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 http://www.welchallyn.com/medical/ 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 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

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

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

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

21. 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

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

23. Normal Fundus

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

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

26. 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)

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

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

29. 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