Using the Ophthalmoscope: Viewing the Optic Disc and Retina

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Using the Ophthalmoscope: Viewing the Optic Disc and Retina Judith Warner, MD University of Utah THE OPHTHALMOSCOPE DIRECT OPHTHALMOSCOPY • Jan Purkinje 1823 • Hermann von Helmholtz 1851 • Hand held ophthalmoscope • Direct up-right image Dials of the Ophthalmoscope RED-FREE FILTER (GREEN LIGHT) 450 nm monochromatic light nerve fiber layer optic nerve drusen OTHER DIALS • Used for measuring lesion size • Looking for the center of fixation OTHER DIALS: SLIT BEAM The wheel has lenses of power Panoptic-ophthalmoscope Direct type Wider field of view Distance from pt greater Similar apertures Not as easy to carry Slightly dimmer light source Not as magnified view of Disc Clean the rubber cup between patients Photographs: http://panoptic.welchallyn.com/faq.html WHEN EVER POSSIBLE: DILATE THE PATIENT Steps to Direct Ophthalmoscopy • Dimly lit room • Dilating drops • Patient fixates distant target • Align yourself • Red reflex • Dial in HOW TO USE THE DIRECT Ophthalmoscope.avi ophthalmoscope.wmv THE RED REFLEX The layers you will go through to see the optic disc THE OPTIC NERVE WHAT YOU SHOULD OBSERVE IN EVERYONE RIGHT EYE AND LEFT EYE THE NORMAL DISC • The disc is 1.62 mm or 1 million fibers • Central retinal artery and vein • Lamina Cribrosa • The optic cup The Normal Disc Appearance The lamina cribrosa is an important disc structure --Means Sieve --Anatomically present in all discs --Visible in about 1/3 --Shallow in myopia Look at the Cup-to-disc ratio: WHAT IS THE CUP-TO-DISC RATIO? .7 NO CUP 0.1 CUP 0.3 CUP 0.7 CUP 0.9 CUP What is the cup to disc ratio? 0.6 0.3 THE COLOR OF THE RETINA The color of the retina is determined by the choroid and RPE-- and the amount of melanin individuals have VIEW THE MACULA VASCULAR SUPPLY TO THE GLOBE AND DISC TWO MAJOR SOURCES by way of the ophthalmic artery+ •Posterior Ciliary arteries •Central retinal artery BLOOD SUPPLY TO THE DISC is from the posterior ciliary arteries The posterior ciliary arteries supply the disc, the choroid and the retinal pigment epithelium CILIORETINAL ARTERY • Present in about 32% of people • Enters separate from the CRA • Isolated occlusion = Temporal arteritis • Spared in CRAO A TOUR OF THE FUNDUS AND VENOUS PULSATIONS TheTour.wmv Spontaneous_Venous_Pulse.wmv The_Tour.avi Spontaneous_Venous_Pulse.avi.

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