The Indirect Ophthalmoscope

George T. Timberlake, Ph.D.

Department of Ophthalmology
University of Kansas Medical Center

Gullstrand Indirect
Ophthalmoscope
ca. 1910
 What You Need to Know

Name

Instructions to Faculty: Please observe the resident perform the following tasks, and grade each step, "P" (successful
completion of step) or "X" (needs additional training or practice). The resident must successfully perform each step in order
to pass t

Trial Trial Trial

THEORY Comments
1 2 3
1. The resident should be able to explain and draw a simplified
diagram of the optics of the binocular indirect ophthalmoscope.

2. The resident should be able to explain the relative image

orientation, field, and magnification of the image using the binocular
indirect ophthalmoscope and various condensing lenses (at least the
20 and 28 diopter lenses).

FAMILIARITY WITH DEVICE

3. The resident should be able to identify the components of the BIO.
 Fundamental Principle of the
Indirect Ophthalmoscope

If the retina could light up….

Emmetropic Image of retina

eye on distant surface

GTT 04
 Fundamental Principle of
Indirect Ophthalmoscope

Aerial image of retina

Ophthalmoscopic lens

GTT 04
Viewing the aerial image with a magnifier

GTT 04
 Allvar Gullstrand
1862 - 1930
Professor of Physical &
Physiological Optics,
University of Uppsala

First “reflex free”

ophthamoscope

Nobel Prize 1911 for

work on optics of eye

Swedish Ophthalmologist
GTT 04
 Gullstrand Principle
for Reflex-free Ophthalmoscopy
Light entrance and exit separated in pupil plane

Light entering eye

Light leaving eye Pupil

GTT 04
 Optical Conjugates

20 D Nikon
Emmetropic Aspheric
Gullstrand Lens Retina
Eye Pupil
Cornea

70 44*
152
168

* back focal plane (Distances in mm)

GTT 04
Retinal Illumination System
Gullstrand Principle—Entrance Pupil

2.0 mm
entrance pupil

1.75 mm

7 mm
diameter
pupil

GTT 04
 Gullstrand Retinal Illumination
Light introduced in pupil
conjugate plane
In focus in pupil plane

20 D
74.1

Pupil Conjugate
Plane
153.6

M pupil 153.6
conjugate = = 2.1
74.1

M conjugate 1
pupil = = 0.48
2.1
GTT 04
 Gullstrand Model Eye
crystalline lens

retina iris cornea

optic axis
pupil

aqueous
vitreous
lens core

Radius of Distance to next Index of

Curvature (mm) surface (mm) Material Refraction, n
retina 11.198 17.051 vitreous 1.336
post lens 6.000 0.636 lens surface 1.386
post lens core 5.760 2.419 lens core 1.406
ant lens core -7.911 0.546 lens surface 1.386
ant lens -10.000 3.100 aqueous 1.336
post cornea -6.800 0.500 cornea 1.376
ant cornea -7.700 air 1.000
GTT 04
 A point in the pupil conjugate plane is
Imaged in the eye’s pupil plane

pupil pupil
conjugate plane
plane

SIDE VIEW
GTT 04
Light leaving the eye from a disk-shaped
area in the pupil is imaged in the pupil
conjugate plane

pupil pupil
conjugate

SIDE VIEW GTT 04

 Real example of entrance pupil continued

1 mm
2.1 mm

SIDE VIEW GTT 04

 Practical Retinal Illumination System

Lamp

Aperture

45 mirror

Pupil conjugate plane

GTT 04
Retinal Imaging System
 Gullstrand Principle--Exit Pupils

2.0 mm
entrance pupil
1.0 mm
exit pupil

4.0 mm
7 mm
diameter
pupil
GTT 04
 Gullstrand Retinal Imaging
Light from retina passes through
area in pupil plane
Pupil-plane area is in focus
in pupil conjugate plane

20 D
Pupil Conjugate
Plane

M pupil 153.6
conjugate = = 2.1
74.1
1
M conjugate pupil = = 0.48
2.1
GTT 04
 RAYS FROM THE EXIT PUPIL PASS THROUGH
THE CONJUGATE PUPIL

Light from retina passing …also passes through

through pupil plane an aperture in the
conjugate….. conjugate pupil plane.

PP
RIP

TOP VIEW
GTT 05
RAYS FROM RETINA MUST GO THROUGH
PUPIL CONJUGATE TO BE SEEN

Light from retina not ….doesn’t get past stop

passing through pupil in the conjugate pupil
plane conjugate….. plane.

GTT 04
 optic
axis
stop in pupil plane
conjugate

circular aperture
in stop

GTT 04
 VIEWING THE RETINAL IMAGE
OL PP
conjugate

PP
RIP

Observer’s pupil at
PP conjugate

out of focus rays—poor image

 SUBJECT

optic
axis

observer’s pupil in
conjugate pupil plane

OBSERVER
VIEWING THE RETINAL IMAGE

Weak + lens brings rays to

focus on retina
 FIRST ATTEMPT AT BINOCULAR VIEW
Obs. L eye

S’s eye

Obs. R eye
Combine L and R eye views

Observer’s eyes have to be too close

GTT 05
IMAGE ORIENTATION

MAGNIFICATION

FIELD OF VIEW
 SUBJECT’S RETINA APPEARS REVERSED
LEFT TO RIGHT

aerial image left-to-right Observer

R exit reversed R Eye
pupil

Subject’s eye subject’s retina appears

reversed L to R

L exit
pupil Observer
L Eye
TOP VIEW
 SUBJECT’S RETINA APPEARS REVERSED
TOP-TO-BOTTOM

aerial image top-to-bottom

reversed
Subject’s eye Observer’s eye
sup

inf
RIP
subject’s retina appears
reversed top-to-bottom

SIDE VIEW
 OPHTHALMOSCOPE MAGNIFICATION

20 D
60 D lens
eye RI

Mag of RI
Peye 60 D
M= = = 3.0
Plens 20 D
 MONOCULAR FIELD OF VIEW

1 mm dia exit pupil

2.0 mm 20 D

42 50 mm

40 mm

GTT 04
 BINOCULAR FIELD OF VIEW

20 D
Area of binocular view

40

GTT 04
 ESTIMATING FIELD OF VIEW
Clear Aperture: CLAP
Working Distance: WD CLAP
= 24 mm

2

WD

47 mm
51.04 mm

54.72 mm

 CLAP
(½ WD
-1
Example: OI Maxlight 20 D = tan (
CLAP = 48 mm
WD = 47 mm  = 23.7 FOV = 47.4
FOV = 50  = 25.2 FOV = 50.3
 = 25.2 FOV = 50.3
 SUMMARY

Draw a simplified diagram of the optics of the

binocular indirect ophthalmoscope.
Illumination planes
Pupil planes
Retinal image planes

Be able to explain:
Image orientation
Field of view
Magnification
 BIO RETINAL ILLUMINATION

light source
entry O.L.
pupil RIP’ Observer

Subject PP Mirror

RIP: Retinal Image Plane

O.L.: Ophthalmoscopic lens
PP: Pupil Plane
 BIO PUPIL & RETINAL IMAGE PLANES
& IMAGE ORIENTATION

M Observer
O.L.
Subject RIP’
PP

PP

O.L.: Ophthalmoscopic lens M: Mirror

RIP: Retinal Image Plane PP: Pupil Plane

GTT 04
BIO MAGNIFICATION

Peye
Maerial =
Plens
image
BIO APPROXIMATE FIELD OF VIEW

CLAP
 2

WD

Clear Aperture: CLAP

Working Distance: WD
 = tan ( WD
½ CLAP
-1
(
FOV = 2 
 OTHER
INDIRECT OPHTHALMOSCOPES
 RETINAL IMAGING SYSTEM
fixing diverging rays from retina

Retinal Image Pupil

Pupil Plane
Plane
Plane

Rays diverging from optic axis

RIP prism
PP

Rays parallel to optic axis

GTT 04
 optic
axis

prism

axis parallel to
optic axis
GTT 04
Formation of Final Aerial Retinal Image

retinal
image
lens

retinal
image

GTT 04
retinal image
GTT 04
 Galilean Telescope
biconvex
(positive)
lens fp

biconcave
(negative)
lens fp

put fp’s
together
fp’s
coincide

final
telescope
parallel
rays
GTT 04
MAGNIFICATION OF GALILEAN TELESCOPE
objective
eyepiece

fep
fobj
Example:
fobj fobj = 50.0 mm
M= fep = - 5.0 mm
fep
50.0
M= = 10.0
- 5.0 GTT 04
 Viewing Through a Galilean Telescope

parallel
iImage
rays
object

emmetropic
eye

UPRIGHT OBJECT APPEARS UPRIGHT

GTT 04
 Complete (monocular) System

Retinal image
plane--begin
new raytrace
Subject
Observer

Galilean
telescope

GTT 04
COMPLETE MONOCULAR
OPHTHALMOSCOPE

telescope

OBSERVER
GTT 04
GTT 04
Complete binocular
Indirect
ophthalmoscope

GTT 04
 Retinal Image Orientation

Subject
Observer

sup.
inf.

Subject’s superior retina appears upward

Subject’s temporal retina appears rightward GTT 04
 RETINAL IMAGE MAGNIFICATION
18.86 D
Asphere
f = 53 mm
56.4 D  = 68 mm
emmetropic
Gullstrand Eye RIP PP

7.77 mm
35.5
70 mm mm

Peye 56.4
M= = = 2.99
2.547 mm Plens 18.86
Himage 7.77
M= = = 3.05
Hobject 2.55
2.99  3.05 (2% diff)
 OPHTHALMOSCOPE MAGNIFICATION
20 D
lens 25D
RI1 12.5X
60 D lens
telescope
eye RI2

p q
230 mm

Mag of RI1 Mag of RI2

Peye 60 D 1 1 1
M= = = 3.0 p + q = q = 48 mm
Plens 20 D f
1 1 q 48
+ q = 25 D M= p = = 0.21
GTT 04 0.230 230
 OPHTHALMOSCOPE MAGNIFICATION
(CONTINUED)

Mtotal = M1 M2 Mtelescope

= 3.0 X 0.21 X 12.5

Mtotal = 7.9

Indirec opthalmoscope magnification depends on:

Power of ophthalmoscopic lens
Power of intemediate field lens
Power of Galilean telescope
GTT 04
 OBSERVER AND SUBJECT PUPILS
ARE CONJUGATE

Observer Subject

telescope field
lens Ophthalmoscopic
lens

THE INDIRECT OPHTHALMOSCOPE IS A

CO-PUPILLARY OPTICAL SYSTEM
GTT/98
Confocal Scanning Laser Ophthalmoscope

GTT/98