Reece Hass

Are ophthalmoscopes still a dying part of the neurological examination or will they make a comeback in 2025? Mackay and Biousse @GreenJournal wrote an important article on the topic in 2015. Are we making progress to re-deploy the examination with improved bedside technology? Key Points: - The authors remind us that a direct ophthalmoscope was first used by Hermann von Helmholtz in 1851. - They stress that viewing the 'living ocular fundus' was critical to the 'golden age of ophthalmology.' - What did the ophthalmoscope inspire? The original descriptions of "retinal artery occlusion (1855), papilledema (1860), and optic disc atrophy (1861). - The authors share that the loss of the art has been driven by "technical difficulty, waning enthusiasm for ophthalmoscopy, and even discouragement from preceptors in medical education." My take: I am not ready to give up my ophthalmoscope, and I believe that neurologists should continue to peer into the living eye and identify papilledema, optic disc pallor and retinal vascular occlusion. Quick diagnosis saves vision even if it triggers an immediate consultation to a ophthalmology or neurosurgery colleague. Nonmydriatic (undilated) fundus photography was suggested in ~2010ish as something to pursue. The most interesting advances have been the use of an iphone (or smartphone) and a condenser lens to take a picture of the fundus after bedside pupil dilatation. This can be pulled off without an ophthalmologist and the picture can be sent to them for immediate discussion. There are now several apps that can pull this off, and if skilled you can even do it without an app. Additionally, many companies like Welch Allyn offer components to attach to your iphone/cell phone (i-Examiner is one such example of a device) and it allows you to pull off the fundus picture without dilating the pupil. Should we be promoting this technology more in emergency rooms, primary care offices and w/ neurologists? pmc.ncbi.nlm.nih.gov/article… #eye #ophthalmology