DIABETIC RETINOPATHY WHAT FOR ???
NO POSTERIOR POLE CHANGES WHAT FOR ???
NO KNOWN ALLERGIES AND THE TWO ABOVE
WHAT FOR ???
NO CHANGES SO MEDICAL LEGAL ASPECT WHAT
FOR ???
THINK ABOUT

64. CONCENTRATION AND QUANTITY

65. WAIT ENOUGH TIME OTHERWISE WAIST ALL THE TIME
EXAMPLE : MAC EDEMA DUE TO DIABETIC RETINOPATHY

68. THANK YOU