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Dr Jay Kumar Chhablani Smt. Kanuri Santhamma Retina & Vitreous Centre
Anatomy of macula
Evaluation of macula
History Examination Investigations
History
Distortion of images Blurring of images Unable to identify faces Difficulty in color vision
Examination
Binocular indirect ophthalmoscpy Slit-lamp biomicroscopy
Provides optical section Provides high magnification and stereopsis Surface contours of chorioretinal lesions better appreciated
Advantages
NONCONTACT METHOD Quicker Examine post op. and infected patients No coupling agent No topical anaesthesia CONTACT METHOD Better stability Better quality of image Some control of ocular movements
Lenses used
NON CONTACT METHOD Hruby lens Aspheric lenses (+60, +78, +90D) CONTACT METHOD Goldman three mirror lens Goldman posterior lens Mainster lens Panfundoscopic Quadrispheric Volk Super Quad
Volk TransEquator
132 Dynamic Field of View 0.7x Magnification 1.44 Laser Spot Magnification Factor
13
160 Field of View 0.5x Magnification 2.0x Laser Spot Magnification Factor
14
Mainster Lens
35 - 48 Dynamic Field of View 0.95 x Magnification 1.05 Laser Spot Magnification Factor
15
FEATURE 60D Magnification 1.18D Field of view 76 degrees Focal length 19mm Clear lens aperture 30mm
Evaluate fundus by
Rotation of mirrors Readjusting the slit beam Redirecting the patients gaze
Wide angle view (upto equator) More useful for Laser photocoagulation
Image plane is very anterior - Difficult focusing Used for examination / Laser treatment
Care of Lenses
Sterilization : ETO gas (520 C) Cleaning:
Rinse in cold / tepid water Clean with dishwashing liquid Rinse and blot dry with lint free cloth
Disinfection:
2% Glutaraldehyde - (20 min.) Rinse in cool water dry 1:10 sol. of Na. hypochlorite (10 min) Rinse Dry
Investigations
Visual acuity measurement Color vision Contrast sensitivity Amsler charts Visual discrimination tests (Two point discrimination) Entoptic imagery tests
Two-point discrimination
Two light sources of equal intensity About 25 inches (or 62 cm) No information is learned about macular potential. Fully mature cataracts or otherwise dense ocular media. Gross color perception
Potential acuity
PAM Reduced snellen chart Laser inferometry
Contrast sensitivity
Terry Acuity Pelli-Robson
Amsler: Set-up
Pt holds grid 28cm-30cm Grid should be brightly illuminated Pt should be wearing best-corrected Rx for near 10 degree of the visual field 10 cm square
Use on pt w/
central scotoma fixation problems
"
Color vision
Ishihara pseudo isochromatic charts FM 100 hue test D 15 test
Macular hole
Traction