Fundus examination

Dilated fundus examination shows drusen and pigmentary abnormalities in the macula... 

Keeler Vantage, Heine Handophthalmoskop Beta 200 used for fundus examination. 

Figure 5-3 Example of handwritten record entry to document informed consent when a patient refuses pupillary dilation. (DEE = dilated fundus examination PVD = posterior vitreous detachment RTC = remrn to clinic.)...

A 58-year-old woman complaining of poor focus and gaps in her vision was examined by an ophthalmologist. These complaints were attributed to her contact lenses however, during the course of the examination Schiqtz tonometry was performed, and readings of 23.8 mm Hg were obtained in each eye. Despite this result no dilated fundus examination or visual field assessment was... 

The rationale for the court s opinion was that the diagnosis of cataract (a disease ) required dilation of the pupil and that had dilation been performed at the time of the optometrist s examination, the possibility of a retinal detachment could have been ruled out. In finding the optometrist liable, the court imposed a medical standard of care.Therefore a dilated fundus examination should be used whenever best-corrected visual acuity is reduced, and coexisting disease should be considered a possibihty until an examination determines otherwise. Optometrists may be held responsible for the diagnosis of intraocular tumors—even those as rare as malignant melanoma—in symptomatic patients. 

Another important precursor of retinal detachment is acute-onset, symptomatic, posterior vitreous detachment. It has been reported that 7% to 15% of patients with acute symptomatic posterior vitreous detachment have a retinal tear. Approximately one-third of these tears progress to retinal detachment. If patients complain of spots, specks, floaters, or other entoptic phenomena that indicate the possibility of posterior vitreous detachment, optometrists must conduct a dilated fundus examination to rule out the presence of a tear. Although feilure to detect the detachment may not be below the standard of care for an optometrist (due to the break s size or location), failure to detect a detachment because pupillary dilation was not used for the retinal examination will be construed as negligent. 

A clinical and legal issue of some importance is posed by the necessity for pupillary dilation. If there is litigation, the use of expert testimony is required to determine whether dilation was needed to conform to the standard of care in a specific instance. If a reasonable practitioner would maintain that a dilated fundus examination was necessary under the circmnstances, then the patient must receive that evaluation or be referred to another practitioner so that it can be performed. There are numerous... 

Because of its prolonged mydriatic and cycloplegic effect and relatively weak cycloplegic action, particularly in darkly pigmented irides, homatropine is not a drug of choice for fundus examination or cycloplegic refraction. Homatropine is primarily used in the treatment of anterior uveitis, in which its effects are similar to those of atropine. 

Although the drugs used for routine pupil dilation are not known to have teratogenic effects, common sense dictates that practitioners must use caution in pregnant women because topically administered drugs may be absorbed systemically. In many cases the dilated fundus examination can be postponed until after delivery. However, if the patient must be dilated, tropicamide is the drug of choice.The risk-to-benefit ratio must be carefully... 

Paris ML, Scheiman M, Coulter RS. Comparison of the effectiveness of a nondilated versus dilated fundus examination in the pediatric population. J Am Optom Assoc 1996 67 266-272. 

Pollack AL, Brodie SE. Diagnostic yield of the routine dilated fundus examination. Ophthalmology 1998 105 382-386. 

Visual acuity (pinhole) SUt-lamp examination ICeratometry (optional) Refraction (optional) Tonometry Dilated fundus examination if vision <20/50 History... 

In patients with history of ocular inflammation, 1% prednisolone acetate, one drop four times a day for 3 to 7 days, can be prescribed prophylactically after Nd YAG. Rarely, a patient without history of inflammation may present with flare or mild cells in the anterior chamber or CME after capsulotomy. This also should be treated with topical steroids in the same manner. Post-YAG elevated lOP can often be prevented by treating the eye with apra-clonidine (lopidine) or other aqueous suppressant topical medication. The recommended dosage is one drop applied before the capsulotomy and one drop immediately after the procedure. Because of the potential risk of a retinal break, patients should receive dilated fundus examinations postoperatively as part of the routine follow-up within 1 to 4 weeks of capsulotomy, or sooner if symptoms develop. 

Because tamoxifen retinopathy can occur at relatively low total doses of drug, it is important to obtain a baseline examination within the first year after therapy is begun. This should include best-corrected visual acuity, visual fields and Amsler grid evaluations, and fundus examination. It is important to monitor symptomatic... 

Fundus examination reveals multiple tiny, yellow-white, glistening particles scattered throughout the posterior pole but concentrated in the capillary bed and small arterioles of the perimacular area (Figure 35-15).The distribution and position of the particles remain stationary over time. In addition to these characteristic lesions, some... 

Patients who are to receive long-term chloramphenicol therapy should be given a comprehensive baseline examination consisting of VA,VF, CY, and dilated fundus examination. 

Baseline examination with visual acuity, central VFs, CV, dilated fundus examination (with photography) is advised. 

Follow-up dilated fundus examinations recommended every 2-4 months initially and every 6 months thereafter depending on dose and duration of drug administration. 

Baseline comprehensive examination including dilated fundus examination. 

CV, dilated fundus examination including optic nerve assessment. 

A fit, healthy, 69-year-old man presented with sudden painless loss of vision in the left eye a few hours after taking sildenafil 100 mg (23). Fundus examination... 

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