Modified Indirect Ophthalmoscopy

A detailed fundus test is essential and needed in all young patients with amblyopia or strabismus so as to exclude organic causes of the amblyopia before the beginning of treatment. Test of very young kids could be quite tough particularly when a thorough view of the optic nerve and macula is needed. The patient co-operation and magnification obtained with head mounted binocular indirect funduscopy utilizing the 20D lens, and slit lamp biomicroscopy utilizing a 90D or other similar lens means which fundus study is generally impossible or difficult on smaller kids. Also the magnification might be insufficient to enable correct assessment of posterior pole information. The direct ophthalmoscope is considered as the best available instrument for thorough retinal test in small children. But, most of the small kinds become scared when the doctor comes closely, since it is important with the direct ophthalmoscope and collaboration or co-operation is lost. In addition young kids often attach the ophthalmoscope light beam and see it as it is moved by the doctor, enabling test of the macula however not of the disc. The area of view is small and the magnification is more than is generally needed. This would prevent the doctor from seeing the large image.
In order to avoid such problems the ophthalmoscope could be utilized in combination with the 20D condensing lens, the kind used with the head mounted BIO (binocular indirect ophthalmoscopes). This conjunction offers a wider angle and reasonably magnified, picture of the posterior pole. This also provides the close proximity between the examiner and patient needed when utilizing a direct ophthalmoscope alone. The method is known as monocular or modified indirect ophthalmoscopy and has been well-known for its ability to offer a good picture of the retina via the small pupil. It is considered as one of the best technique by most of the ophthalmologists.

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