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1

what is the purpose of doing Dilation Fundus Exam FDE?

to evaluate the peripheral retina to search for ( rhegmatogenous) since it is missed with direct and indirect monocular

2

what are the advantages of BIO?

1- quick assessment of entire retina and vitreous
2- Stereoscopic Examination of the Entire retina and Vitreous

3

what it means that BIO is a Stereoscopic examination?

1- allow a binocular , high resolution view
2- allow a large fov
3- independent of pt. refractive error

4

what are the disadvantages of BIO ?

1- lower mag than SLEx with lenses and direct
2- require dilated pupil
3- the BIO light is very bright

5

what is the Mag of BIO with 20D lens ? how to increase the mag.?

BIO has 3X Mag with 20D lens
the ONLY way to increase the Mag is to change the Diapter lens not getting closer to the patient

6

what is the distance between the Dr and the lens ? between the lens and the Pt. eye?

it is 50cm=16-20 inches from Dr to the lens
it is 50mm from lens to eye

7

what are the indications for BIO?

1- every Pt. with a comprehensive eye exam
2- flashes , floater complaints
3- Myopia >4.00D
4- systematic Diseases

8

What are the contraindications for BIO ?

1- Narrow angle
2- Caution with Down's syndrome since they are sensitive to Tropicamide

9

what is the Pupil Dilation Protocols?

1- review history
2- Acuities = best corrected with trial frame
3- Pupils , EOMs
4- SLEx for cornea and angles with VH
5- IOP
6- Gonio
7- Pt education
8- Instillation of drops

10

what you should be Caution about if Pt have low BP?

Vasovagal Syncope = loss of consciousness caused by transient cerebral hypoperfusion as a result of low HP, HR
symptoms : Nausea, Pale ,
lightheaded, warm

11

what you should do with Vasovagal ?

1- stay calm
2- recline the Pt. wit elevation of their feet
3- while that , take BP, Pulse until return to normal
4- alert the preceptor
5- be careful and support the Pt

12

What are the three DO NOT with VasoVagal ?

1- DO NOT Pt leave until BP, Pulse are back to normal
2- DO NOT let the Pt walk alone if unsteady
3- DO NOT give water

13

what are the drops you use for dilation ?

1-Anesthetic ( Proparacain )
2--- Tropicamide 1% or for lighter eyes 0.05% ---> Block sphincter( Para symp.) muscle result in dilation
3- Phenylephrine 2.5% will activate the dilator muscle( Sympathetic) mydriasis and vasoconstrictor --> weak Dilator , NOT the standard of care for pupil dilation ( need Tropicamide with it )

14

what are the two things u need to do before Dialtion ?

IOP , VH

15

what are the properties of Tropacmide ?

1- STING make sure eye is numb 1st ,
2- Caution overdose with kids
could cause dry mouth, fast HR, Headaches, drowsiness , redness of skin
3- Blurry Vision at near , Photophobia

16

what are the properities of Phenylephrine ?

ONLY when use 10 %
1- Dizziness , fast HR, increase BP
2- High BP since is it is vasoconstrictor

17

what are the side effects of dilation ?

1- explain that it will be blurry vision at near > distance for 2-6h ( blue eyes stay longer )
2- photophobia
3- Pt may wish to have driver ( Older Hyperopic
4- Cycloplegia may wear off before dilation of Pupil

18

how to record the dilation ?

1- which drop , how much , which eye , when
2- record that u educated the Pt before the dilation

19

what are the steps to start using the BIO ( binocular Indirect Opthalmoscope ) ?

1- make sure u have the BIO comfortable on ur head
2- PD , oculars are properly set before viewing the lens( see the top part of thumb in the middle of the circle )
3- hold the lens in a way that ur fingers not in the way
4- make sure u see single vision
5- make sure u see a red reflex
6- then put the lens close to the eye
7- then Trombone

20

what happened if you increase the dioptric power of the lens?

increase D -->will increase Field of view, DECREASE Mag , decrease WD
(More Diopters= Less Mag)
Change Aperture will change the Mag

21

which is the lens standard ?

20D lens gives the BEST balance between mag and Fov ( field of view )

22

what is the working distance of 20D lens , Pan retinal 2.2=25D, 28D?

1- working distance of 20D is 50mm( from the lens to the eye)
2- working distance is 40mm
3- working distance for 28D is 33mm

the lower power lens u use ---> the farther aways from the eye the lens should be

23

how changing the Aperture will affect the Mag ?

Change Aperture will change the Mag
15 D= 4X
20 D = 3X
30 D = 2X
2.2 = 2.5X

24

how field View related to the Mag ?

Field View is inversely related to Mag.

25

What are the elements that will change if u INCREASE the Lens D power ?

increase D lens -->
1- Increase the field of view
2- Decrease the Mag = change aperture will change Mag
15 D= 4X
20 D = 3X
30 D = 2X
2.2 = 2.5X
3- Decrease WD

26

what is the unit used for Field of view ? what is the field of view of 20D lens ? Direct scope

1- Disc Diameter is the unit used for field of view
2- 20D =8DD ( Disc Diameter)
3- Direct scope= 2 DD

27

what is the distance between ONH to Macula?

it is 2 to 3 DD

28

How you should hold the lens ?

1- Grasp the lens between the index finger and Thumb ( silver ring toward the pt)= more reflecting surface
2- the ring, middle , little finger can be used for :
retract the upper lid,
allow stable extension
act as a Pivot ( to tilt the lens)
3- Open arm of V facing u which is the less reflecting surface
4- keep ur eye slightly bent , pull the lens towards u ( keep the light source and pupilalry reflex centered on the lens )
5- Align the Purkinji images
6- keep pulling until--> tromboning

29

how u know ur tromboning ?

keep pulling until--> the entire lens is full with a view of fundus-->tromboning
1- true for Posterior pole and midperipher ONLY

30

what you should do each time you have a pt moves their fixation ?

Each time you have the patient moves their fixation, you should be moving yourself to maintain a position ~180° from the patient’s fixation