2 Why do a fundus exam?To enable detection of the three most common causes of blindness early enough to prevent blindness:1. Diabetic retinopathy (age group: 20-5o years)2. Glaucoma (age group: years)3. Age related macular degeneration (70+ years)These are all detectable by examination of the posterior pole of the eye by using a direct ophthalmoscope. Vision-saving treatments are available for these disorders if detected and referred to ophthalmologists early.
7 Tips for successful viewing Stabilization:Room lights dimmedPatient seated, removes eyeglasses; observer standing with eyes at samelevel. Observer may leave eyeglasses onDo not remove contact lensesObserver at same eye level, standing, with hand on chair or shoulderPatient should fixate straight aheadUse your right hand and right eye to view patient’s right eyeUse your left hand and left eye to view patient’s left eyeGrasp handle near the topTechnique:Center red reflex in view beginning about 10 inches from faceMaintain degree temporal angle from direct frontal approachRapidly close distance to about 0.5 inch or less from eye (standard scope)maintaining red reflex centrally in view; with Panoptic place collapsibletube on faceIf disc not in view after 5-10 seconds of viewing, give yourselfand patient a 10 second breakRepeat if necessary until disc is in view; focus if necessary
8 Find the disc!Using the PanopticUsing the standardWelch-Allyn head
9 Maximum viewing area with regular ophthalmoscope RED EYE and TRAUMAWhat can I see?Traumatic retinal tears are usually located far anteriorly and out of the view of the direct ophthalmoscope.Maximum viewing area withregular ophthalmoscope
10 The View White circle: Standard direct ophthalmoscope view Large grey circle: Panoptic view
12 The posterior pole Where is the macula? Patient uses foveola (center of macula) to fixate on target.
13 What am I supposed to do? Normal disc Normal Macula Have a plan: 1. Examine the disc for:colorsizesharpness of marginssize and shape of cuppattern of disc vessels2. Look at vessels and their pattern3. Look at the macular area for:pigmentary changeshemorrhagesexudatescotton wool spots4. Briefly examine all four quadrantsNormal discNormal Macula
14 Examination of the optic nerve Normal optic nervePapilledemaNote blurring of margin, swollen (choked) appearancetortuosity of vessels, and small hemorrhages