How to use an ophthalmoscopeBMJ 2004; 329 doi: https://doi.org/10.1136/sbmj.0409320 (Published 01 September 2004) Cite this as: BMJ 2004;329:0409320
- Irene Cozma, ophthalmology senior house officer1,
- Scott Fraser, consultant ophthalmologist2,
- Anil K Nambiar, fellow3,
- Neena Peter, ophthalmology senior house officer4,
- David Spokes, phthalmology senior house officer5
- 1St James's University Hospital, Leeds
- 2Sunderland Eye Infirmary, Sunderland
- 3Moorfields Eye Hospital, London
- 4Worthing and Southlands NHS Trust, Worthing
- 5Kidderminster General Hospital, Kidderminster
Here is a selection and amalgamation of five readers' collected wisdom on using an ophthalmoscope--from senior house officer to consultant ophthalmologist
The ophthalmoscope seems a simple tool. But, in reality, “fundi NAD” written in the notes often means “not actually discerned.” The ophthalmoscope is not difficult to use but it requires some practice. Try to get in the habit of using it in every neurological examination--you'll soon get the hang of it.
Prepare your equipment
Does it work?
Check that the ophthalmoscope actually works--the batteries may be flat or it may not have been charged. Some ophthalmoscopes have a small cover over their aperture which, if closed, may lead you to think that it is not working.
How does it work?
There are different types of ophthalmoscope, and it always pays (with the lights still on) to familiarise yourself with the various dials and levers. When switched on, the emitted light should be:
Bright--turn it to maximum
White--ignore all other colours
Circular--again, ignore all the slits and crosses; turn the dial until you get a round circle.
Many people find it confusing to have to think about their own glasses and the patient's glasses. Don't worry about this--set all the numbers on the ophthalmoscope to “0.” Ask the patient to remove his or her glasses--you can keep your own on or remove them as you prefer. Contact lenses do not need to be removed.
Switch the room lights off or dim them, but don't make the room too dark.
Prepare your patient
Explain what you are going to do to the patient. Warn the patient that the bright light can temporarily dazzle them.
Position the patient …