Dr. Frank Weinstock
September 18th, 2008
When an ophthalmologist, or any physician, looks into the back of your eyes, he or she can visualize the blood vessels, the nerve and the other structures at the back of the eye (the fundus). We use a special light, an ophthalmoscope, which enables us to see thru the pupil. The view of the fundus gives an amazing panoramic view of the eye and of your health (eye and body).
Since the pupil constricts (gets small) with bright lights, we often use drops to dilate the pupil (make it larger) so that we can get a better view or picture of the back of your eye. We can take photographs for better analysis or for comparison records over time.
There is a small number of patients in whom it is dangerous to dilate the pupils which might cause a type of glaucoma (angle closure) in some susceptible patients. We usually can detect these susceptible patients during the first part of our exam when we look with the microscope (slit lamp). They are then informed as to the potential dangers of dilation in the future. If these patients must be dilated, we take special precautions.
The ophthalmoscope is so valuable that, on trips to Third World countries, this was the only instrument that I carried. I also keep one at home in case any eye problems occur in my family or need magnification for evaluation of scratches, foreign bodies in the eye, cataracts, removing splinters and a myriad of other uses.
The ophthalmoscopic exam may be performed by all physicians and should be a part of routine and most exams. It is especially necessary when following patients with diabetes, high blood pressure, cancers and many other diseases. It may be used to make a diagnosis, confirm a diagnosis or to follow a disease since many systemic diseases may affect the eyes.
What can be diagnosed with the ophthalmoscope during a “routine” physical exam - by the primary care physician or the ophthalmologist? Diabetes, high blood pressure, brain tumors, leukemia, kidney disease, breast and other cancers and many more may show up during the ophthalmoscopic exam. These, and many other diseases, may first show up during the exam with the ophthalmoscope. Once a diagnosis is made, it is essential to periodically use the ophthalmoscope to follow the patient. Changes in the ophthalmoscopic findings often demonstrate the need to change medications or modify treatment of the disease being followed.
The ophthalmoscope is one of the most important instruments we have in medicine. There is no extra cost to the patient or the insurance company and it provides invaluable information in a very short period of time with essentially no discomfort to the patient.
It is sad for me to see a patient who has been followed a regular basis by a physician on a regular basis and who doesn’t look in the eyes, thereby missing significant eye disease findings of diabetes or other conditions. Part of the reason for this is that the eye exam is thought to be so specialized that physicians avoid it. Often the eye receives little attention in medical school or other training.
It is also disappointing to have patients have no eye exam for many years and to find conditions such as diabetes or glaucoma which might have had the vision loss avoided
if he or she had come in for an exam sooner.
Many of these eye conditions do not cause changes which may be noticed by the patient until much time has passed before he or she notices that the vision is “not correct.” Our goal is to find diseases as early as possible in order to prevent vision loss or to restore vision loss.
The ophthalmoscope is one of the most valuable instruments in our arsenal of technology. It costs relatively little, yields amazing information and may be used by almost every physician to diagnose, not only diseases of the eye, but will enable the diagnosis of many systemic diseases of the body.
Dr. Frank Weinstock is a Professor of Ophthalmology- NEOUCOM
Affiliate Clinical Professor at Florida Atlantic University. © 2008 Frank J. Weinstock
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