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What is funduscopy? And… Why is it important to you?

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.

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What is funduscopy? And… Why is it important to you?

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  1. What is funduscopy?And…Why is it important to you?

  2. 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

  3. Review of ocular anatomy

  4. Retinal Layers

  5. Optic Nerve Anatomy

  6. Choroidal Vessels

  7. Funduscopy Techniques/instruments • Direct Ophthalmoscopy • Indirect Ophthalmoscopy • Fundus Biomicroscopy • Fundus Contact Lens

  8. Why do we dilate pupils?

  9. 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

  10. PanOptic Ophthalmoscope • Manufacturer: Welch Allyn • Increased field of view & mag • Increased working distance • Hand held but less portable • www.panoptic.welchallyn.com

  11. 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

  12. Indirect Ophthalmoscopy

  13. Fundus Biomicroscopy • Field of View & Mag: • FOV <indirect but >direct • varies w/lens & slit lamp mag • Inverted image • Stereopsis • Dilated pupil • Requires skill

  14. Fundus Biomicroscopy

  15. Fundus Contact Lens • Requires physical contact w/eye • Viewed w/Biomicroscope • Advanced dx & surgery • Field of view & Mag vary w/lens design

  16. Direct Ophthalmoscopy: Basic skills • Optics: • Illumination system • Magnifier • Hyperopes • myopes • Observation system • Lens wheel • Apertures

  17. Direct Ophthalmoscopy: Basic skills • Viewing ocular media • Observe red reflex • Look for media opacities • Cataracts • Corneal scars • Large floaters

  18. Direct Ophthalmoscopy: Basic skills • Proper position for central fundus viewing • Right eye to right eye • Left eye to left eye • Don’t rub noses…

  19. Direct Ophthalmoscopy: Basic skills • Proper position for peripheral fundus viewing

  20. 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

  21. Direct Ophthalmoscopy: Basic skills • Clinical pearls • FOV incr. when closer to Pt. • Larger pupil increases FOV • Contact lenses • Check lens wheel– watch accommodation

  22. Normal Fundus

  23. Viewing the Optic Nerve Head • Observe: • Size • Shape • Color • Margins • Cup to disc ratio (C/D) horiz & Vert

  24. Blood Vessel Evaluation • Observe: • Vessel diameter • Shape/tortuosity • Color • Crossings • Light reflex • Artery/Vein (A/V) ratio: after 2nd bifurcation

  25. 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)

  26. Vessel “Crossings” Normal crossing Direction change “banking’” or “nipping”

  27. Arteriolosclerosis • Increased light reflex (1/2) • “Copper wire” arterioles • “Silver wiring” arterioles • whitish appearance w/continuing sclerosis • Increased A/V crossings

  28. 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

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