The document outlines techniques for retinal drawing used by retinal surgeons to document fundus pathology, emphasizing the importance of fundus evaluations including optic disc and retinal vasculature assessments. It details the methodology for creating retinal charts, showing various retinal conditions through the use of color-coded annotations. Additionally, it highlights steps for accurately depicting lesions in relation to the optic nerve and other landmarks.

1. Dr Sabin Sahu
M.S. Ophthalmology
SCEH, Lahan

2. Retinal diagrams
Most retinal surgeons are trained to create formal
retinal drawings of the fundus.
Retinal drawings are useful to document pathology,
although more and more people now prefer fundus
photographs.
Can be used for serial follow up of patients to
document changes in the pathology.

3. Fundus evaluation
A. Optic Disc evaluation
Size, shape, colour of the disc
Vertical cup-to-disc ratio (CDR)
Neuroretinal rim
Disc margins: distinct/ blurred
Peripapillary changes

4. B. Retinal vasculature
 Changes:
 attenuation
 tortuous
 dilated
 nicking
 A/V ratio: ratio of artery size compared to vein
size, should be checked after the 1st
bifurcation.
(normal 2/3)

5. C. Macula
Flat/intact and uniformly pigmented
Yellowish foveal reflex
Look for any abnormal pigment/ blood or fluid

6. D. Vitreous and retinal periphery
Vitreous:
 clear/ cells
 posterior vitreous
detachment
Periphery
 complete 3600
 look for retinal holes/
breaks/ blood

7. Technique of retinal drawing
View in the condensing lens is real and in front of the
patient:
Image is inverted and reversed
You may invert the paper and draw anomaly as it
appears inside the condensing lens; in same location
as you are observing.

8. Retinal charts/ Cartographs
2 concentric circles:
Outer: ora serrata
Inner: equator
Macula is located centrally
Optic nerve head is located nasal to the macula

11. BLUE
Retinal vessels
Sub retinal fluid
Detached Retina
Edema

12. RED
Attached retina
Hemorrhage (preretinal, retinal or subretinal)
Retinal tear
Microaneurysm
Preretinal neovascularization

13. YELLOWYELLOW
Exudate
Inflammatiom (retinal)
Cotton wool spots
Drusen
Subretinal fibrosis
Atrophic areas (paving stone degen.)
White deposits (Stargardt’s Dis.)
Amelanotic mass lesions

14. GREEN
Media opacity (corneal pathology, cataract, vitreous
debris or hemorrhage)
Pre retinal fibrosis or membranes
Vitreous detachment (Weiss ring)

15. BROWN
Melanocytic lesions
Uveal tissue
Malignant choroidal melanomas
Edge of buckle beneath detached retina
Choroidal detachment

16. BLACK
RPE (Retinal pigment epithelium)
Pigment clumping
Retinal pigmentation
Scar

17. Steps of retinal drawing
Have available colored pensils and retinal chart
paper.
Mark fovea and the disc.
Draw boundaries of the RD by starting at the disc and
extending peripherally.
Draw detached and attached retina.
Indicate the course of retinal veins.
Examine the peripheral retina with scleral
indentation.

19. How big is the lesion?
Size in disc diameters (DD)
compare lesion to optic nerve head size.

20. Where is the lesion:
Location:
Clock-dial
superior, supero-nasal, nasal, infero-nasal, inferior,
infero-temporal, temporal, supero-temporal.
Anterior/ posterior to the equator/ oral lesion.

21. Distance:
In disc diameter.
May use relation to constant landmarks:
 optic nerve head
 vortex veins
 vessels