Fundus Examination with

+20D Lens
Presented to: Dr. Ammara Affi
 Presenters

Iqra Salam Bsop-Fa19-001

9th sem

Bsop-fa19-057 Malaika Hussain

9th sem
Content:
Introduction 1
How to Evaluate Fundus 2
How 20D Lens work 3
Case:1 Normal Fundus 4
Case:2 Diseased Fundus 5
 3 Introduction to Fundus of Eye:

• The fundus of the eye refers to the interior surface of the eye, including the
retina, optic disc, macula, and blood vessels. Examining the fundus is an
essential part of a comprehensive eye examination.
• The fundus can be examined by ophthalmoscopy or fundus photography or
further we can examine using +20D lens attached with phone at
specific focal-length of lens for screening purpose.
How to Evaluate
Fundus
 Fundus Evaluation: Clinical Summary

• Optic Disc: The disk is pale pink, approximately 1.5 mm in diameter,

with sharp, flat margins. The physiologic cup is located within the disk
and usually measures less than six-tenths the disk diameter. it is also
known as the "blind spot" because it lacks photoreceptor cells.
• Macula: it is located temporal to the disc. The fovea is an area of
depression approximately 1.5 mm in diameter (similar to the optic disc)
in the center of the macula. It contains a high concentration of cone
cells.
• Blood Vessels: Arteries and veins supply blood to the retina. The
appearance of these vessels, including their size, caliber, and any
abnormalities, can provide important information about the health of the
eye.
How +20D Lens Works
to evaluate Fundus
 3 How +20D lens Works:
A +20D lens is commonly used in ophthalmic examinations to evaluate the
fundus of the eye, a procedure known as indirect ophthalmoscopy. This lens
helps eye care professionals get a magnified view of the retina, optic disc,
macula, and blood vessels in the fundus.
1. Convex Lens Property: The +20D lens is a convex lens, meaning it is
thicker in the center than at the edges. Convex lenses converge light rays,
bringing them together.
 3 How +20D lens Works:
2. Real Image Formation: When the +20D lens is held close to the patient's
eye, it forms a real, inverted image of the fundus at a certain distance behind
the lens.
3. Virtual Image Perception: The examiner observes the real image through
the lens, but since the image is inverted, they mentally correct for the
inversion, resulting in a virtual, upright image.
4. Magnification: The convex nature of the lens causes the light entering the
eye to converge, resulting in magnification of the fundus structures.
This magnification allows for a detailed examination of the retina.
 3 How +20D lens Works:

5. Focusing and Scanning: To examine different areas of the fundus, the

examiner may move the lens closer to or farther from the patient's eye. This
focusing and scanning technique allows for a comprehensive assessment of
the entire fundus.
6. Pupil Dilation: Prior to the examination, the pupil is often dilated to allow
more light to enter the eye and improve visualization of the fundus.
 Prerequisite
• Fully Dark Room
• Appropriate Examiner and patient Distance
• Patient’s Pupil should be fully Dilated ( Using Mydriasis)
• Lens should hold at appropriate focal length
• Ask Patient to fixate on distant Object to visualize Optic Disc
• Ask Patient to look into light or at you to visualize Macula
• Ask patient to look up, down, right and left to visualize peripheral retina
• Use Tear drops for patient’s comfort
 Case:1:
Normal Fundus
 Case:1: Normal Fundus
1. Patient Information:
• Name: Lint-e-Muqadas
• Age: 22 years
• Gender: Female
• Occupation: Nill
• Chief Complaint: Irritation, Watering, Photophobia
2. Medical History:.
• No known ocular diseases or surgeries.
3. Ocular History:
• Routine eye examinations every 1 year.
• No history of significant eye trauma or surgeries.
 Case:1: Normal Fundus
Fundus Examination:
•Optic Disc: Sharp margins, pink color, cup-to-disc ratio within normal limits.
•Macula: Intact with no signs of macular edema or hemorrhage.
•Blood Vessels: Arteries and veins appear normal in caliber with no signs of
hypertensive or diabetic retinopathy.
•Retina: No signs of retinal detachment or tears.
•Peripheral Retina: Examined for any signs of retinal pathology.
 Case:2:
Diseased Fundus
 Case:2: CSME Fundus
1. Patient Information:
• Name: Amjad
• Age: 52 years
• Gender: Male
• Occupation: Nill
• Chief Complaint: continuous central reduced vision, black spots in field, watering, halos
• 2. Medical History:.
• Anti-Hypertensive Drugs
• PRP performed
3. Ocular History:
• History of significant eye surgeries.
 Case:2: CSME Fundus
Fundus Examination:
•Optic Disc: blur diffuse margins, pale color, cup-to-disc ratio within normal limits.
•Macula: swollen and cystic signs of macular edema or hemorrhage.
•Blood Vessels: Arteries and veins appear dilated and tortious and excessive growth of
vessels.
•Retina: No signs of retinal detachment but small tears at macula, exudates.
•Peripheral Retina: Abnormal blood vessels elsewhere
Thank you
Any Question????