PC - Fundus Lens - Week 1

Question 1

When should the posterior eye always be examined?

Answer 1

As part of a routine eye exam.

Question 2

Must patients always be dilated for a fundus lens exam?

Answer 2

No, undilated fundus lens should be attempted routinely on a patient not being dilated at the current visit, or when a DFE is contraindicated.

Question 3

Consider a patient that has been dilated with no contraindications. Should you perform a fundus lens exam, or do a BIO exam?

Answer 3

Always perform both on a dilated patient.

Question 4

Are cataracts an indication for a fundus lens exam?

Answer 4

Yes

Question 5

Name 3 general indications for a fundus lens exam.

Answer 5

Indications for DFE
1st presentation
Reduced best corrected VA

Question 6

Name 15 PC indications for a fundus lens exam.

Answer 6

Reported visual disturbance
Photopsia
Floaters
Metamorphosia
Metachromatopsia
Shadows
Veils
Curtain of reduced vision
Scotoma
VF deficit
HA
Diplopia
Ptosis
Pupil abnormalities
Trauma (hyphaema)

Question 7

Name 5 GH indications for a fundus lens exam.

Answer 7

Diabetes
Hypertension
Cancer
High cholesterol
Lupus

Question 8

Aside from general, PC, GH, and cataracts, name 4 indications for a fundus lens exam.

Answer 8

Known PVD
Previous RD
Retinal/choroidal lesion

Question 9

Would suspicion of glaucoma be enough indication for a fundus lens exam?

Answer 9

Yes

Question 10

Consider the power of a fundus lens. What do high and low powers mean for the field of view and magnification?

Answer 10

Low powers give higher magnification, but a lower field of view
High powers give low magnification, but a higher field of view

Question 11

What light set up is ideal for a fundus lens setup?

Answer 11

Dim room lights

Question 12

Consider a fundus lens exam on a patients right eye. What is an ideal fixation point? Name 3.

Answer 12

Your right ear, the dial, or a pixation light.

Question 13

What is an ideal range of magnification to start a fundus lens exam with?

Answer 13

Start low, vary during examination

Question 14

What height should the light beam be during a fundus lens exam?

Answer 14

Small, no bigger than the pupil

Question 15

Where should 90D, and superfield lenses be held in relation to the eye vs 78D?

Answer 15

90D+ - close to the lashes

78D - 8mm from the eye

Question 16

Where should the lens first be placed, and where would the top of the lens coincide with?

Answer 16

In front of the pupil

Top of the lens should be approximately at the brow

Question 17

What can you do if you lose view of the fundus?

Answer 17

Try small movements of the lens, check recentration, and the light.

Question 18

What can you use to check the stereo of your view?

Answer 18

Examining the NR/cup

Question 19

What is the time limit on viewing a given fundus area on medium settings?

Answer 19

> 1 minute

Question 20

What can you do to determine the conour of the fundus area you are examining?

Answer 20

Use a thin slit, and deviations will suggest a raised or depressed area.
Practise on the foveal pit.

Question 21

How can floaters within the vitreous humour be brought into focus?

Answer 21

Pull the SL back, the retina will become out of focus, and the floater will appear, usually yellow.

Question 22

Suppose you are looking at the optic disc and are satisfied. What should you do next?

Answer 22

Follow the major BV arcades from the disc in all quadrants.

Question 23

Consider using a SL and a lens, which direction should it be moved in?

Answer 23

SL - moved in the opposite direction to retina examined

Lnes - same direction

Question 24

Consider the following areas of the retina to be examined:
Superior
Inferior
Temporal
Nasal
What direction should the patient’s gaze be directed?

Answer 24

Superior - up
Inferior - down
Temporal - temporal
Nasal - nasal

Question 25

Consider needing to estimate the distance of a site of interest from the peripheral retina to the optic disc. How can this be achieved if both structures cannot be viewed within a single field of view?

Answer 25

Direct small changes in gaze to the patient, and estimate disc diameters as you progress towards the disc.

Question 26

Consider a situation where the patients gaze is directed in one of the following:
Up
Down
Left
Right

Answer 26

Up - inferior edge enwards
Down - superior edge inwards
Left - left edge inwards
Right - right edge inwards

Question 27

What is the purpose of the red-free filter, and what is the light transmitted by it chiefly absorbed by?

Answer 27

Used to differentiate pigment from blood, and allows localisation of pigmentary lesions.
Absorbed by the RPE and Hb.

Question 28

What can the red-free filter allow visualisation of?

Answer 28

The nerve fibre layer.

Question 29

What ratio is the red-free filter used for?

Answer 29

C:D

Question 30

Give a template of a recording for a fundus lens exam?

Answer 30

Undilated or dilated
Drops - %, type, dose, time, eye (R/L)
Findings - draw findings in correct sector
Hint - can turn paper upside down to help out, but write what the structures are when right way up.