1. What else is fundo known as?
    • aspheric biomicroscopy indirect fundus lenses
    • funduscopy
    • vitreoretinal biomicrscopy
  2. What is fundo?
    a technique of IO using SL
  3. What is the FOV for a Hruby lens?
  4. What is the effect of a small FOV?
    opacities + reflections can impede ease of viewing
  5. What is Hruby lens?
    • plano high minus concave lens
    • mainly superseded by funduscopy lens
  6. why fundo
    • high res stereoscopic
    • high mag view
    • can see peripheral retina if dilated
    • variable illuminants + apertures/filters
    • photodocumentation of anomalies
  7. fundo is good for detecting
    • ONH changes
    • macula oedaema
    • retinal neurovascularisation
  8. adv of fundo
    • non-invasive
    • can be performed undilated
    • stereopsis
    • variable mag + illumination
    • excellent view of vit
    • can use red-free filter to assess NFL
  9. disadv of fundo
    • difficult to get to periphery
    • can be tough to interpret when viewing periphery
  10. indications for fundo
    • every px - dilated or undilated
    • DR (especially)
    • Glaucoma
    • MD
    • papilledema
    • vascular obstructions
  11. DR stands for
    • diabetic retinopathy
    • damages b.v. in retina
  12. papilledema
    • optic disk swelling caused by raised intracranial pressure
    • tortuous vessels are associated
    • indistinct ON margin
  13. The image in fundo is
    reversed and inverted
  14. fundo lens is
    high plus lens to produce an image of fundus or vitr
  15. magn and FOV is dependent on
    the selection of CL - may be irrelevant as on SL
  16. Standard 90D lens has
    • baseline mag = 0.76x
    • FOV = 74deg
    • WD = 7mm
  17. Superfield lens has:
    • 95deg
    • 0.76x
    • 7mm
  18. Digital wide field lens has:
    • 103deg
    • 0.72x
    • 4-5mm
  19. base line mag 0.76x, WD = 7mm and FOV = 74deg is for which lens?
    the standard 90D lens
  20. adv of contact fundo lenses
    • enhanced image quality
    • reduced reflections
    • stability
    • surgical implications
  21. disadv of contact fundo
    • corneal distortion
    • corneal dehydration
    • kertopathy
    • vasovagal reflex
  22. fundo set up
    • small vertical rectangle beam
    • low-med intensity
    • low mag
    • 0deg
    • initially focus on TF or cornea
  23. one viewing technique of fundo
    • track path of the 4 major arteries out and track back along corresponding veins
    • macula is last
  24. if px is dilated, you can.......
    • elongate slit vertically and simply scan across retina in low mag
    • macula last
  25. how to view more peripheral?
    • slightly move lens + SL in same direction as px gaze
    • tilt lens to improve view + reduce reflection
  26. adv of using a slit beam in fundo
    • can observe  if area is elevated or depressed 
    • transillumination of surrounding area = can make better detection of central serous retinopathy
  27. when recording for fundo
    • record lens used
    • location of lesions = location you are looking at
    • aerial image is inverted and reversed
  28. avg DD
  29. what is drance haemorrhage
    bleeding at ON
  30. bayonetting of vessels =
    blood vessels bend or kink sharply when they pass over the edge of the cup
  31. DO measurement of ONH
    dia of DO = 5deg = avg DD (1.6-2mm)
  32. measuring ON size with fundo
    • bracket it with ht of beam
    • use a table to correct the magn of the lens used
  33. crescents are typically more__________
  34. exudate vs drusen
    • exudate = lipid deposits from lipoprotein leakage from b.v.
    • drusen = waste material from RPE
    • exudate is more yellow
  35. uneven pigmentation on fovea can suggest
  36. loss of foveal reflex suggests
    macula oedema
  37. abt macular oedema
    • main cause of visual impairment in diabetic px
    • can occur at any stage of DR
    • abnormally permeable capillaries and IRMA leak lipoproteins etc
    • fluid fills extracellular space = macular thickening
    • seen clinically as blurring of underlying choroidal vessels and blunting of foveal reflex
  38. whats is IRMA?
    intraretinal microvascular abnormalities
  39. CSMO
    clinically significant macular pedema
  40. CSMO is defined by
    • one or more of the following
    • retinal oedema within 500um of centre fovea
    • hard exudates within 500um of fovea if associated with adj retinal thickening
    • retinal oedema one DD or larger, any part that is within one DD of centre fovea
  41. what is microaneurysm
    • small pouch coming out of weak vessel wall
    • characteristic of diabetes
  42. red free filter is
    • used to detect NFL dropout e.g. slightly darker bands = wedge defects
    • it decreases image brightness increases BIO or SL brightness
    • makes blood darker
    • choroidal naevi = cannot see  as red + green cancel each other out
    • retinal naevi = seen with red-free in place
  43. cotton wool spota
    • white fluffy lesions in NFL
    • infarcts within NFL
    • caused by blockage of flow within arteriole -> NFL axoplasmic flow interrupted -> swelling of neural tissue
  44. define infarct
    small localised area of dead tissue resulting from failure of blood supply
  45. retinal haemmorhages
    • 2ndary to ruptured microaneurysms, capillaries or venules
    • shape is dependent on location with the retinal layers
    • sever retinopathy = dot seen at margins of non-perfused area
    • flame haem occurs in superficial NFL; resolves in 6wks to 4 months
  46. hard exudate
    • accumulation of lipids from leaky capillaries
    • may for a circular pattern
    • located in OPL
    • can be anywhere in macula
    • DDx = drusen
  47. NPDR
    non proliferative DR
  48. mild NPDR
    • microaneuryms
    • dot and blot haemorrhages
    • hard (intra-retinal exudates)
  49. moderate to sever NPDR
    • mild NPDR lesions usually more sever
    • cotton-wool spots
    • venous bleeding and loops (bumpiness along veins)
    • IRMA (arteriole to venule shunts with capillary dropout)
  50. proliferative DR
    • NVE, NVD or NVI
    • fibrous tissue adherent to vitr face of retina
    • retinal detachment
    • vitr haemorrhage
    • pre-retinal haemorrhage
  51. maculopathy
    • CSMO
    • Ischaemic maculopathy
  52. ischaemia is
    inadequate blood supply
  53. NVE
    neurovascularisation of the retina
  54. neurovascularization is
    formation of functional microvascular networks with RBC perfusion (delivery of blood to capillary bed)
  55. NVD
    new vessels at the optic disc
  56. NVI
    new vessels at the iris
  57. high risk proliferative DR
    • poor visual prognosis
    • NVD > or = 1/3 disc area in extent
    • any NVD with vitr or pre-retinal haemorrhage
    • NVE > or = disc area in extent associated with vitr or pre-retinal haemorrhage
    • vitr or pre-retinal haemorrhage obscuring > or = 1 disc
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