This procedure is standard when examined by an ophthalmologist. It is needed so that a specialist can assess the condition of the retina, fundus, its vessels, the optic nerve in the patient’s eye. The name of the procedure is ophthalmoscopy of the fundus. It usually requires an ophthalmoscope and a fundus camera / lens.
Despite the apparent simplicity, using such an ophthalmoscopy it is possible to identify a number of injuries and diseases of the visual structures. The procedure is completely safe for the patient, painless and does not cause discomfort. In the article we will get acquainted in detail with ophthalmoscopy of the fundus, indications and contraindications to it, varieties of the procedure, its implementation.
What it is?
Let's start with the very concept of fundus ophthalmoscopy. What is it? This is the name of non-invasive diagnostics, which allows you to conduct a detailed examination of the fundus, assess the transparency of the optical environment, the state of blood vessels, optic nerve discs, and also identify various dystrophic processes, developmental abnormalities, pathological changes, and retinal injuries.
Fundus ophthalmoscopy is performed using several methods - direct and indirect, with a narrowed and dilated pupil. Diagnosis is used not only by oculists, but also by other medical specialists. Indeed, with its help it is possible to clarify such diagnoses as diabetes mellitus and hypertension, visually assess the condition of the patient's vascular system.
Ophthalmoscopy (fundus examination) is performed for 5-10 minutes. During this time, the doctor manages to identify or exclude the following pathologies:
- Glaucoma.
- Retinal detachment.
- Pathologies in the vitreous.
- Diabetic retinopathy, etc.
The cost of ophthalmoscopy of the fundus in Chelyabinsk and other cities of Russia is low. In most cases, it is already included in the price of an examination with an optometrist.
How is the procedure performed?
Ophthalmoscopy is a fairly simple procedure. The doctor directs a ray of light into the patient's eye - through the pupil to the retina. Light can come directly from the lamp of the device used (ophthalmoscope) or be reflected from another source.
In a certain position, the optometrist examines important parts of the fundus - the macula (the area of highest visual acuity), the optic disc, the retinal vessels, and the periphery. During such an examination, you may notice clouding of the lens or vitreous body.
For a more thorough examination, an expanded pupil is needed. This is achieved artificially by instillation of a 1% tropicamide solution 15-20 minutes before the diagnostic procedure.
The study itself can take about 5 minutes (in individual cases up to 15 minutes). It is painless and harmless. However, the patient may feel a little discomfort from the fact that the source of bright light will be directed directly into his eyes. Perhaps, after examination, bright spots will “float” before your eyes for some time. However, this is a temporary effect, which for a short time eliminates itself.
If the patient is allergic to the components of the drug, an ophthalmologist must be warned about this before instillation.
Types of Diagnostics
The following main types of fundus ophthalmoscopy are distinguished:
- Direct method.
- Indirect method.
- Ophthalmochromoscopy (a combination of direct and indirect).
Let us characterize each of them in more detail.
Direct way
This study produces a direct (non-reversed) image with approximately 15x magnification. Hence the name of the method.
With direct fundus ophthalmoscopy, the doctor brings the ophthalmoscope as close as possible to the patient’s eye. The examination itself is carried out in low light conditions separately for each eye. The specialist gets the opportunity in these conditions to see the eye structures a little further than the equator. With a clouded lens, diagnostics cannot be performed.
For the procedure, a direct ophthalmoscope is used, respectively. This is a tool resembling a small flashlight. It is equipped with several lenses that can magnify the image by 15 times. As for ophthalmological examinations, this kind of diagnosis is most often carried out.
Basically, direct ophthalmoscopy is prescribed in the following cases:
- Suspicion of pathological processes in the macular region.
- The presence of hemorrhages or neoplasms in the area of the retina.
Indirect way
When carrying out the procedure according to an indirect method, an inverted (indirect) image comes out in a 2-5-fold increase. How is fundus ophthalmoscopy performed here? The device is located at arm's length from the patient’s eye. The procedure, on the contrary, is carried out in bright conditions.
As part of an indirect method, a specialist can examine the ocular structures up to the periphery of the retina. Inspection is also possible through a cloudy lens.
For diagnosis, respectively, use an indirect ophthalmoscope. This is the name of the light source attached to the headband. It is complemented by a small pocket lens. These devices together provide a wider overview of the inside of the eye than with the direct method. Moreover, an overview of the fundus is better even when the lens is clouded.
Indirect ophthalmoscope can be in two variations - monocular and binocular. The device is used to examine the periphery of the eye retina.
The reverse (indirect) method is shown in the presence of the following violations:
- Pathological processes in the peripheral parts of the retina.
- Retinal tissue dystrophy.
- Diagnosis of retinopathy in premature infants.
Ophthalmochromoscopy
How is fundus ophthalmoscopy performed in this case? Use a light source not of one, but of various colors. The specialist switches them, the light is reflected from the fundus. Such a procedure is considered more highly informative than direct and indirect ophthalmoscopy. In particular, switching the filter of different colors allows you to identify pathologies that are not visible under normal lighting.
For ophthalmochromoscopy, the equipment already described above is used. Only in this case, ophthalmoscopes are additionally equipped with light filters that allow you to switch the shades of light.
Other survey methods
In certain cases, an ophthalmoscopy is performed using a slit lamp. This is already called biomicroscopy. The study is also carried out using a Goldman lens (or a mirror lens).
Inspections with a mirror lens provide information on the condition of the fundus from the center to the most extreme periphery. Using this technique, they also successfully examine the angle of the anterior chamber of the eyes.
With a Goldman lens, ophthalmologists study the condition of the peripheral regions of the retina with myopia. With this pathology, a tendency to the development of peripheral retinal dystrophy, as well as peripheral vitreochorioretinal dystrophies, is characteristic. Such examinations are most often prescribed to pregnant women and patients before laser vision correction.
Indications for the procedure
We list the main indications for ophthalmoscopy of the fundus:
- As part of a standard examination in the office of an optometrist.
- Suspicion of damage to the optic nerve.
- Diabetes.
- Malignant formations of the skin, which spread to the tissues of the eye.
- Clinical symptoms of retinal detachment.
- Hypertension.
- Glaucoma.
- Infectious damage to the retina.
- Suspicion of macular degeneration.
- Clarification of such diagnoses as myopia and hyperopia.
It is worth noting that, as part of prevention, each person should undergo such a diagnostic procedure at least once a year. There are also certain population groups to whom fundus ophthalmoscopy is indicated more often than other people:
- Diabetes patients.
- Patients with myopia.
- Pregnant women.
- Suffering from arterial hypertension.
- People diagnosed with kidney disease.
In a word, such a diagnosis is indicated for all patients whose conditions, diseases of which are fraught with complications on the retina. With the help of ophthalmoscopy, pathological processes can be detected at an early stage, in time to prescribe adequate treatment.
Contraindications
Fundus ophthalmoscopy is a safe and painless procedure. Nevertheless, there are a number of contraindications to its implementation:
- Infectious diseases affecting the front of the eye.
- Inflammatory processes also affecting the anterior region of the eye.
- Pathologies, diseases, the symptoms of which include photophobia and profuse lacrimation.
- A pathological condition when a constantly narrowed pupil is observed.
- Insufficient transparency of optical ophthalmic media (observed with cataracts).
- The impossibility of medical expansion of the pupil (it can be with angle-closure glaucoma and a number of diseases in which it is forbidden to take adrenomimetics).
Study preparation
This diagnostic procedure involves the instillation of special preparations for the artificial expansion of the pupil. This is necessary in order to get a wider overview of the fundus.
For the patient, the use of such drops is negative in that it leads to blurred vision and photophobia for about 3-4 hours. Therefore, many oculists advise their patients to bring dark glasses and one of those accompanying them. Or return home by taxi.
Eye drops for the expansion of the pupil are not taken in two cases: if the patient has an individual intolerance to the components of these drugs or glaucoma is diagnosed.
What can be revealed?
Using ophthalmoscopy, an ophthalmologist reveals the following:
- In case of circulatory disturbance in the eye - congestive processes in the optic nerve.
- The pallor of the optic nipple is atrophic processes.
- Changes in the retina may indicate inflammation, impaired blood flow, developmental abnormalities, dystrophy, the fact of hemorrhage, opacities, impaired vascular function.
- The presence of tumor formations in the area of the optic disc or in another part of the retina.
- Violations of the normal state of the choroid - dystrophy, sclerosis, inflammation, malformations, tumor formations.
- Malformations of the optic nerve itself.
Research results
During the procedure, the ophthalmologist evaluates the general condition of the patient’s eye structures. Examines the condition of blood vessels, checks for the presence / absence of hemorrhages. The retina is examined especially carefully for inflammatory processes and hemorrhages.
Ophthalmoscopy today is one of the most accurate methods. The reliability of such a survey is estimated at 90% and higher. However, it is important that an ophthalmoscopy is performed by an experienced specialist.
Ophthalmoscopy is a simple and relatively quick study. With its help, one can judge the development of many serious pathologies (not only ophthalmological ones) even at an early stage of their development.