Examination techniques in ophthalmology V. Matušková Basic examination techniques •Visual acuity (natural, best corrected) •Measurement of intraocular pressure •Slit lamp examination •Fundus examination vyš Visual acuity •Visual acuity (natural, best corrected) • •Distance vision •Near vision • • • • • • • • •Charts • •Snellen •Landolt ring •Pictures •ETDRS • •Jaeger • Charts complete.gif lcd-optotyp-scs-3200.jpg optotyp Near vision Jaeger chart VODS: s +2,5 Dsf J.No. 1 Printable Jaeger Eye Chart Visual Acuity •5/50 (metres, feet 20/200) •0,1 • •Minimum separabile – minimum angle of resolution • images.jpg Visual acuity •Counting finger (metres ) •Hand movement •Light perception • •Amaurosis •Practical blindness andy-williams-eye-chart.jpg content.jpg •Refractive error is an optical abnormality in which the shape of the eye fails to bring light into sharp focus on the retina, resulting in blurred or distorted vision. •In optometry, a "refraction" procedure is the measurement of refractive error •Autorefractor Refraction 1-autorefraktometr-rt-7000 Autorefractor Visual acuity •VOD: 5/50, s – 2,0 Dsf a -1,0 Dcyl ax 90 5/5 •VOS: 5/30, s – 2,5 Dsf a -1,5 Dcyl ax 100 5/7,5, • •VOD: visus oculi dextri •VOS: visus oculi sinistri •Dsf: dioptry sferic •Dcyl: dioptry cylindric •Ax: axis • • • • Visual acuity •Frame •Lenses •Axis nosič skel brylova-skrin brylovy-nosic Tonometry • Contact techniques • Schiötz tonometry •Goldmann applanation tonometry • •Non contact techniques •Jet air (air puff) anatomie_komora-400 Schiötz tonometry • 7/7,5 •Topical anestesia • • • 1862_big.jpg Schiötz tonometry szemem.jpg Goldmann tonometry • The normal range is 10-21 mmHg • •Topical anestesia, fluorescein •Force required to flatten the cornae AT1 Goldmann tonometry obr AT1 obr Non contact tonometry 1249315134-25744.jpg tonoref2_006.jpg mereni-NCT Examination of anterior segment •Aspection Ectropium Ptosis Lagophtalmus Entropium Slit lamp biomicroscopy •table mounted microscope with a special adjustable illumination source attached prevobr21.jpg iris Slit lamp biomicroscopy Slit lamp biomicroscopy Nalezený obrázek pro cornea slit lamp Slit lamp biomicroscopy (A, B) Slit lamp images showing a moderately deep anterior chamber ... Anterior segment slit-lamp biomicroscopy of the same eye 12 months ... Slit lamp biomicroscopy rohovka foto intum katarakta traumatická katarakta , Synechiae posterior uveitida Sunconjunctival haemorrhage 8301262508_002_002 Corneal abrasion 4 Hyphema hyphema Hypopyon hypopyon Examination of fundus •Ophthalmoscopy - direct (no steropsis, worse for periphery) • - indirect • Slit lamp biomicrocsopy • (high power convex lens, the image is vertically inverted • and laterally reversed) • • Mydriasis is neccesary ! • • • oftalmoskop-piccolight-e_75.jpg trhlina2 [USEMAP] https://lh3.googleusercontent.com/5AkUuTV0typogapV1EQXScYO78YzhrMmZmaVJAKivd0knbe-Fz9TD_tDF0K4LaJVV dMHFg=s154 indirect fig22 • Ocular fundus zdrave Status of the lens •Phakic eye (own lens) •Pseudophakic eye (arteficial intraocular lens) •Aphakic eye (without any lens) • • Nalezený obrázek pro lens eyes slit lamp Slit-lamp photograph of the right eye showing the ICL and inthe-bag IOL ... Farmacology •Pilocarpin - parasympatomimetics •Atropin – parasympatolyticum (anticholinergicum) •Scopolamin, tropikamid Special examination techniques Gonioscopy • Gonio lens ( mirrors) • • Angle structures • Fundus examination • 2949_352 gon3mir gonio2a obr 27 Optical coherence tomography E:\Clanky\OCT SM\vypaleni\MatuskovaOCTobr1.jpg E:\Clanky\OCT SM\vypaleni\MatuskovaOCTobr4.jpg http://www.medicine.uiowa.edu/uploadedImages/Departments/Ophthalmology/Content/Patient_Care/Imaging _Services/OCT-CME%281%29.jpg Fluorescein angiography Výsledek obrázku pro fluorescein angiography Výsledek obrázku pro fluorescein angiography • •ERG (electroretinography) • diagnosis of functional defects of retina •Record of an action potential produced by the retina when it is stimulated by light • • •VEP (visual evoked potential) • -diagnosis of functional defects of visual pathways •Record of electrical activity of the visual cortex created by stimulation of the retina Electrophysical tests Electrophysical tests • vep vep Electrophysical tests 1743_VEP_small Ultrasound Bscan1 UZV přístroj UZV vyšetření Ultrasound •Non transparent optical media •UBM- high frequency ultrasound – imaging of anterior segment Bscan1 UBM Ultrasound •A scan ( biometry) • •B scan • • • dermoid usg A Pigment2 Ultrasound ags-fig08b_mm TRD Retinob3 24 10-013_CD Color vision – HUE test 10-014_CD Hertl exoftalmometry hertl hertl1 hertl2 Hertl4 fish_eyes Děkuji za pozornost!