I am old enough to remember headset indirect ophthalmoscopy technique being an integral part of the undergraduate clinical skills training in optometry.
It is true the technique is not widely used in general primary care practice these days and this may be for a number of reasons. Attempting fundoscopy without dilation is not a good idea. Also, the patients under examination (often very young) are never grateful for the blast of light you hit them with while asking them to look to their extremes, often while poking them with an indenter.
But lack of practice and patients’ transient discomfort should not obscure the advantages of this technique. With suitable viewing lenses (mine are seen along with the indenter in Figure 1, the higher dioptric lens offering excellent peripheral field possibilities) and good dilation, a large swathe of far peripheral retina is visible in one view.
In good conditions, the pan-retinal lens (on the right) affords a view of up to 52 degrees making it excellent for, for example, peripheral retinal degeneration viewing, establishing the extent of a schisis, or (though I confess I have limited experience of this) viewing a detachment. This is way beyond the view offered by our familiar fundus viewing lenses at the slit-lamp.
There is also a school of thought that argues (again from a position I do not pretend to have the relevant know-how to confirm or deny) the working distance if combined with a sensitively controlled rheostat means this technique allows a clinician to see the retina of a very young, a learning impaired, or a supine and immobile patient when other techniques do not.
Heine Sigma 250
I always found the traditional headset difficult to fit, and that was before the mid-life crisis ponytail. The headset invariably slipped and I was constantly having to relocate vertically the viewing unit. The power cable restricted movement, or worse, constituted a trip hazard. The new Heine 250 addresses all of these concerns, and I found myself trying a technique again that I confess I had let lapse some years back. I even managed an acceptable view within a short time, though still only after a full dilation.
The unit is powered by a portable charge pack which easily lasts a day clinic (Figure 2) and, clipped to the trousers or waistcoat, allows full freedom of movement helping you to see the further retinal reaches with some physical acrobatics. The rheostat location makes patient-friendly adjustment easy too.
[CaptionComponent="1181"]The head set fits over the Heine S-Frame (Figure 3) or the S-Guard, the latter for use over one’s existing spectacles. Vertical adjust, PD, stop size choice, blue filters and diffuser are all present and easily set.
[CaptionComponent="1182"]For those looking to develop this skill or merely reawaken a forgotten technique, the Heine 250 is well worth a look.
For further information visit www.carletonltd.com
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