Fundoscopy- HELP
Anyone have any tips for fundoscopy? I seem to have practised and practised however all I see is red blur. I have no problem focusing on far and near targets when it is not looking into an eye, think I get close enough and look in all angles.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
Original post by Rose2912
Anyone have any tips for fundoscopy? I seem to have practised and practised however all I see is red blur. I have no problem focusing on far and near targets when it is not looking into an eye, think I get close enough and look in all angles.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
Have you tried to alter the focus on the ophthalmoscope?
Original post by Rose2912
Anyone have any tips for fundoscopy? I seem to have practised and practised however all I see is red blur. I have no problem focusing on far and near targets when it is not looking into an eye, think I get close enough and look in all angles.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
I have the same problem. What I found somewhat helped with practice/figuring out whats wrong was printing out many small colour pictures of fundi on an A4 paper, holding it up in front of me, and using the ophthalmoscope on those pictures. My problem seems to be that I'm not focusing the lens correctly, and also I'm unable to close just one eye which rapidly causes watering eyes. Its really frustrating as everyone else seems to get it pretty easily. I can see a blurry patch of white as the optic disc, and one blurry horizontal vessel (usually).. but none of the details that would be needed for even the most basic ophthal diagnoses
For exams you usually can hazard a guess on what findings you're supposed to see, based on what you think the diagnosis is from the history. But yeah its scary to think about not being able to do it in real clinical situations
(edited 9 years ago)
Focussing the thing makes a massive difference. Just flick the dial around a lot until it starts to work and try to remember roughly where that is to aim for it next time. Remember to compensate for the person whose eye you're looking in. Also, pick a target. If you head in towards the nose, you're almost guaranteed to hit the optic disc roughly around there and it's probably the most recognisable thing out of focus, so you can use that to focus yourself in. Take your time and eventually you should get it... even I eventually got it and I'm mostly rubbish at practical skills. I find that the more methodical and slow you are, the more likely you are to get it right. I tend to have a look and feel guilty about not finding something within X seconds (feels infinite...) and then give up and feel useless a bit too easily. Not saying you do necessarily, just that it's a problem I know *I* have, if that helps you figure out your problem!
Also are you astigmatic? Those things only correct for refractive error on the dial, you haven't a hope in hell of seeing much if you let them convince you to take your glasses off because it looks 'unprofessional' and 'like you don't understand the principle of the fundoscope' etc... that turned out to be another reason for the perennial orange blur! Though I'm still worried about being marked down in exams for not appearing to compensate for my own eyesight.
Good luck! It's amazing to have your own fundoscope, I'd love to be able to practice properly. I'm sure you'll get it once you've got a fool-proof method
Also are you astigmatic? Those things only correct for refractive error on the dial, you haven't a hope in hell of seeing much if you let them convince you to take your glasses off because it looks 'unprofessional' and 'like you don't understand the principle of the fundoscope' etc... that turned out to be another reason for the perennial orange blur! Though I'm still worried about being marked down in exams for not appearing to compensate for my own eyesight.
Good luck! It's amazing to have your own fundoscope, I'd love to be able to practice properly. I'm sure you'll get it once you've got a fool-proof method
(edited 9 years ago)
Thanks for your suggestions everyone, much appreciated. Yeah I have literally scrolled through the whole focus settings and darkened the room with little luck, however will keep trying! My parents, friends and cats will probably be blind by the time I've finished, lol. Deathcraze that sounds like a good idea with the images, I'll try that to avoid damaging people's eyesight and feeling continually hopeless. I might also get my eyes checked. I had laser surgery previously however think I may have been burying my head in the sand about subsequent deterioration :-(
As above, but also make sure you get really close too, like almost touching foreheads. If you're too far away, you won't see jack.
Original post by Rose2912
Thanks for your suggestions everyone, much appreciated. Yeah I have literally scrolled through the whole focus settings and darkened the room with little luck, however will keep trying! My parents, friends and cats will probably be blind by the time I've finished, lol. Deathcraze that sounds like a good idea with the images, I'll try that to avoid damaging people's eyesight and feeling continually hopeless. I might also get my eyes checked. I had laser surgery previously however think I may have been burying my head in the sand about subsequent deterioration :-(
Wouldn't want to get that close to my kitties with an ophthalmoscope
Tip from me would be that you need to be closer than you think. Too far and you won't see anything except red reflex. With focusing, pick a blood vessel first of all and get that focused sharp, then follow it to the target.
Original post by Rose2912
Anyone have any tips for fundoscopy? I seem to have practised and practised however all I see is red blur. I have no problem focusing on far and near targets when it is not looking into an eye, think I get close enough and look in all angles.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
Go along to your local eye unit and ask the nurses to help you. I worked in an ophthalmology unit for 2 years and the nurses there were great. Alternatively go to your local friendly optician and ask
hey
I work with eyes though I do volk! opthalmosocopes imo are rubbish..what I see with volk is a thousand times better than opthals quality
so basically make sure your mag is on like zero... if you have no prescription and good eyes. start at like +6.00 or something like that.. otherwise adjust the dial accordingly to compensate for your prescription. get the patient to just look straight ahead. use your right eye for the patients right eye and use your left eye for patients left eye. so you get close to px don't be afraid to use one of your hands to support against patients head. get close to patient but not so close your are touching them make sure you literally have the opthal in front of your eye.. .. so initially you will be focused on lens.. get patient to UP/DN/LE/RE then what you are doing is decreasing the plus focus to focus on vitreous get patient to blink to check for any floaters and get px to look UP/DOWN. then you keep on focusing till the disc and just general retina or any blood vessel comes in focus. you need to be quite close to px to start with.. you will normally see either a pink fundus in Caucasians or blonde fundus in Asians. its just practice.. focus towards minus. slowly and you will eventually start seeing stuff.. its just practice.
I work with eyes though I do volk! opthalmosocopes imo are rubbish..what I see with volk is a thousand times better than opthals quality
so basically make sure your mag is on like zero... if you have no prescription and good eyes. start at like +6.00 or something like that.. otherwise adjust the dial accordingly to compensate for your prescription. get the patient to just look straight ahead. use your right eye for the patients right eye and use your left eye for patients left eye. so you get close to px don't be afraid to use one of your hands to support against patients head. get close to patient but not so close your are touching them make sure you literally have the opthal in front of your eye.. .. so initially you will be focused on lens.. get patient to UP/DN/LE/RE then what you are doing is decreasing the plus focus to focus on vitreous get patient to blink to check for any floaters and get px to look UP/DOWN. then you keep on focusing till the disc and just general retina or any blood vessel comes in focus. you need to be quite close to px to start with.. you will normally see either a pink fundus in Caucasians or blonde fundus in Asians. its just practice.. focus towards minus. slowly and you will eventually start seeing stuff.. its just practice.
(edited 9 years ago)
Both eyes are meant to be kept open...and c time your meant to learn the suppress the other image Also dim lights will dilate pupils. Don't use largest size aperture use medium aperture for normal to large sized pupils and use small aperture for small,pupils...im wondering if ur not seeing structures and only red reflex if mag is not on zero....
(edited 9 years ago)
Original post by the_effendi
hey
I work with eyes though I do volk! opthalmosocopes imo are rubbish..what I see with volk is a thousand times better than opthals quality
so basically make sure your mag is on like zero... if you have no prescription and good eyes. start at like +6.00 or something like that.. otherwise adjust the dial accordingly to compensate for your prescription. get the patient to just look straight ahead. use your right eye for the patients right eye and use your left eye for patients left eye. so you get close to px don't be afraid to use one of your hands to support against patients head. get close to patient but not so close your are touching them make sure you literally have the opthal in front of your eye.. .. so initially you will be focused on lens.. get patient to UP/DN/LE/RE then what you are doing is decreasing the plus focus to focus on vitreous get patient to blink to check for any floaters and get px to look UP/DOWN. then you keep on focusing till the disc and just general retina or any blood vessel comes in focus. you need to be quite close to px to start with.. you will normally see either a pink fundus in Caucasians or blonde fundus in Asians. its just practice.. focus towards minus. slowly and you will eventually start seeing stuff.. its just practice.
I work with eyes though I do volk! opthalmosocopes imo are rubbish..what I see with volk is a thousand times better than opthals quality
so basically make sure your mag is on like zero... if you have no prescription and good eyes. start at like +6.00 or something like that.. otherwise adjust the dial accordingly to compensate for your prescription. get the patient to just look straight ahead. use your right eye for the patients right eye and use your left eye for patients left eye. so you get close to px don't be afraid to use one of your hands to support against patients head. get close to patient but not so close your are touching them make sure you literally have the opthal in front of your eye.. .. so initially you will be focused on lens.. get patient to UP/DN/LE/RE then what you are doing is decreasing the plus focus to focus on vitreous get patient to blink to check for any floaters and get px to look UP/DOWN. then you keep on focusing till the disc and just general retina or any blood vessel comes in focus. you need to be quite close to px to start with.. you will normally see either a pink fundus in Caucasians or blonde fundus in Asians. its just practice.. focus towards minus. slowly and you will eventually start seeing stuff.. its just practice.
I think this is good advice, I'm just on an ophthalmology module and this is pretty much what works for me. Everyone says to just use 0, but using a plus focus and going down has produced much better results for me. The annoying thing, however, is that even when you can see the disc and macula and the patient is dilated, it's still pretty darn hard to make a diagnosis based on direct opthalmoloscopy
.Original post by AnonymousPenguin
I think this is good advice, I'm just on an ophthalmology module and this is pretty much what works for me. Everyone says to just use 0, but using a plus focus and going down has produced much better results for me. The annoying thing, however, is that even when you can see the disc and macula and the patient is dilated, it's still pretty darn hard to make a diagnosis based on direct opthalmoloscopy .
.So your at uni? Well c opthal apart from poor view u kinda forget what you've seen cos ur bending ur back lol. They should give you a slit lamp a chair and a volk lens but u can't give that to every gp cos my job would then be over!
Original post by the_effendi
So your at uni? Well c opthal apart from poor view u kinda forget what you've seen cos ur bending ur back lol. They should give you a slit lamp a chair and a volk lens but u can't give that to every gp cos my job would then be over!
Are you an ophthalmology trainee? Yeah I do agree, slit lamps are much better, but most ophthalmologists don't seem to be keen on letting students play with them and a 60D lens. The level of detail and the improved contrast is so much better.
Original post by AnonymousPenguin
Are you an ophthalmology trainee? Yeah I do agree, slit lamps are much better, but most ophthalmologists don't seem to be keen on letting students play with them and a 60D lens. The level of detail and the improved contrast is so much better.
Nope. Optician trying second time to get into med school want to become opthal. You see more at once c volk anyway and it's great for seeing past intermediate pathology and you can't be ruining backs at a young age doing ophthalmoscopy...
Original post by the_effendi
Nope. Optician trying second time to get into med school want to become opthal. You see more at once c volk anyway and it's great for seeing past intermediate pathology and you can't be ruining backs at a young age doing ophthalmoscopy...
Nope, but you need to be able to do it for the exam.
I close one eye when doing ophthalmoscopy. I recall colleagues at uni using their hand to close their eye with their hands. The fact that you're looking at a 1D image means you only need one eye.
I find it has always been easier to start on a plus focus and rack down until it is in focus. You notice a gradual improvement in clarity so you'll never miss the best focus.
You need to be really close to the patient. And angle close to their nose. If you have missed the disc then focus on a blood vessel and track towards the disc.
To look at the macula it is usually 2 disc diametres temporal to the optic disc.
Or you can lower the brightness and get the patient to look into your light.
Practice on people with large pupils to feel comfortable on positioning.
Posted from TSR Mobile
I find it has always been easier to start on a plus focus and rack down until it is in focus. You notice a gradual improvement in clarity so you'll never miss the best focus.
You need to be really close to the patient. And angle close to their nose. If you have missed the disc then focus on a blood vessel and track towards the disc.
To look at the macula it is usually 2 disc diametres temporal to the optic disc.
Or you can lower the brightness and get the patient to look into your light.
Practice on people with large pupils to feel comfortable on positioning.
Posted from TSR Mobile
Original post by Helenia
Nope, but you need to be able to do it for the exam.
Of course.
Original post by Rose2912
Anyone have any tips for fundoscopy? I seem to have practised and practised however all I see is red blur. I have no problem focusing on far and near targets when it is not looking into an eye, think I get close enough and look in all angles.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
I saved up and bought an opthalmoscope to practise myself however still cannot see a thing. To rub it in my non-medic parents had a go and saw all the vessels and optic disc on first attempt :-(
I am so frustrated as I cannot be a doctor if I cannot check whether someone has papilledema or not etc! Let alone pass exams.
Many thanks for any help you can offer.
Something like 40% of GPs admit they would not feel confident using a fundoscope in the management of a patient, don't worry. And anyway, they're going to be obsolete in a few years - there are smartphone modifications in prototype form which can do digital retinal photography!
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