Ophthalmoscopy

Ophthalmoscopy, also called funduscopy,

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, optic disc, and vitreous humor.
 Ophthalmoscopy

Ophthalmoscopic exam: the medical provider

would next move in and observe with the
ophthalmoscope from a distance of one to
several cm.

MeSH D009887 (https://mes

hb.nlm.nih.gov/recor
d/ui?ui=D009887)

[edit on Wikidata]
The pupil is a hole through which the eye's
interior will be viewed. Opening the pupil
wider (dilating it) is a simple and effective
way to better see the structures behind it.
Therefore, dilation of the pupil (mydriasis)
is often accomplished with medicated eye
drops before funduscopy. However,
although dilated fundus examination is
ideal, undilated examination is more
convenient and is also helpful (albeit not
as comprehensive), and it is the most
common type in primary care.

An alternative or complement to
ophthalmoscopy is to perform a fundus
photography, where the image can be
analysed later by a professional.

Types

Ophthalmoscope (left) and otoscope combination by Welch Allyn

F nd s photographs of the right e e (left image) and left e e (right image) seen from front so that left in each image is to
Fundus photographs of the right eye (left image) and left eye (right image), seen from front so that left in each image is to
the person's right, demonstrating the structures that can be seen in ophthalmoscopy. Each fundus has no sign of disease
or pathology. The gaze is into the camera, so in each picture the macula is in the center of the image, and the optic disc is
located towards the nose. Both optic discs have some pigmentation at the perimeter of the lateral side, which is
considered non-pathological. The left image (right eye) shows lighter areas close to larger vessels, which has been
regarded as a normal finding in younger people.

It is of two major types:

Direct ophthalmoscopy one that

produces an upright, or unreversed,
image of approximately 15 times
magnification.
Indirect ophthalmoscopy one that
produces an inverted, or reversed, image
of 2 to 5 times magnification.
 Features Direct ophthalmoscopy Indirect ophthalmoscopy

Condensing lens Not Required Required

As close to patient's eye as

Examination distance At an arm's length
possible

Image Virtual, erect Real, inverted

Not as bright; not useful in hazy

Illumination Bright; useful for hazy media
media

Area of field in focus About 2-8 disc diameters About 8 disc diameters

Stereopsis Absent Present

Up to Ora serrata i.e. peripheral

Accessible fundus view Slightly beyond equator
retina

Examination through hazy

Difficult to not possible Possible
media

Each type of ophthalmoscopy has a

special type of ophthalmoscope:

The direct ophthalmoscope is an

instrument about the size of a small
flashlight (torch) with several lenses that
can magnify up to about 15 times.[1]
This type of ophthalmoscope is most
commonly used during a routine
physical examination. The pan-
ophthalmoscope has a larger primary
lens with a variable focusing, allowing
for a wider field-of-view.
An indirect ophthalmoscope, on the other
hand, constitutes a light attached to a
headband, in addition to a small
handheld lens. It provides a wider view
of the inside of the eye. Furthermore, it
allows a better view of the fundus of the
eye, even if the lens is clouded by
cataracts.[1] An indirect
ophthalmoscope can be either
monocular or binocular. It is used for
peripheral viewing of the retina.
Medical uses
Ophthalmoscopy is done as part of a
routine physical or complete eye
examination, mainly done by optometrists
and ophthalmologists. It is used to detect
and evaluate symptoms of various retinal
vascular diseases 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 (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).

Dilation of the pupil

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, or simply reducing the
brightness of the ophthalmoscope, which
may slightly increase natural mydriasis,
allowing a better view of the posterior eye.
It is primarily considered ophthalmologist
or optometrist equipment, but is used by
other specialists as well, including
neurology and internal medicine. Recent
developments like scanning laser
ophthalmoscopy can make good quality
images through pupils as small as 2
millimeters, so dilating pupils is no longer
needed with these devices.
History
Dr. William Cumming in 1846 at the Royal
London Ophthalmic Hospital (later
Moorfields Eye Hospital), of his pioneering
work wrote "every eye could be made
luminous if the axis from a source of
illumination directed towards a person's
eye and the line of vision of the observer
were coincident".[2]

Although some credit the invention of the

ophthalmoscope to Charles Babbage in
1847, it was not until it was independently
reinvented by Hermann von Helmholtz in
1851 that its usefulness was recognized -
it was to revolutionize ophthalmology.[3]

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, Francis A. Welch and William
Noah Allyn invented the world's first hand-
held direct illuminating ophthalmoscope,[4]
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 Welch Allyn started as a result of
this invention. In the 1970s a new
ophthalmoloscope was developed with a
larger primary lens allowing a 5x larger
field-of-view, called the "Panoptic" or "pan
ophthalmoscope".[5]
Etymology and pronunciation
The word ophthalmoscopy
(/ˌɒfθælˈmɒskəpi/) uses combining forms
of ophthalmo- + -scopy, yielding "viewing
the eye". The word funduscopy
(/fʌnˈdʌskəpi/) derives from fundus + -
scopy, yielding "viewing the far inside". The
idea that fundus can and should
correspond to a combining form fundo-
drives the formation of an alternate form,
fundoscopy (fundo- + -scopy), which is the
subject of a descriptive-versus-prescriptive
difference in acceptance. Some
dictionaries enter the fundo- form as a
second-listed variant,[6][7] but others do not
enter it at all,[8][9] and one prescribes its
avoidance with a usage note.[10]

See also
Charles Schepens
Retinoscope
Scanning laser ophthalmoscopy

References
1. "Ophthalmoscopy | Michigan Medicine" (htt
ps://www.uofmhealth.org/health-library/h
w5223) . Healthwise. Retrieved 10 July
2019.
2. "Ophthalmoscopes Part 1" (http://www.coll
ege-optometrists.org/en/knowledge-centr
e/museyeum/online_exhibitions/optical_ins
 truments/ophthalmoscopes/) . Retrieved
2013-01-25.
3. "Principles of Ophthalmoscopy" (http://ww
w.lifehugger.com/doc/617/Principles_of_O
phthalmoscopy) . lifehugger.com. Retrieved
2009-05-24.
4. Hoovers Citation (http://www.hoovers.com/
welch-allyn,-inc./--ID__54678--/free-co-facts
heet.xhtml)
5. Allyn, Welch. "PanOptic Ophthalmoscope"
(https://www.welchallyn.com/en/products/
categories/physical-exam/eye-exam/ophth
almoscopes--wide-view-direct/panoptic_op
hthalmoscope.html) .
www.welchallyn.com. Retrieved
2019-01-29.
 . Merriam-Webster, Merriam-Webster's
Medical Dictionary (http://unabridged.merri
am-webster.com/medical/) , Merriam-
Webster.
7. Merriam-Webster, Merriam-Webster's
Unabridged Dictionary (http://unabridged.m
erriam-webster.com/unabridged/) ,
Merriam-Webster.
. Elsevier, Dorland's Illustrated Medical
Dictionary (http://dorlands.com/) , Elsevier.
9. Houghton Mifflin Harcourt, The American
Heritage Dictionary of the English
Language (https://web.archive.org/web/20
150925104737/https://ahdictionary.com/) ,
Houghton Mifflin Harcourt, archived from
the original (https://ahdictionary.com/) on
2015-09-25, retrieved 2015-10-21.
10. Wolters Kluwer, Stedman's Medical
Dictionary (http://stedmansonline.com/) ,
Wolters Kluwer.

External links
Ophthalmoscopy on Medlineplus (http
s://www.nlm.nih.gov/medlineplus/ency/
article/003881.htm)
Ophthalmoscopy on WebMD (http://ww
w.webmd.com/eye-health/ophthalmos
copy)
Overview at bmjjournals.com (https://w
eb.archive.org/web/20080420061116/h
ttp://careerfocus.bmjjournals.com/cgi/c
ontent/full/329/7461/56)
 Medlineplus (https://www.nlm.nih.gov/
medlineplus/ency/article/003881.htm)
about different types of
ophthalmoscopy

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