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Funduscopy in Optometry: Importance and Techniques

Learn about the significance of funduscopy in optometry and various techniques including direct and indirect ophthalmoscopy, fundus biomicroscopy, and fundus contact lens examination. Explore the anatomy of the retina, optic nerve, and choroidal vessels. Understand the advantages and disadvantages of different fundus examination methods. Enhance your clinical skills and diagnosis with insights on hypertensive retinopathy, vessel evaluations, and macula assessment.

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Funduscopy in Optometry: Importance and Techniques

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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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