Making the most out of your equipment

Your ‘30 second’ ophthalmic assessment tool. This technique does not rely on the direct ophthalmoscope (DO) although the focused light source and coaxial illumination provided by the DO make this the preferred instrument. Any light source which can be placed close to the observer’s visual axis can be used, e.g. a pen torch, head torch, auroscope or DO set to ‘0’. At arm’s length the patient is encouraged to direct their gaze towards the observer, who aims to observe reflected light from the retina – the ‘tapetal’ or ‘fundic reflex’ or reflection. Using this technique one can observe and assess:
• Pupil size, shape, symmetry and response to light.
• Changes in tapetal and fundic reflectivity.
• Opacities both in and out of the visual axis; localisation of lesions can be estimated by assessing movement of opacities relative to the pupil ...