2This session 1 Over the next hour Ophthalmoscopy in a younger person Need to practice for older patients15 minute introductionPractice on each other for 40 minutes3 minute summaryIf time we may cover refraction
3This session 2 Very briefly In more detail, ophthalmoscopy itself External examinationTest pupilsTest visual fieldsIn more detail, ophthalmoscopy itselfRed reflexExamine discRest of retina
11Ref reflex technique Check red reflex from 10 cm, focusing on iris +3.00 lens?Actually focus on the pupil marginBrightest light in ophthalmoscopeStay on same side of patient for both eyesRoom lights dim
13Ophthalmoscopy 2 What is your refraction What is the patient’s refraction……what lens do you use in the ophth.?Light travels from patient retina to your retina
14Ophthalmoscopy 3Distance: closer you are, the greater the visual field..1” away is bestPupil size for ophthalmoscope beam must match patient’s pupil size (otherwise get too much reflection)Too bright…pupil goes smallToo dim..not seeNeed room lights off/dim
15Ophthalmoscopy 4the closer you get, the larger area of retina seen at one time;Look in from 2 cm away
16Ophthalmoscopy 5 Match beam diameter with pupil size.. not too wide Just right, no reflectionToo wide a beam leads to increased reflection
17Ophthalmoscopy 6 Match beam diameter with pupil size..not too narrow Too narrow a beam…too little retina is seen
18Ophthalmoscopy 7If beam is too bright, pupil goes small (then get a reflection).Too dim, won’t see anything!
19Ophthalmoscopy 8Patient looks up, doctor down (more comfortable/quicker)
20Ophthalmoscopy 9 Index finger on focus dial, Thumb on brightness control (rheostat)
21Ophthalmoscopy 10Consider using middle finger to gently touch cheek …steadies ophthalmoscope and prevents banging into eye
22Ophthalmoscopy 11Consider resting ophthalmoscope on thumb (which rests over eyebrow) to steady ophthalmoscope and prevent banging into the eye
23Ophthalmoscopy 12Hold ophthalmoscope immediately adjacent to your own (observer’s) eye to get the best view.
24Ophthalmoscopy 13Examine optic first (looking medially 15o. Otherwise, as soon as light hits the fovea, pupil will go smaller, making examination more difficult.
25Ophthalmoscopy 14Use the grid to locate the fovea (the centre of the macula).
26What is the most important part of the retina for the none-ophthalmologist? The optic nerve ….Papilloedema, raised intracrainial pressure & many other conditions
27How to find the optic nerve Look medially 15o …optic nerve, pituitary, optic tract/cortex lie on the same 15o axis
28How to find the optic disc Vessels point to the optic nerve, so find a vessel fork and move towards optic disc
33summary What did you find easy Hard Red reflex +3.0 d Retina focus..your prescription + patient’sDim room lightMatch beam diameter with pupil size at 2 cmGet close…2 cm….larger area of retina visibleBeam not too bright otherwise pupil goes smallPatient looks up 15oRest finger on cheek?Follow vessel branching towards the optic discDisc is 15o medialUse grid in ophthalmoscope to locate fovea
36Refraction 2 Use the appropriate lens for the eye Add to your own spectacle prescription for ophthalmoscopy
37Refraction 3: how to find the plus lens Focus on something very close
38Refraction 4: how to find patient’s spectacle prescription Hypermetropiclens magnifiesMyopic lens makes everything appear smallerEmmetropic
39Refraction 5: examining high myopes For myopes there is only one focal plane…any further back and you will be out of focus. This is unlike emmetropes: you will be in focus even if you examine from a distance (although only a tiny amount of retina will be visible).Also, unless you have an excellent ophthalmoscope, you may be best examining by looking through the patient’s own spectacles.