Are you guys good at using the hand-held ophthalmoscope?

[crystalgreen]

Hey guys! I only use the slit lamp and indirect in clinic so I am very bad at using the direct hand held ophthalmoscope. Some of my primary care colleagues ask me to teach them but I am not very good. How are you guys at using it? Are there any good resources/trick?

thanks!

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[Bronze Medal]

I really like this resource from the Stanford 25. Geared toward medical students trying to master general examination skills.

http://stanfordmedicine25.stanford.edu/the25/fundoscopic.html

 

[dantt]

Yes. assuming no dilation, key is to keep lights down. Being ophthalmologists, it's also helpful we know where the optic nerve should be! Tracing a vessel towards the nerve is a helpful hint but it's nice to be looking in the general Vicinity. (Nasally)

 

[Visionary]

Haven't used one of those in over 10 years! I'll have to give it a try!

 

[eye love lamp]

Setting up the patient correctly is 90% of the work.

- Dark room (as dark as possible)
- Have the patient look 15 degrees over their nose
- Make sure you're at the same level as them (ie eyes in the same plane vertically)
- Have the patient look at a distant non-accommodative target
- Start at -5 (Red 5) on the direct when you start looking for the disc, it usually will be in focus unless theres bizarre refractive errors going on.

You should be able to see a blood vessel from a far distance. Once you lock on come within a cm of their eye and trace it to the disc.

Practice this on every one of your patients who you use indirect on to compare. Start with post dilated patients then transition to non dilated after 2 days. You'll be comfy and ready to teach by the end of the week.

 

[DrZeke]

Setting up the patient correctly is 90% of the work.

- Dark room (as dark as possible)
- Have the patient look 15 degrees over their nose
- Make sure you're at the same level as them (ie eyes in the same plane vertically)
- Have the patient look at a distant non-accommodative target
- Start at -5 (Red 5) on the direct when you start looking for the disc, it usually will be in focus unless theres bizarre refractive errors going on.

You should be able to see a blood vessel from a far distance. Once you lock on come within a cm of their eye and trace it to the disc.

Practice this on every one of your patients who you use indirect on to compare. Start with post dilated patients then transition to non dilated after 2 days. You'll be comfy and ready to teach by the end of the week.

Remember you can raise the chair up and down to make eye level easier for you...