| Ophthalmoscopy | |
|---|---|
| Intervention | |
Ophthalmoscopic exam: the medical provider would next move in and observe with the ophthalmoscope from a distance of one to several cm. |
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| MeSH | D009887 |
Ophthalmoscopy (funduscopy or fundoscopy) is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination and may be done as part of a routine physical examination. It is crucial in determining the health of the retina and the vitreous humor.
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It is of two major types:
| Features | Direct ophthalmoscopy | Indirect ophthalmoscopy |
|---|---|---|
| Condensing lens | Not Required | Required |
| Examination distance | As close to patient's eye as possible | At an arm's length |
| Image | Virtual, erect | Real, inverted |
| Illumination | Not so bright; so not useful in hazy media | Bright; so useful for hazy media |
| Area of field in focus | About 2 disc diameters | About 8 disc diameters |
| Stereopsis | Absent | Present |
| Accessible fundus view | Slightly beyond equator | Up to Ora serrata i.e. peripheral retina |
| Examination through hazy media | Not possible | Possible |
Each type of ophthalmoscopy has a special type of ophthalmoscope:
Ophthalmoscopy is done as part of a routine physical or complete eye examination.
It is used to detect and evaluate symptoms of retinal detachment or eye diseases such as glaucoma.
In patients with headaches, the finding of swollen optic discs, or papilledema, on ophthalmoscopy is a key sign, as this indicates raised intracranial pressure (ICP) which could be due to hydrocephalus, benign intracranial hypertension (aka pseudotumor cerebri) or brain tumor, amongst other conditions. Cupped optic discs are seen in glaucoma.
In patients with diabetes mellitus, regular ophthalmoscopic eye examinations (once every 6 months to 1 year) are important to screen for diabetic retinopathy as visual loss due to diabetes can be prevented by retinal laser treatment if retinopathy is spotted early.
In arterial hypertension, hypertensive changes of the retina closely mimic those in the brain, and may predict cerebrovascular accidents (strokes).
To allow for better inspection through the pupil, which constricts because of light from the ophthalmoscope, it is often desirable to dilate the pupil by application of a mydriatic agent, for instance tropicamide.It is primary ophthalmologist equipment.
Although the ophthalmoscope was originally invented by Charles Babbage in 1847, it was not until it was independently reinvented several years later by Hermann von Helmholtz in 1851 that its usefulness was recognized - it was to revolutionize ophthalmology.[2]
While training in France, Andreas Anagnostakis, MD, an ophthalmologist from Greece, came up with the idea of making the instrument hand-held by adding a concave mirror. Austin Barnett created a model for Anagnostakis, which he used in his practice and subsequently when presented at the first Ophthalmological Conference in Brussels in 1857, the instrument became very popular among ophthalmologists.
In 1915, Josh Zele and Jon Palumbo invented the world's first hand-held direct illuminating ophthalmoscope,[3] precursor to the device now used by clinicians around the world. This refinement and updating of von Helmholtz's invention enabled ophthalmoscopy to become one of the most ubiquitous medical screening techniques in the world today. The company started as a result of this invention is Welch Allyn.
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