What do you see? This is a color fundus photo showing the left eye of a 55 year old A.A. male who claims no past medical history. He has not been to a PMD in over 10 years. When looking at the retina during a fundus exam, look systematically. Just like a chest X-ray, a methodical approach to reading the image will help to make sure you don't miss anything. The findings here are very subtle, which makes asking a sequence of questions very helpful.1) Disc? I always find cup-disc ratio really difficult on a 2-d photo. Is there Neovascularization? Elevation? Are the margins sharp?
2) Macula? Is there any edema (again, hard to tell on a photo), exudate, drusen?
3) Vessels? Any vascular changes? Look closely. This will tell you something about this patient's systemic health.
4) Periphery? Is there any hemorrhage? Any exudates or cotton wool spots (CWS)?
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ReplyDeleteThis is my first post on a really well made site (good job, Colin!). Let's try to help the young'uns:
ReplyDeleteLet's just focus on the vessels for now. Compare the shape/size of the vessels with those from the previous few posts. Where do they go? How are these different? Look at how they course, and describe them. The first step in ophthalmology is to describe what you are seeing.
Thanks, Alex. Good suggestion. Working on a basic post to address what you are talking about.
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