Presentation at BVA Congress

24 – 26 September 2009
Cardiff, UK

PLEASE NOTE:
While this presentation may be quoted from it
cannot be reprinted in full without the permission
of the author and the BVA

OPHTHALMOLOGY
Part 1
Examination of the eye and the
BVA/KC/ISDS Eye Scheme
Professor Sheila Crispin
© SM Crispin 2009

With immense gratitude to my friend

and mentor, Dr Keith Barnett

With acknowledgements to Dr David

Gould, Mr Jim Carter, Mr Rob Lowe, Mr
John Mould and Dr Andy Matthews

1
BASIC OPHTHALMIC EQUIPMENT

1. Penlight
2. Condensing lens
e.g. 20D or 2.2 pan retinal
3. Direct ophthalmoscope
4. Magnifying device
e.g. otoscope, magnifying
loupe, slit lamp, ophthalmoscope

EXAMINATION
• Careful observation of the whole patient whilst
taking the history
• General physical examination
• Relevant neurological examination
(incorporated in ophthalmic examination)
• Routine ophthalmic examination
• Additional diagnostic techniques and tests if
indicated
• Careful recording of findings
• Accurate diagnosis!

2
 OPHTHALMIC EXAMINATION
• Correct instruments
• Quiet environment
• Adequate facilities (light and dark)
• Logical order of examination of BOTH eyes and
their adnexa (adnexa = eyelids, lacrimal
apparatus, orbit and para-orbital areas)
• If the eye is red, painful, or visually impaired and
the diagnosis is in doubt seek advice – do not
adopt a wait and see approach

Observe, compare,
analyse, record

3
 Routine examination
– in the light
• Under normal lighting conditions perform
‘hands off’ examination followed by ‘hands on’
examination of orbit, eyelids, lacrimal
apparatus and internal eye, magnification may
be needed
• [Basic neuro-ophthalmological tests
performed in the light if indicated:
oculovestibular reflex, menace and visual
tracking responses, palpebral and corneal
reflexes]

EXAMINATION

Initial assessment is
made by careful
observation (hands off)

4
 Close examination
involves inspection,
usually with
manipulation (hands
on)

Check for normality of

- orbit and paraorbital area
- inner aspects of the
upper and lower lids and
the lacrimal puncta
- outer aspect of the third
eyelid (+/-
(+/- inner aspect)
- ‘white’
white’ of the eye

Routine examination
– in the dark
• Examine external eye and internal eye (to
vitreous) – light source and magnification
• Check for symmetry of gaze, pupil size
and shape, any opacities in the ocular
media – distant direct ophthalmoscopy
• Posterior segment (vitreous to fundus) –
indirect and close direct ophthalmoscopy
• [Basic neuro-ophthalmological tests
performed in the dark if indicated:
pupillary light reflex, swinging flashlight
test, dazzle reflex and visual tracking with
a beam of light]

5
Illumination

6
Magnification

Magnification will usually be

needed for comprehensive
examination
- e.g. extraneous lashes
(distichia and ectopic cilia) may
easily be missed if magnification
is not used
Slit lamp examination allows a slit
beam to be used in conjunction
with magnification

7
 Ophthalmoscopy

Normal gross
and
histological
appearance

Courtesy of JRB Mould

CANINE OCULAR FUNDUS

OPHTHALMOSCOPY
Both indirect and direct ophthalmoscopy should be
used, darkness is essential, mydriasis is helpful

8
 Monocular indirect ophthalmoscopy

• A cheap and simple way of viewing the ocular fundus

using penlight and condensing lens (e.g. 2.2 pan
retinal), the image is magnified, virtual, inverted and
reversed from left-
left-to-
to-right

Monocular indirect ophthalmoscopy

• With commercial instruments the image is magnified

and the right way up – at a price!

9
 Binocular indirect
ophthalmoscopy
• Has the advantage of steropsis (depth perception)

DIRECT
OPHTHALMOSCOPE
Basic requirements
•lens carousel
(-20 to +20)
•large aperture, slit
beam and graticule
•red-
red-free light

10
 DISTANT DIRECT OPHTHALMOSCOPY

DISTANT DIRECT
OPHTHALMOSCOPY

Valuable for assessment of:

- Symmetry of gaze
- Symmetry of pupil size
- Opacities of the ocular media

11
 Remember
- close orbital fit
- keep light
intensity low
- rest finger(s)
against animal

CLOSE DIRECT OPHTHALMOSCOPY

NORMAL PIGMENTATION

12
SUBALBINOTIC EYE

CLOSE DIRECT
OPHTHALMOSCOPY

13
NORMAL

NORMAL

14
 Normal ageing
Senile nuclear
sclerosis of lens
with normal
pigmented eye

Fundus examination
- retinal and choroidal blood
vessels
- optic nerve head (myelinated
in most dogs)
- tapetal and non-
non-tapetal fundus

THE BRITISH VETERINARY

ASSOCIATION - KENNEL CLUB -
INTERNATIONAL SHEEP DOG
SOCIETY EYE SCHEME
• The Eye Scheme started more than 40 years ago
• Inherited conditions (Schedule A) are certified (as
affected or unaffected)
• Other ocular abnormalities, including those under
investigation as possibly inherited (Schedule B), are
recorded in the middle section of the certificate
• From January 1st 2010 permanent identification will be
required for dogs presented for certification
• Litters of puppies (up to 12 weeks) can be screened
for congenital and neonatal disease

15
 EYE PANEL
• Currently just over 30 panellists
• Existing panellists have been trained to
Certificate and /or Diploma level
• All new panellists are trained to Diploma level
– European and/or Royal College of Veterinary Surgeons
• Aspirant panellists undertake a practical and
theoretical examination
• All panellists undertake continuing professional
development and undergo annual re-
assessment

THE EYE SCHEME

Inherited and breed related disease –
what are we aiming for?
• Healthy dogs that are free
of inherited eye disease
• Freedom from ocular
conditions that are
blinding and/or painful
• Freedom from ocular
conditions that require
surgical correction
• Freedom from ocular
conditions that require
long term medical therapy

16
 CERTIFICATE OF EYE EXAMINATION
AND LITTER SCREENING FORM
• First section
– Details of animal and owner or agent
– Verification of permanent identification as from January 1st 2010
• Second section
– Examination technique and instruments used
– Any abnormalities identified, whether or not they are inherited
• Third section
– The known inherited eye disease for the breed being examined
– Everything other than gonioscopy is classified as ‘affected’
affected’ or
‘unaffected’
unaffected’
– Gonioscopy is a separate examination and a grading system for
the degree of goniodysgenesis is to be introduced next year

SCHEDULE A CONDITIONS
Congenital and neonatal
Goniodysgenesis
Congenital inherited cataract
Persistent hyperplastic primary vitreous
Collie eye anomaly
Multifocal retinal dysplasia
Total retinal dysplasia
[Persistent pupillary membrane - removed]
Non-congenital (acquired)
Hereditary cataract
Primary lens luxation
Retinal pigment epithelial dystrophy
Generalised progressive retinal atrophy

17
 GONIODYSGENESIS
AND PRIMARY
GLAUCOMA

Courtesy of John Mould

normal

GONIODYSGENESIS

18
GONIODYSGENESIS AND PRIMARY
GLAUCOMA

PERSISTENT HYPERPLASTIC
PRIMARY VITREOUS (PHPV)

19
 COLLIE EYE ANOMALY

Normal puppy (left eye)

Puppy with
Collie Eye Anomaly (left eye)

COLLIE EYE ANOMALY

20
COLLIE EYE ANOMALY

TOTAL RETINAL
DYSPLASIA

21
MULTIFOCAL RETINAL DYSPLASIA

MULTIFOCAL RETINAL DYSPLASIA

22
MULTIFOCAL RETINAL DYSPLASIA
(GEOGRAPHIC)

INHERITED
CATARACT
Congenital and
non-congenital

23
 PRIMARY LENS
LUXATION

RETINAL PIGMENT
EPITHELIAL DYSTROPHY
(CENTRAL PROGRESSIVE RETINAL ATROPHY)

24
RETINAL PIGMENT EPITHELIAL DYSTROPHY
(CENTRAL PROGRESSIVE RETINAL ATROPHY)

GENERALISED
PROGRESSIVE
RETINAL ATROPHY

25
 normal

GENERALISED
PROGRESSIVE
RETINAL
ATROPHY

UNDER INVESTIGATION

Multiple ocular
anomalies and
persistent
pupillary
membrane
remnants Persistent
pupillary
membrane
remnants

26
 UNDER INVESTIGATION

Abnormal pigment deposition

UNDER INVESTIGATION

Optic nerve hypoplasia Coloboma

27
ADNEXAL ABNORMALITIES

FIT FOR FUNCTION -

FIT FOR LIFE

28