OPTICS IN DIRECT &

INDIRECT
OPTHALMOSCOPE
Presenter : DR MD ZULFADLI
Supervisor: DR HENRY
 INTRODUCTION

HISTORY

CONTENT PRINCIPLE

DIRECT OPTHALMOSCOPE

INDIRECT
OPTHALMOSCOPE
 introduction
Ophthalmoscopy is a clinical examination of
the interior of eye by means of an
ophthalmoscope. Click icon to add picture
It is primarily done to assess the state of
fundus and detect the opacities of ocular
media.

It is done as part of an eye examination

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 history
 The ophthalmoscope was invented by Babbage ,1848.
 In 1850,Hermann von Helmholz reinvented the
ophhalmoscope and revolutionized ophthalmoscopy.
 Helmholtz could place his eye in the path of the light rays
entering and leaving the patient’s eye ,by looking through the
source of light ,thus allowing the patient’s retina to be seen

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 principle
• Helmholtz instrument operated by using a mirror to shine a
beam of light into the eye.
• The observer would look through a tiny aperture (opening ) in
the mirror.
• Helmholtz found that looking through the lens into the back of
the eye only produced a red reflection.
• By attaching a condenser lens he obtained a clearer inverted
image ,which was then magnified five times.

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 DIRECT OPTHALMOSCOPE

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  It is the most commonly practise method for routine fundus
examination.
 It is done as close to the patient as possible .

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 • Consists of a system of lenses which focus light from an
electric bulb on to a mirror where a real image of the bulb
filament is formed.
• The mirror reflects the emitted light in a diverging beam
which is used to illuminate the patient’s eye
• The mirror contains a hole through which the observer views
the illuminated eye
• The image of the bulb is formed below the hole, so that its
corneal reflection does not lie in the visual axis of the
observer.

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 • the field of view : the area of retina which can be seen at any
one time.
• The image A1B1 of the sight hole AB is constructed using a
ray through the nodal point, N, & a ray parallel to the visual
axis which is refracted by the eye to pass through its posterior
focal point. (figure 14.2)

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Light reflected from the illuminated patient’s
retina passes back through the hole in the mirror
and into observer’s eye

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 • The figure shows that the field of view is smaller in myopic
eye (Rm), and larger in a hypermetropic eye (Rh), than in an
emmetropic eye (R)

Because the real image

lies just below the
sight-hole, the field of
view is not evenly
illuminated:
Area bc more brighter
than ac

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 • Figure 14.4 shows that the field of view enlarged when the
pupil is dilated  the advantage of instilled mydriatic prior to
fundoscopy

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 • Figure 14.5 shows that as the distance between the patient and
the observer decreases, the field of view becomes larger.

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 • The position & size of the image formed in observer’s eye can
be constructed by first constructing the image,xy, of the
illuminated retina XY which is formed at the patient’s far
point.
• A ray from the top of that image,passing through the
observer’s nodal point, No, locates the position of the top of
the image, X’Y’ on the observer’s retina Ro
• R,P,N, Fa : patient’s retina, principal plane, nodal point,
anterior focal point
• Ro, Po, ,No : observer’s retina,principal plane, nodal point

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 • The image formed in the observer’s eye is inverted &
seen as erect
• The image size varies with the patient’s refractive state:
larger in myopia > emmetropia > hypermetropia
• In emmetropic : the rays of light leaving the patient’s
eye are parallel and focused on the observer’s retina
without accommodative effort/use of correcting lens
• In hypermetropic : a diverging beam of light leaves
patient’s eye & an emmetropic observer to
accommodate / to use a correcting lens, to bring the
light to focus on the retina. If not corrected, a virtual
image xo, yo is formed behind the observer’s retina
(blurred image)
• In myopic : converging beam of light is brought to a
focus in front of observer’s retina (blurred image)

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 • For a clear retina view in refractive errors patient, it is
necessary to use a correcting lens to bring the image to a focus
on the observer’s retina.
• A range of correcting lenses is incorporated in the
opthalmoscope.
• The correcting lens power should be equal to the degree of
convergence or divergence of light emerging from the
patient’s eye.

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 • The correcting lens render the beam parallel &
the emmetropic observer’s eye will form a
focused image on retina, XrYr
• a ray from x passing through the centre of the
correcting lens, determines the direction of the
parallel beam formed after refraction of the
emerging beam by the correcting lens
• The ray in the parallel beam which passes
through the observer’s nodal point No locates Xr
on the retina
• The use of a correcting lens reduces the
discrepancy in size , whether the patient’s is
hypermetropic, emmetropic or myopic

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 • 2 possibilities for observers who have a refractive errors:
a. The observer can remove his spectacles & rack up the
appropriate lens in the opthalmoscope by algebraic sum of
his own & the patient’s refractive error, to give a clear view
of patient’s fundus.
b. The observer can use the instrument with his glasses on,
however his field of view will be restricted as the sight-hole
in the mirror will be futher from his eye.

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 • The posterior pole of a highly myopic fundus is been seen
with the direct opthalmoscope if patient keeps his glasses on.
• The magnification of patient’s retina through direct
opthalmoscope can be calculated using formula:
M= F/4, M: magnification, F: dioptric power of the patient’s
eye
e.g: the magnification of direct opthalmoscope is x15, if
dioptric power is 60D to the patient’s emmetropic eye.
• The magnification is useful in evualating microaneurysm of
patients with retinopathy.

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 • Modern direct opthalmoscope incorporate red free filter which
the resulting green light causes the microaneurysm shown as
black dots again a green background.
• Direct opthalmoscope can be used to examine the anterior
segment of the eye, e.g. lens opacities can be directly
inspected through the +10 D correcting lens.

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 INDIRECT OPTHALMOSCOPE

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 • Offers a better view of retina and vitreous

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 • A powerful convex lens (condensing lens) is held in front of
patient’s eye : frequently used +20 D & +13D
• The illuminating light beam passes through the condensing
lens into the eye and light reflected from the retina is refracted
by the condensing lens to form a real image between the
condensing lens and the observer.

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 • The light from observer’s head is convergent by the
condensing lens, then enters the patient’s eye & is
brought to focus within the vitreous by the eye’s
refractive system
• The diagram shows the field of illumination is
largest in myopia and smallest in hypermetropia.
• The size of the subject’s pupil limit the field of
illumination

M: myopia, E : emmetropia, H: hypermetropia

Ps : subject’s principal plane S: subject’s pupil

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 • The field of illumination is limited by::
a. The subject’s pupil size : more dilated subject’s pupil, the larger field of illumination
- It is usual to dilate the patient’s pupil widely prior to indirect opthalmoscopy
b. The subject’s refractive state:
- The field of illumination is largest in myopia and smallest in hypermetropia

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 • The field of view is limited by:
a. The size of the observer’s pupil
- It is not practical to dilate the observer’s pupil because he would suffer an increase in
aberrations & loss of accommodation
b. The aperture or size of the condensing lens
- The larger diameter lenses give a larger field of view

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 • Light emerging from the patient’s eye is refracted by the condensing lens to form a
real image of the retina between the condensing lens and the observer.
• The image is both vertically & laterally inverted (upside down & back to front).
• The image situated at the second principal focus of the condensing lens, i.e
approximately 8cm in front of a +13D.

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 • CF : focal length of condensing lens
• BN : distance between nodal point & the retina
of the subject’s eye.
• If BN distance is 15mm, the linear magnification
• Parallel light emerges from the retina AB of of +13 D lens (f= 75mm) is approximately x5,
emmetropic subject’s eye, & refracted by the while for + 20 D lens (f= 50mm) is x3.
condensing lens to form an image ab in its
principal focal plane F

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 • If the dioptric power of the subject’s eye is taken to be 60D, a +13 D lens magnifies approximately x5,
meanwhile a +20 D lens magnifies approximately x3
• The refractive state of the patient’s eye affects the size of the image formed by the condensing lens

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 • Rays emerging from emmetropic eye are parallel, the image of the retina is always located at the
second principal focus of the condensing lens
• Rays emerging from hypermetropic eye are divergent, the real image is formed outside second
principal focus of condensing lens
• Rays emerging from myopic eye are convergent, the real image is formed within the second focal
length of lens.

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 • The figure shows the changes in image size
when the first principal focus of the condensing
lens F1 is moved relative to the anterior focus
Fa of the eye
• The image size :
a. Emmetropia : same in all positions of
condensing lens
b. Myopia : increase as the condensing lens is
moved away from the eye, smaller if near the
eye
c. Hypermetropia : smaller as the condensing
lens is moved away from the eye, increase if
near the eye

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 The relative merits of the direct and indirect opthalmoscope

• The direct ophthalmoscope is much smaller and lighter than the indirect
• indirect ophthalmoscopes are larger instruments with more powerful light
sources  they are more useful in examining opacities in the ocular media.
• The combination of good illumination and wide field of view makes the
indirect ophthalmoscope the instrument of choice when examining the
peripheral retina, patients with retinal detachments and malignances.
• The indirect ophthalmoscope is also the ophthalmoscope of choice for use
during retinal detachment surgery because it is used at a distance which
allows the surgeon to preserve a sterile operative field.
• Laser energy can be delivered through the indirect ophthalmoscope to
effect retinal photocoagulation.

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thank you
 reference
 chapter 14 : instruments, CLINICAL
OPTICS, 3rd Edition, ELKINGTON
Click icon to add picture

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