slit lamp biomicroscopy volk lens binocular indirect ... · slit lamp bio procedure low mag around...
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1
Slit Lamp Biomicroscopy &
Volk Lens Binocular Indirect
Ophthalmoscopy
Competency Lecture for
Scottish Eye Examination (Updated 2015)
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New Contract for Scotland
in 2006
Significant changes to the Scottish Eye
Examination GOS regulations
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GOS
regulations
(as at 07/12/15)
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New Contract for Scotland
in 2006
External examination of the eye using slit lamp
microscopy and appropriate diagnostic agents
Fluorescein sodium
Rose bengal
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GOS
regulations
(as at 07/12/15)
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GOS
regulations
(as at 07/12/15)
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GOS
regulations
(as at 07/12/15)
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Why?
Magnification can be varied
Condensing lens power
Slit lamp control
Binocular view aids diagnosis
Power of slit lamp illumination aids viewing of
fundus image in the less optically clear eye
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What about the younger
patients? Direct ophthalmoscopy is acceptable
Slit lamp BIO is possible with a 3mm pupil
Binocular viewing requires a minimum of 5mm
High powered condensing lens will work more readily
with small pupils
Undilated examination is possible with younger
patients
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Pupil dilation
Tropicamide 0.5%, 1%
Blocks sphincter muscle
Phenylephrine%, 2.5%
Stimulates dilator muscle
Not usually adequate as sole drug for slit lamp BIO
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Explanation and advice to
patients
A record of all drugs administered to the patient
should be included in the patient notes
Ideally an information sheet should be handed to the
patient when they leave the practice. It should include
information about the normal to be expected and the
length of time these may last
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College of Optometrists
Advice for good practice
Publications/Other guidance and advice/installation of
eyedrops
Includes advice notes to be given to patients following
drop installation
www.college-optometrists.org members area
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College of Optometrists
guidance
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College of Optometrists
guidance
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Record keeping
standards are
essential – you may
have to rely upon
them in any dispute.
College advice and
literature in
members only area
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Slit lamp BIO procedure
Low mag around 10x initially
Narrow slit – approx 2mm wide
Illumination and observation axis at 90 degrees to
corneal apex
Focus on corneal apex
Add condensing lens close to cornea- stabilise on
brow with fingers
Pull slit lamp back observing for red reflex
Focus image of fundus by moving slit lamp
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Slit lamp BIO procedure
•The image is formed between the observer and the
condensing lens
•This image is both inverted and reversed
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Slit lamp BIO procedure
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Slit lamp BIO procedure RE
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Mid peripheral retinal
viewing
As per direct ophthalmoscopy
The same patch of retina is illuminated in BIO
as in direct ophthalmoscopy
BUT you view this patch of retina as an
inverted reversed image
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Condensing lenses
Availability and choice
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Retinal view
Approximation of view with
90D condensing lens and 10x
slit lamp mag
Approximation of view with
60D condensing lens and 10x
slit lamp mag
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Condensing lenses
wide field low magnification lenses; generally more
suitable for small pupil exam
90D classic
Superfield
Super Vitreofundus
Superpupil XL
Digital Widefield
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Condensing lenses
reduced field higher magnification lenses; generally
more suitable for detailed exam, particularly of disc
and macula
60D classic
78D classic
Super 66 Stereo Fundus lens
Digital 1x Imaging Lens
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Practice makes perfect!
Select condensing lens appropriate to the task
- best to have 2 lenses: 1 x low mag
1 x high mag
Go for it – it will become quick and easy with
practice!!
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