Fundus examination (ophthalmoscopy): types, price, what it shows. Fundus examination – what does it show, what eye structures can be examined, which doctor prescribes? Types of fundus examination: ophthalmoscopy, biomicroscopy (with Goldmann lens, with fundus

Fundus lenses are an optical element that is necessary for an ophthalmologist in everyday practice. They are much easier to work with than high-diopter aspherical optics. The relative ease of their use is determined by the fixed position of the lens. This eliminates focusing problems caused by the choice of lens position in front of the patient's eyeball. Due to the fact that fundus lenses have a large field of view, they allow you to obtain a panoramic picture of most of the area without requiring additional manipulations with the lens.

Purpose of fundus lenses

The purpose of contact fundus lenses is a wide-field stereoscopic examination of the fundus of the eye, as well as the intraocular cavity using biomicroophthalmoscopy. They are used in the process of laser interventions, which are performed on the internal structures and membranes of the eyeball.

Fundus lenses, used in combination with a binocular microscope found in a slit lamp, make it possible to carry out a sequential view of the fundus, up to the post-equatorial zone, using the light slit scanning method. With their help, subtle structures are examined along its entire length: starting with the retrolental space and ending. Due to the fact that fundus lenses have high resolution, stereoscopicity and excellent image quality, they allow the doctor to get an approximate idea of ​​the pathology of the organ of vision, as well as to make morphological details of the changes found.

With their help, it is possible to determine the exact spatial-depth localization of the pathological process. A clear image makes it possible to visualize even minor abnormalities present in the vitreous body, as well as in the fundus. In addition to the fact that fundus lenses perform general diagnostic tasks. They are used for laser interventions performed on the fundus, and, above all, for panretinal coagulation of the retina. Fundus lenses are indispensable for this procedure. They can also be used, if necessary, to perform coagulation for peripheral dystrophies, as well as for thrombosis of retinal vessels.

Technical characteristics of fundus lenses

Currently, fundus lenses produced by Volk and Ocular Instrument (USA) are widely used. With a magnification of 1.25 to 0.52, they respectively have a field of view that ranges from 75° to 165°. These companies also produce macular fundus lenses with a field of 35-36° and a magnification close to unity (from 0.93 to 0.98).

In Russia, fundus lenses are produced by Firm OLIS LLC. They are represented by four models (FL1 - FL4), having focal lengths of 13.3, 16.1, 9.1 and -22.0. The light diameter, according to the model, is 25, 25, 22 and 13. Ini gives magnification of 0.8, 1.1, 0.5 and 1.5. The field of view, according to the model, is 1200, 750, 1400 and 200. Fundus lenses of models FL1 to FL3 form a reverse real image. For FL1 and FL3 it is reduced, and for FL2 it is increased in size. When using the FL4 lens, a virtual upright magnified image is created.

Models FL1 and FL2 have two lenses, and the optical part of the FL3 model also includes an intermediate lens. The FL4 model consists of a single negative lens. All types of lenses are made of silicate optical glass. For the visible part of the spectrum, an anti-reflex coating is applied to the observing surface. The lenses are sealed. They are equipped with haptic flanges for better fixation during the examination.

Features of using fundus lenses

In order to install a fundus lens on the eyeball, superficial anesthesia is first performed. In this case, an immersion medium must be used. The lens is placed on the same axis with the optical observation channel. If necessary, the position of the illuminator is changed arbitrarily until optimal illumination of the area to be examined. During an ophthalmological examination, it is not recommended to move the fundus lens over the eyeball. The fact is that this will not improve visualization, but the lens may well partially “come off” from the cornea of ​​the eye. As a result, an air bubble will get under it, which makes inspection difficult. In order to reach the desired area, it is better to ask the patient to perform small eye movements.

When using fundus lenses, there is one very important feature: you can visualize the fundus of the eye even with a narrow lens, the diameter of which is more than three millimeters. The method of using a fundus lens to perform coagulating laser interventions performed on the retina is not fundamentally different from other technologies. But, due to the fact that there is a large field of view, and, accordingly, low magnification, coagulates, even of medium diameter, look small. In reality they are one and a half times larger.

You should also know that the optics in fundus lenses models FL1 - FL3 completely wraps the image, so the lower parts of the retina should be examined through the upper part of the lenses, and the upper parts through the lower parts. The FL4 lens is designed to examine the central area of ​​the fundus. It allows you to detect subtle, insignificant changes in the macular area. This lens model provides direct, virtual and magnified images.

When the lens is installed on the same axis with the optical system of the slit lamp, and the illuminator, which provides maximum illumination of the intraocular cavity without reflexes, is in the correct position, not only the vascular arcades, but also the optic nerve head should be visible at the same time. At this time, high stereoscopicity is ensured. During the examination, you should not move the lens; it is enough to “scan” the motionless retina with your own eyes. The innovative model of the fundus lens, made recently, has a field of view of 160°. It gives an almost complete picture of the fundus. It is rarely used for production due to its low magnification.

The image obtained using a fundus lens looks demonstrative and visual. Since no slit lamp is designed to photograph such a wide field of the fundus, fundus lenses are extremely useful for photographic recording of the observed picture. Since the use of FL1-FL3 fundus lenses has a large field of view, using them allows you to obtain maximum information about large and protruding pathological changes, such as the retina and tumor. They make it possible to fairly accurately assess the manifestations of diabetic retinopathy, peripheral dystrophies, as well as retinal vascular thrombosis.

When using fundus lenses, the process of diagnosing diseases of the visual organs is facilitated. They are recommended for use in the daily practice of ophthalmologists. However, you should know that in case of damage, the use of fundus lenses, like other contact optics, is contraindicated.

Prices for fundus lenses

Information on lens models and costs is available upon request.

The next selection of materials (see No. 5/6-2004, p. 18) is devoted to another optical element necessary in everyday practice - the fundus lensm. Working with such lenses, in our opinion, is less complicated. The relative ease of their use (in comparison with high-diopter aspherical lenses) is determined by the fixed position of the lens - after all, these lenses are contact lenses. Therefore, there are no focusing problems caused by choosing the position of the lens in front of the patient's eye. Thanks to the large field of view of fundus lenses, they allow you to obtain a panoramic picture of a significant part of the fundus of the eye, without requiring additional manipulations with the lens itself.

Purpose of fundus lenses

Contact fundus lenses are intended for wide-field stereoscopic examination of the fundus (and intraocular cavity) using biomicroophthalmoscopy, as well as for laser interventions on the inner membranes and structures of the eye.

Fundus lenses in combination with a binocular slit lamp microscope make it possible to perform a sequential view of the fundus of the eye to the post-equatorial zone using light slit scanning, as well as to examine the fine structures of the intraocular cavity (vitreous body) throughout: from the retrolental space to the retina. Thanks to their high resolution, stereoscopicity and image quality, fundus lenses allow not only to obtain an approximate idea of ​​the pathology, but also morphological detail of the changes found, and their precise spatial-depth localization. A clear image makes it possible to diagnose even minor disorders in the vitreous body and fundus.

In addition to general diagnostic tasks, fundus lenses are intended for performing laser interventions on the fundus and, due to the large field, primarily for panretinal coagulation of the retina. For this procedure they are simply irreplaceable. With their help, it is possible to perform coagulation both for peripheral dystrophies and for thrombosis of retinal vessels, etc.

Technical characteristics of fundus lenses

Of the foreign lenses, fundus lenses from companies are currently the most famous Ocular Instrument(USA) and Volk(USA). They have a field of view from 75° to 165° with a magnification of 1.25 to 0.52 respectively. These companies, in addition to wide-field lenses, also produce macular fundus lenses with a field of 35-36° and a magnification close to unity (0.93-0.98).

In Russia, fundus lenses are produced by Firma OLIS LLC, some technical parameters of which are given in the table.

Fundus lenses of models FL1 – FL3 form a reverse real image (for FL1 and FL3 - reduced in size, and for FL2 - increased in size). The FL4 lens produces a virtual upright magnified image.

The optical part of models FL1 and FL2 consists of two lenses, FL3 also has an intermediate lens; Model FL4 - single negative lens. The lenses are made of silicate optical glass. The observation surface of the lenses is coated with an anti-reflex coating for the visible region of the spectrum. The lenses are sealed and have haptic flanges for better fixation during examination.

Features of working with fundus lenses

Like any contact lens, fundus lenses are installed on the eyeball after preliminary superficial anesthesia, and an immersion medium is necessarily used.

The lens must be positioned coaxially with the optical observation channel, and the position of the illuminator, if necessary, can be arbitrarily changed (until optimal illumination of the area selected for study). During the examination, the fundus lens does not need to be moved over the eyeball (this will not improve visualization, but the lens may partially “come off” from the cornea, as a result of which an air bubble will get under it and make the examination difficult). To reach the desired area, it is better to ask the patient to make small eye movements.
Let us repeat once again that with the help of a fundus lens (using the method of scanning a light slit along the fundus of the eye), when the subject looks “directly”, both the posterior pole of the retina and the equatorial zone of the fundus of the eye are examined. The periphery of the retina also becomes accessible for visualization with additional eye abduction.

An extremely important feature when using these lenses is the ability to clearly visualize the fundus even with a narrow pupil, starting from 3 mm.
The technique of using a fundus lens when performing coagulating laser interventions on the retina is not fundamentally different from known others. However, due to the large field of view and correspondingly low magnification of the observed image, coagulates, even of medium diameter (200-300 μm), look small (in reality their size is 1.5 times larger).
It should be noted that the optics of fundus lenses models FL1 - FL3 provide full wraparound, therefore, through the upper part of these lenses, the lower parts of the retina are examined and vice versa.

The FL4 lens, designed for examining the central zone of the fundus and allowing to detect subtle, minor changes in the macular area, has a direct, virtual and enlarged image.
When the lens is installed coaxially with the optical observation system of the slit lamp, and the position of the illuminator, which provides maximum and non-reflex illumination of the intraocular cavity, is chosen correctly, the vascular arcades and the optic nerve head should be immediately visible. This ensures high stereoscopicity. There is no need to move the lens - “scan” with your own eyes according to the image of the motionless retina, and that’s it.

Recently, a prototype of a fundus lens with a field of view of 160° has been produced. This lens already provides an almost complete (panoramic) picture of the fundus, but due to its low magnification it is less suitable for laser coagulation.
In general, the image with a fundus lens is extremely visual and demonstrative. Since no photo-slit lamp is designed to photograph such a large field of the fundus, these lenses are very useful for photographic recording of the observed picture.
Due to the large field of view, the use of FL1-FL3 fundus lenses is most informative in the presence of pathological changes that are extensive in area and duration, such as retinal detachments, tumors, when assessing the manifestations of diabetic retinopathy, retinal vascular thrombosis, peripheral dystrophies, etc.
The use of fundus lenses greatly facilitates the diagnosis. Therefore, we advise, if possible, to apply them in everyday practice, which will significantly enrich your experience and professional skills.
It should be noted that if the cornea is damaged, fundus lenses, as well as other contact systems, should not be used.

Modern medicine refers to fundus examination as ophthalmoscopy. Such an examination allows ophthalmologists to identify a number of pathologies and possible serious diseases. Examination of the fundus can accurately assess the condition of the retina, as well as all its individual structures: the choroid, the macula area, the optic nerve head, etc. This procedure should be carried out regularly, you should not be afraid of it, since it is absolutely painless and does not require long period of time. Moreover, examination of the fundus is mandatory for pregnant women, as well as premature babies in case of manifestation of pathological symptoms of ophthalmological diseases.

Even if a person does not have any problems with the functioning of the visual system, examination of the fundus must be carried out regularly. This procedure is recommended for pregnant women, as it helps to identify certain ophthalmological diseases that can be transmitted to the baby. It is also necessary to carry out such an examination for people suffering from diabetes mellitus, since this pathological disease can have a very negative effect on the condition of the retina.

Checking the condition of the fundus is also mandatory for people suffering from retinopathy, a non-inflammatory disease, as well as any inflammatory ophthalmological processes. These diseases lead to a sharp deterioration in visual function, since the fundus of the eye during the development of pathologies suffers from an aneurysm, which causes the ability to expand the lumens of the retinal vessels to be impaired.

An examination of the retina is also necessary in order to promptly recognize signs of retinal detachment. With this pathology, a person does not feel any painful symptoms, but his vision gradually deteriorates. The main symptom of retinal detachment is the appearance of a “veil” or “fog” before the eyes. Ophthalmoscopy helps to recognize this pathology in a timely manner, since during this examination it is possible to see all the irregularities in the retina of the eye, leading to its detachment.

Preparation for fundus examination

An ophthalmological examination is carried out only by a medical specialist. Before performing a fundus examination, the patient needs to dilate the pupil. For this, the ophthalmologist uses special medications (usually a 1% solution of tropicamide or drugs such as Irifrin, Midriacil, Atropine).

If the patient wears glasses, they must be removed before the fundus examination procedure. If vision correction is carried out using contact lenses, the issue of the need to remove them is decided by the ophthalmologist individually.

No other special preparation is required before examining the fundus.

Fundus examination

A medical examination of the fundus of the eye is not difficult. For all adults, as well as for children, the methods of conducting such an examination are the same. How is a fundus examination performed?

As a rule, a mirror ophthalmoscope is used for examination - this is a mirror with a concave lens and a small hole in the center. The ophthalmologist looks into the patient's eye through the device. A thin beam of light passes through a small hole in the ophthalmoscope, which allows the doctor to see the fundus of the eye through the pupil.

How is a fundus examination performed? The procedure for examining the fundus can be direct or reverse. With direct inspection, you can see the main areas of the fundus, as well as their pathologies. A reverse fundus examination is a quick and general examination of all areas of the eye.

The examination procedure must be carried out in a darkened room. The doctor directs a beam of light into the patient's eye, first at a short distance, and then brings the corresponding device closer and closer to the eye. This manipulation allows the ophthalmologist to carefully examine the fundus, lens, and vitreous body. The fundus examination procedure takes about 10 minutes; the ophthalmologist must examine both eyes, even if the patient assures that his vision is absolutely normal.

During the examination, the doctor examines:

• the area of ​​the optic nerve is normal when it has a round or oval shape, clear contours, and a pale pink color;
• the central region of the retina, as well as all its vessels;
• the yellow spot in the center of the fundus is a red oval, along the edge of which there is a light stripe;
• pupil – normally, the pupil may become red during examination, but any focal opacities indicate the presence of a certain pathology.

Ophthalmoscopy is also performed using other methods:

• Vodovozov technology – during the fundus examination procedure, multi-colored rays are used.
• Biomicroscopy or examination of the fundus with a Goldmann lens - a slit light source is used during the examination. This examination method can be carried out even with a constricted pupil.
• Laser ophthalmoscopy – the fundus of the eye is examined using a laser.
• Examination of the fundus with a fundus lens - the device is used in conjunction with a binocular microscope, which are available in a slit lamp. With this method, all areas of the fundus are scanned, even up to the post-equatorial zone.

Who needs a fundus examination?

An ophthalmological examination is a preventive procedure and should be carried out regularly for every person, but there are a number of diseases for which examination of the fundus is mandatory:

• atherosclerosis;
• hypertension;
• cataract;
• diabetes;
• increased intracranial pressure;
• stroke;
• osteochondrosis;
• prematurity in children;
• retinal dystrophy;
• night blindness syndrome;
• color vision disorders.

Contraindications to fundus examination

• The patient has ophthalmological pathologies with symptoms of photophobia and lacrimation;
• Inability to dilate the patient's pupil;
• If the patient has a physiological deviation - insufficient transparency of the lens of the eye, as well as the vitreous body.

Precautions when examining the fundus

1. The ophthalmological procedure should be prescribed by a therapist to people suffering from cardiovascular diseases. In some cases, this procedure is contraindicated for such patients.
2. You should not drive after having a fundus examination.
3. After the procedure, you must wear sunglasses.

In contact with

Ophthalmology is a field of medicine whose subject of study is the human visual apparatus and its diseases. Every person sooner or later faces eye problems, because in the modern world the load on vision has increased significantly. Diagnosis of diseases in the early stages is an important factor in maintaining visual health.

Pediatric ophthalmology in Minsk

In addition to services for adults, we treat children. Pediatric ophthalmology in our center provides a range of services at a high level.

The effectiveness of diagnosis and the effectiveness of subsequent treatment largely depends on the quality of the equipment of the ophthalmology office and the qualifications of the ophthalmologist. The qualifications and experience of the doctors at the Kravira Medical Center, combined with modern methods for diagnosing eye diseases, will allow us to diagnose problems at the earliest stages and preserve the health of children’s eyes for a long time.

Ophthalmologist (ophthalmologist) in Minsk

Reasons for visiting an ophthalmologist (ophthalmologist):

• decreased vision, image distortion
• redness of the eyes
• feeling of blurred vision
• feeling of chronic eye fatigue
• itching, burning, lacrimation
• pregnancy period
• diabetes mellitus, neurological and endocrinological pathologies, hypertension, etc.

• children from birth to graduation from educational institutions
• patients with unfavorable heredity
• patients over 40 years of age (annual visits to ophthalmologists with intraocular pressure measurement to prevent glaucoma are indicated)
• pregnancy period
• diabetes mellitus (fundus examinations with a fundus lens are advisable to diagnose diabetic retinopathy once a year)
• neurological and endocrinological pathologies, hypertension, etc.
• patients with myopia (fundus examinations with a fundus lens are recommended to check for peripheral retinal dystrophy)

Fundus examination with fundus lens

A fundus lens is used for detailed examination of the retina. It allows you to identify the presence of dystrophy, ruptures and retinal detachment. The condition of the fundus vessels is also determined and other changes are detected.

Testing with a fundus lens is recommended for patients with arterial hypertension, diabetes mellitus, and varying degrees of myopia. In addition, it is advisable for patients with myopia to undergo a fundus lens diagnosis before passing a driver's examination or before giving birth.

Preparation for examination with a fundus lens

• You must come without contact lenses (be sure to bring glasses with you)
• take care of how you will get home (driving a car after the test is prohibited, as the pupils will be dilated, as a result of which visual acuity will be reduced for several hours)

How is an examination performed with a fundus lens?

Approximately 15-30 minutes before the procedure, the patient is given a drop of medication to dilate the pupils. After some time, a local anesthetic is administered. A Goldmann lens is then placed on the eye and a fundus examination is performed using a slit lamp. The procedure allows for examination of the retina at the posterior pole, in the equatorial region and at the periphery, which cannot be done with standard ophthalmoscopy.

An allergy to antibiotics and anesthetics may be a limitation for performing an examination with a fundus lens.

Children's ophthalmologist - ophthalmologist for a fee in Kravira Minsk

Treatment of children has its own characteristics and requires special attention. Our doctors have extensive experience working with children. Consultation with an ophthalmologist (ophthalmologist) is provided for a fee.

Appointment and consultation with an ophthalmologist - oculist:

• appointment and consultation with an ophthalmologist for children and adults
• comprehensive examination of ophthalmological patients
• pneumatonometry (non-contact measurement of intraocular pressure)
• autorefractometry (measurement of the refractive power of the optical means of the eye using modern equipment, which allows for more accurate testing of visual acuity and selection of the necessary spectacle correction)
• biomicroscopy (examination of the anterior segment of the eye using a slit lamp to determine the condition of the eyelids, conjunctiva, cornea, lens, vitreous body)
• fundus ophthalmoscopy (examination of the fundus to determine the condition of the optic nerve head and retina)
• examination of the fundus with a fundus lens (detailed examination of the fundus, recommended for patients with myopia, diabetes mellitus, arterial hypertension, neurological and endocrinological pathology, as well as during pregnancy and when passing a driver’s examination)
• gonioscopy (examination of the anterior chamber angle, recommended for patients with glaucoma)
• visual acuity test
• glasses selection consultation

Ophthalmologist services In Minsk

Appointment by phone: (+375 17) 211 25 43, ( Velcom) (+375 29) 100 00 03, (MTC) (+375 33) 900 00 03

Like any contact lens, fundus lenses are installed on the eyeball after preliminary superficial anesthesia, and an immersion medium is necessarily used (Fig. 4).

The lens must be positioned coaxially with the optical observation channel, and the position of the illuminator can be changed arbitrarily if necessary (up to optimal illumination of the area selected for examination and maintaining binocularity, but not more than 30 degrees! - in order to avoid shielding of the fundus by the lens body). During the examination, the fundus lens does not need to be moved over the eyeball (this will not improve visualization, but the lens may partially “come off” from the cornea, as a result of which an air bubble will get under it and make the examination difficult). To reach the desired area of ​​interest, it is better to ask the patient to make small eye movements.

It is important to recall that with the help of a fundus lens, the ophthalmobiomicroscopy technique is carried out, that is, scanning with a light slit along the fundus of the eye. When the subject looks “directly,” both the posterior pole of the retina and the equatorial zone of the fundus are examined. With an additional slight abduction of the eyes, the periphery of the retina becomes accessible for visualization. When the lens is installed coaxially with the optical observation system of the slit lamp, and the position of the illuminator, which provides maximum and non-reflex illumination of the intraocular cavity, is chosen correctly, the equatorial structures should be immediately visible. This ensures high stereoscopicity. There is no need to move the lens - “scan” with your own eyes according to the image of the motionless retina, and that’s it.

An extremely important feature when using these lenses is the ability to clearly visualize the fundus even with a narrow pupil, starting from 3 mm, which was impossible previously (that is, examining a large field of view with a narrow pupil).

The technique of using a fundus lens when performing coagulating laser interventions on the retina is not fundamentally different from known others. However, due to the large field of view and correspondingly low magnification of the observed image, coagulates, even of medium diameter (200-300 μm), look small (in reality their size is 1.5 times larger).

It should be noted that the optics of fundus lenses models FL1 - FL3 provide full wraparound, therefore, through the upper part of these lenses, the lower parts of the retina are examined and vice versa.

In general, the image with a fundus lens is extremely visual and demonstrative. Since no fundus camera is designed to photograph such a large field of the fundus, these lenses are very useful for photographic recording of the observed picture.

Analyzing the image on the left (in Fig. 5), we pay attention to the huge field of the lens, a very small visual disc of the optic nerve, next to which there is a large fibrous lesion, 3 times the diameter of the disc. On the right - in the light section, fresh coagulates are clearly visible, applied, by the way, using a fundus lens (diabetic retinopathy). From these photographs you can see how beneficial the use of fundus lenses is, what panoramic examination can be carried out with its help in case of disseminated fundus pathology.

Naturally, a large field of view and a reduced image of the fundus, the use of fundus lenses FL1-FL3 is most informative in the presence of pathological changes that are extensive in area and duration, such as retinal detachments, tumors, when assessing the manifestations of diabetic retinopathy, retinal vascular thrombosis, peripheral dystrophies and so on.

As for the disinfection of lenses, the rules are the same as when using any contact lenses (for example, the Goldmann type) (Fig. 6). At the beginning of use, the lenses lie with the haptic part down in a Petri dish filled with triosept (at least 10 minutes).

Then the corneal part is washed in running water and the lens is installed with the corneal part down in a Petri dish with a furacillin solution, a level of no more than 5 mm. The aspherical outer part must not be in water!

After work - examination, coagulation, the lens is again washed in running water and placed in a furacillin solution until the next use. If the lens has not been used for a long time, or is expected to be used rarely, the lens should be placed in a disinfectant solution. Don't forget to rinse it before installing the optical element on the patient's cornea!

The use of fundus lenses greatly facilitates the diagnosis. Therefore, we advise, if possible, to apply them in everyday practice, which will significantly enrich your experience and professional skills.

We emphasize that in case of damage to the cornea, the use of fundus lenses, as well as other contact systems, should be avoided.