Course Code: Applied Optics Lab

SAS Module #13

Name: RANON, LYAN ANACLETO Q.

Lesson title: Ophthalmoscopy

Activity 1: What I Know Chart, part 1 (3 mins)

What I Know Questions: What I Learned (Activity 4)

An instrument that has a
light and several small
lenses on it.
A test in order to see the
fundus of the eye.
Examining the back of the
eye or the fundus.
1. What is an ophthalmoscope?
2. What is Ophthalmoscopy?
3. What is the main purpose in
performing Ophthalmoscopy?
A device that views the back
of the eye. And a device
usedby ophthalmologists in
examining patients.
Ophthalmoscopy is a routine
exam done by
ophthalmologists to examine
the inside of the back of the
eye, also known as the
fundus or posterior segment.
Allows a health professional
to see inside the fundus of
the eye and other structures
using an ophthalmoscope. It
is done as part of an eye
examination and may be
done as part of a routine
physical examination

Activity 2: Content Notes (13 mins) Lab

Activity:

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

I. Identify the parts of the

ophthalmoscope

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

II. Give the uses of each parts mentioned above.

Parts of the Direct Ophthalmoscope Uses/Description

1.) Viewing window Contains a lens that modifies light rays to assist the
user.
2.) Filter switch allows you to select a light filter

3.) Aperture dial allows the ophthalmoscope to be used for different

purposes.
4.) Diopter dial adjusts the lens used to view the eye

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

5.) Rheostat runs along circumference of tube and controls intensity

of beam output.
6.) Brow rest allows the eye doctor or examiner to wear glasses
while using the ophthalmoscope.
7.) Viewing windows contains a lens that modifies light rays to assist the
user.
8.) Diopter power display shows the current lens being used

9.) On/off switch turns the device on and off

Parts of the Indirect Ophthalmoscope Uses/Description

1.) Headband size adjustment knob A protective helmet with a crown made of synthetic
material comprises a fixing device with a strap and
means for adjusting the head-band size.
2.) band tension knob located on the sides of the headset also allows good fit
overhead.
3.) bulb are filled with iodine, bromine, or other halogen gases
and last longer.
4.) angle knob Used to adjust the angle of the eyepiece for better
viewing and allows for adjustment and tighten when in
position
5.) filter level allows the ophthalmoscope to be used for different level
have 2 or 3 sizes of light to use depending on the level
of pupil dilation.
6.) mirror angle control A spindle located on either side of the binocular block
that allows the light to position vertically into the upper
two thirds of the field of view, for better viewing and
illumination.
7.) headband height adjustment knob Adjusts the height of the Ophthalmoscope for
better fit.
8.) battery Rechargeable

9.) band tension knob A band in the ophthalmoscope and allows good fit.

10.) brightness control knob Controls the light

11.) aperture selection lever Always set the Aperture Selection (H) to the large light
and rotates the aperture knob to select different
apertures

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

12.) eyepiece Allows the examiner to view the fundus of the patient

13.) front window Front window

III. Write the set-up and step by step procedure in performing Direct Ophthalmoscopy.

Set-up

Room illumination: Dim

Test target: far
Examiner will seat in front of the patient.

Step by step Procedure

1. Wash your hands.
2. Introduce yourself to the patient and explain what you are going to do.
3. Position the patient so that the ophthalmoscope is held directly at the
level of the patient’s eye.
4. Turn on the ophthalmoscope and set the light to the correct aperture.
5. Dim the lights.
6. Instruct the patient to focus on an object straight ahead on the wall.
7. To exam the patient’s RIGHT eye, hold the ophthalmoscope in your
RIGHT hand and use your RIGHT eye to look through the instrument.
8. Place your left hand on the patient’s head and place your thumb on
their eyebrow.
9. Hold the ophthalmoscope about 6 inches from the eye and 15 degrees
to the right of the patient.
10. Find the red reflex.
11. Move in closer, staying nasally until you see the optic nerve.
12. Rotate the diopter lens until the optic nerve comes into focus.

 The farsighted eye requires more plus/green number lenses.

 The nearsighted eye requires more minus/red number lenses.

13. Measure the cup to disc ratio.

14. Scan slightly up, down, right and left to look at the vessels.
15. Move out temporally to find the macula and fovea.
16. Repeat the same technique on the other eye.

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

IV. Write the set-up and step by step procedure in performing Indirect Ophthalmoscopy.
.
Set-up

Room illumination: dim

Patient in supine position
Room space must be large enough

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

Step by step Procedure

1. Dilate properly - To conduct a good peripheral exam, the patient’s eyes
must be well dilated. Use both 1% tropicamide and 2.5% phenylephrine for
the best dilation. Patients with darker-colored irides may need more
than one set.

2. Position the patient for optimal viewing - Successful indirect

ophthalmoscopy depends on proper positioning. Ideally, you want the
patient to lay flat in a reclining chair with room for you to move freely
around the head. Remember: - When examining the superior retina, “the
patient looks up and doctor gets small”. -When examining the inferior
retina, “the patient looks down and doctor gets tall.” You will find that subtly
tilting the head (usually in the direction of gaze) helps improve the view.

3. Choose the right lens - You have two main options for indirect
ophthalmoscopy. - 20 D: The most commonly
used binocular indirect ophthalmoscopy (BIO) lens. - 28 D: Viewing
pathology near the ora serrata is easier with a 28-D lens. The 28-D lens
sacrifices some magnification (2.27°—) but offers a larger 69° dynamic field
of view.

4. Minimize lens distortion - Because of the lenses’ aspheric nature, you

have to hold the lens right-side up to minimize distortions. Move the lens in
and out to focus and refine the view. If your hand is large enough, it helps
to stabilize the lens with a finger on the patient’s head.

5. Adjust the indirect headset - First, adjust the headband so that the scope
is secure on your head. Then adjust the pupillary distance and height of the
beam so you can see a full beam with each eye. Set the light
aperture to the largest spot for a fully dilated patient. Use the smallest
aperture for smaller pupils and intraocular
gas. The medium light gives an 8-mm-diameter view when in focus with the
20-D lens. Generally, use the white
light filter. A diffuser can improve the field of view and is softer and more
comfortable for the patient. Adjust the light intensity to allow yourself a clear
view while attempting to make the patient comfortable.

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

6. Depress the sclera - This allows for dynamic viewing of the retina.
Always perform scleral depression for patients with signs and symptoms
concerning for retinal tears or detachments (flashes and floaters). The
inward curvature of the anterior retina requires you to depress or deform
the globe in order to bring the peripheral retina into your field of view. This
is referred to as the “bump.” The dynamic exam allows you to elevate
retinal breaks and more easily evaluate them. Topical anesthetic can help
make the patient more comfortable. Scleral depressors can vary is size and
shape. When in a pinch, a cotton-tip applicator works nicely.

V. Differentiate Direct from Indirect Ophthalmoscopy.

Factor/s Direct Ophthalmoscopy Indirect Ophthalmoscopy

1.) Time for Pre-focusing. Time consuming Not time consuming

2.) Time for Examination. Not time consuming Time consuming

3.) Ease of Technique Px is sitting Px is lying down

4.) Need for Mydriatic Do not need mydriatic Needs mydriatic

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

5.)Magnification 15x 2x-5x

6.) Position of Image Virtual and erect image Real and inverted image

7.)Field of View Limited field of view Wide field of view

Periphery of retina beyond Periphery of the retina can be
equator is difficult to see examined even to the ora
8.) Peripheral View. serrata

9.) Versatility handy Permits binocular vision

10.) Distance from patient Close to Px 40cm away from Px

Guide Question:
1.) Which is more commonly used type of Ophthalmoscopy in optometric practice? Why?
In the optometric practice the ophthalmoscopy that is commonly used is the direct ophthalmoscope since it is
handy and easy to carry. When visiting the optical clinic direct ophthalmoscopy are commonly used.

2.) Give at least two advantages in using Ophthalmoscopy in the practice?

Easy to hold since it is hand held
Can easily be able to detect problems in the fundus.

3.) Write the normal recordings for both types of Ophthalmoscopy.

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

Normal fundus for direct ophthalmoscopy Normal fundus for indirect ophthalmoscopy

VI. Label the parts of the normal retina seen under the ophthalmoscope.

Physiologic cup
Fovea

Neuroretinal rim Macula

Retinal vein Retinal artery

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

Activity 3: Skill-building Activities (with answer key) (18 mins + 2 mins checking)

Give some example of a result from Direct and Indirect Ophthalmoscopy. Show some pictures and paste in
the space below with the interpretation of results.

Result from Direct Ophthalmoscopy

Pathological optic cupping – note cup to disc ratio at least 0.8

Optic Disc Edema – Surface is covered by cotton wool spots the axons is damaged and flame hemorrhages
the blood vessels is damaged.

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

Result Indirect Ophthalmoscopy

Retina hemorrhage- become elevated with indentation, holes will either gape open, look larger and appear
darker with the surroundings.

Activity 4: What I Know Chart, part 2 (2 mins)

Give a brief summary of “WHAT you previously know” and “WHAT you know now:?
I learned a lot about the direct ophthalmoscope and the indirect ophthalmoscope

Activity 5: Check for Understanding (5 mins)

A.) As an optometry student, which type of Ophthalmoscopy procedure is more convenient? Why?

The direct ophthalmoscope is more convenient since it is hand held, it so handy.

B.) Give at least two advantages in using direct ophthalmoscopy

.-It has larger magnification

- It is less time consuming.

C.) Give at least two disadvantages of using Indirect Ophthalmoscopy.

- It needs mydriatic drugs.
- It has lesser magnification.

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 Course Code: Applied Optics Lab
SAS Module #13

Name: RANON, LYAN ANACLETO Q.

C. LESSON WRAP-UP
1) Activity 6: Thinking about Learning (5 mins)

{*Teacher directs the student to mark their place in the work tracker which is simply a visual to helpstudents
track how much work they have accomplished and how much work there is left to do. Thistracker will be part
of the student activity sheet}

{**To develop habits on thinking about learning, teacher writes a question or two that
may ask studentsabout their learning experience, if they met the learning target, what
they found difficult / easy about the

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