3.1.3 Examines the fundi using both direct and indirect techniques.

Direct ophthalmoscopy apertures

Top tips for direct ophthalmoscopy

• Darken the room enhances pupillary dilation and red reflex

• Fixate on distance reduces accommodation so bigger pupil

• Start at arms length centre red reflex before moving closer

• Move in slowly stay along visual axis keeping reflex in view

• Find the optic disc first by following vessels

• Scan retina systematically superior, nasal, inferior, temporal

• Examine macular last patient looks at light, can be uncomfortable

• Keep both eyes open reduces practitioner fatigue

• Use the smallest aperture for undilated pupils

Diopter wheel

Start at 0D - good if optom and px are emmetropic

If the patient has refractive error:

• Myope: you’ll usually need a negative (–) lens.

• Hypermetrope: you’ll usually need a positive (+) lens. If you see retinal vessels but they’re blurred, roll the wheel until they sharpen.

• You can also scroll through the diopters systematically (start + and go to –) to “sweep” from anterior → posterior.

Advantages of direct ophthalmoscopy

Erect image of the fundus

Portable

Suitable for all patients

Advantages of binocular indirect ophthalmoscopy

Stereoscopic view of fundus

Increased FOV

View of fundus is beyond equator

Image of fundus can be achieved in patients with cataract and high ametropia

Increased working distance compared to direct and indirect monocular ophthalmoscopy

VOLK lens Magnification Field of View Working Distance Use:

Analysing peripheral retina with VOLK

Keep the lens tilted slightly toward the pupil to maximise the red reflex and avoid reflections.

Rule of thumb:

Patient looks where you want to examine; you move your Volk lens the opposite way.