Instruments: Head out on the highway

There are occasions where direct ophthalmoscopy is not able to offer an adequate view of a patient’s fundus during a domiciliary eye examination. For elderly patients, this is usually due to lens opacification and makes retinal viewing difficult, even after dilation. For learning disabled patients and the very young, the close proximity required for adequate direct viewing is all too often not possible. I have tried modified (monocular) indirect ophthalmoscopy, where the direct ophthalmoscope is positioned some 18cm from the patient’s eye before which a 20DS condensing lens (or, on occasion, a 20D trial lens) is placed. This can offer some view of the retina, but I confess all too often the recorded result is ‘glimpses only’.

Over the years, I have had some limited success with older patients using the monocular indirect PanOptic device, but have found this less helpful with those patients where proximity is problematic and also found peripheral retinal viewing tricky. Another option tried has been to use the Keeler Portable Slit Lamp (which I usually have with me) with a 90DS lens, but having to hold both the lens and the viewing/illumination unit makes this somewhat cumbersome and I do not claim any great results from this method.