This is a standard procedure for eye examinations. It is needed so that a specialist can assess the condition of the retina, fundus, its vessels, and the optic nerve in the patient's eye. The name of the procedure is fundus ophthalmoscopy. It usually requires an ophthalmoscope and a fundus camera/lens.
Despite its apparent simplicity, with the help of such an ophthalmoscopy it is possible to detect 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 the fundus ophthalmoscopy itself, indications and contraindications for it, the types of the procedure, and its implementation.
What is this?
Let's start with the very concept of "ophthalmoscopy of the fundus". 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 discs, as well as identify various dystrophic processes, developmental anomalies, pathological changes, injuriesretina.
Ophthalmoscopy of the fundus is carried out by several methods - direct and indirect, with narrowed and dilated pupils. Diagnostics is used not only by ophthalmologists, but also by other medical specialists. Indeed, with its help, you can clarify such diagnoses as diabetes mellitus and hypertension, visually assess the state of the patient's vascular system.
Ophthalmoscopy (examination of the fundus) is performed within 5-10 minutes. During this time, the doctor manages to identify or exclude the following pathologies:
- Glaucoma.
- Retinal detachment.
- Pathologies in the vitreous body.
- Diabetic retinopathy and more
The cost of fundus ophthalmoscopy in Chelyabinsk and other cities of Russia is low. In most cases, it is already included in the price of an examination by an ophthalmologist.
How is the procedure performed?
Ophthalmoscopy is a fairly simple procedure. The doctor directs a beam of light into the patient's eye - through the pupil to the retina. The light may come directly from the lamp of the device being used (ophthalmoscope) or be reflected from another source.
In a certain position, the oculist examines important parts of the fundus - the zone of the macula (the area of highest visual acuity), the optic nerve head, retinal vessels, and the periphery. During such an examination, clouding of the lens or vitreous body may be noticed.
For a more thorough examination, a dilated pupil is needed. This is achieved artificially - by instillation of a 1% solution of tropicamide 15-20 minutes before the diagnosticprocedures.
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 a bright light source is directed directly into his eyes. Perhaps, after examination, bright spots will “float” before the eyes for some time. However, this is a temporary effect that will disappear on its own within a short time.
If the patient has an allergy to the components of drugs, it is imperative to warn the ophthalmologist about this before instillation.
Varieties of diagnostics
The following main types of fundus ophthalmoscopy are distinguished:
- Direct method.
- Indirect method.
- Ophthalmochromoscopy (combination of direct and indirect).
Let's characterize each of them in more detail.
Direct method
This study produces a straight (not inverted) image at approximately 15x magnification. Hence the name of the method.
During direct fundus ophthalmoscopy, the doctor brings the ophthalmoscope as close as possible to the patient's eye. The examination itself is carried out in dimly lit conditions separately for each eye. Under such conditions, the specialist gets the opportunity to see the eye structures a little further than the equator. If the lens is clouded, the diagnosis cannot be made.
For the procedure, respectively, a direct ophthalmoscope is used. This is a tool that resembles 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 carried out most often.
In general, direct ophthalmoscopy is prescribed in the following cases:
- Suspicion of pathological processes in the macular area.
- The presence of hemorrhages or neoplasms in the area of the retina.
Indirect method
When carrying out the procedure according to the indirect method, an inverted (indirect) image is obtained at 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 light conditions.
As part of the indirect method, a specialist can examine eye structures up to the periphery of the retina. Examination can also be carried out through a cloudy lens.
For diagnostics, respectively, an indirect ophthalmoscope is used. 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 view of the inside of the eye than with the direct method. Moreover, the view 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 retina.
The reverse (indirect) method is shown in the presence of the following violations:
- Pathologicalprocesses in the peripheral areas of the retina.
- Retinal tissue dystrophy.
- Diagnosing retinopathy in premature babies.
Ophthalmochromoscopy
How is fundus ophthalmoscopy performed in this case? Use a light source of not one, but different colors. The specialist switches them, the light is reflected from the fundus. This 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 shades of light.
Other methods of testing
In certain cases, 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).
Examinations with a mirror lens allow you to obtain information about the condition of the fundus from the center to the most extreme peripheries. This technique also successfully examines the angle of the anterior chamber of the eye.
With a Goldmann lens, ophthalmologists study the condition of the peripheral areas of the retina in myopia. With this pathology, a tendency to develop peripheral retinal dystrophy, as well as peripheral vitreochorioretinal dystrophies, is characteristic. Such examinations are most oftenprescribed for pregnant women and patients before laser vision correction.
Indications for the procedure
Let's list the main indications for fundus ophthalmoscopy:
- As part of a standard examination in the optometrist's office.
- Suspicion of damage to the optic nerve.
- Diabetes mellitus.
- Malignant skin lesions that have spread to the tissues of the eye.
- Clinical symptoms of retinal detachment.
- Hypertension.
- Glaucoma.
- Infection of the retina.
- Suspicion of macular degeneration.
- Clarification of such diagnoses as myopia and hypermetropia.
It is worth noting that as part of prevention, each person should undergo such a diagnostic procedure at least once a year. There are certain groups of the population to whom the ophthalmoscopy of the fundus is shown more often than other people:
- Patients with diabetes.
- Myopia patients.
- Pregnant women.
- Suffering from arterial hypertension.
- People diagnosed with kidney disease.
In a word, such a diagnosis is shown to all patients whose conditions are fraught with complications on the retina. With the help of ophthalmoscopy, pathological processes can be detected at the earliest stage, and adequate treatment can be prescribed in time.
Contraindications
Ophthalmoscopy of the fundus issafe and painless procedure. Nevertheless, there are a number of contraindications to its implementation:
- Infectious diseases affecting the anterior sections of the eye.
- Inflammatory processes that also affected the anterior part of the eye.
- Pathologies, diseases, the symptoms of which include photophobia and profuse lacrimation.
- Pathological condition, when there is a constantly narrowed pupil.
- Insufficient transparency of the optical media of the eye (observed with cataracts).
- The impossibility of medically expanding the pupil (may be with angle-closure glaucoma and a number of diseases in which it is forbidden to take adrenomimetics).
Preparing for the study
This diagnostic procedure involves the instillation of special drugs to artificially dilate the pupil. This is necessary in order to get a wider view 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 ophthalmologists advise their patients to bring dark glasses and someone to accompany them. Or return home by taxi.
Eye drops for pupil dilation 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, the ophthalmologist reveals the following:
- In case of circulatory disorders in the eye- congestive processes in the optic nerve.
- According to the pallor of the optic nerve papilla - atrophic processes.
- Changes in the retina can indicate inflammation, impaired blood flow, developmental anomalies, dystrophy, the fact of hemorrhage, opacities, disruption of blood vessels.
- The presence of tumor formations in the area of the optic disc or on another part of the retina.
- Disorders of the normal state of the choroid - dystrophy, sclerosis, inflammation, malformations, tumor formations.
- Defects of the optic nerve itself.
Research results
During the procedure, the ophthalmologist evaluates the general condition of the patient's eye structures. Examines the state of blood vessels, checks for the presence / absence of hemorrhages. The retina is examined especially carefully for inflammation and hemorrhage.
Ophthalmoscopy is one of the most accurate methods today. The reliability of such a survey is estimated at 90% or more. However, it is important that an experienced specialist perform ophthalmoscopy.
Ophthalmoscopy is a simple and relatively fast examination. It can be used to judge the development of many serious pathologies (not only ophthalmic) even at an early stage of their development.
