Fundoscopy : Procedure, Benefits, Limitations and Risks

Fundoscopy is a medical examination that uses an ophthalmoscope, a tool with a small light and lens, to examine the retina and blood vessels in the back of the eye. This examination helps to detect changes in the eye’s anatomy and identify potential eye diseases, such as diabetic retinopathy, glaucoma, and age-related macular degeneration.

The history of fundoscopy dates back to the early 1800s, when the German physician and physicist Hermann von Helmholtz invented the ophthalmoscope. This tool made it possible for physicians to see the inside of the eye for the first time and to diagnose eye diseases. Over the years, the design of the ophthalmoscope has improved, and new technologies have been developed to make fundoscopy more precise and accurate. Today, fundoscopy is an essential part of a comprehensive eye examination and is widely used by eye care professionals to diagnose and manage a range of eye conditions.

Fundoscopy is an eye test to examine the back of the eye.⁽¹⁾ It allows the doctor to see the structures in the eye and help diagnose the condition that may be impacting the retina.

The purpose of the Fundoscopy test is to assess the health of the retina, optic nerve, and blood vessels and diagnose conditions including retinal detachment, glaucoma, diabetic retinopathy, and the effects of certain medications. It can also be helpful in detecting systemic conditions including hypertension, diabetes and cardiovascular diseases.

Common eye conditions detected with fundoscopy include:⁽²⁾

• Retinal Detachment: Separation of the retina from the underlying tissue leading to vision loss
• Diabetic Retinopathy: A complication of diabetes, that damages the blood vessels of the retina and leads to vision loss
• Glaucoma: Group of eye diseases damaging the optic nerve and causing vision loss
• Macular Degeneration: A gradual decline in the central part of the vision that affects reading, driving, and performing day-to-day activities
• Hypertensive Retinopathy: Damage to the retinal blood vessel due to hypertension
• Cataracts: clouding of the natural lens of the eye causing blurry or hazy vision
• Age-Related Macular Degeneration: A degenerative condition affecting the central part of the retina that can cause vision loss.

Fundoscopy is also known as ophthalmoscopy.⁽¹⁾ It is performed with a help of a hand-held ophthalmoscope or head-mounted light and magnifying lens.

The fundus which involves the back and the inside of the eye and the retina is examined during fundoscopy. Fundus photography is used to take the picture of the back of the eyes.

Before conducting the exam, the doctor might use eye drops to dilate the pupil. This makes them large and easier to look through.

The eye drops may cause blurry vision and make the eye sensitive to light for a few hours. It is therefore important to get sunglasses for the appointment. Also, someone should be there to take the person back home.

The person should inform the doctor if allergic to any medication. Also, some medications might interact with the eye drops, therefore, it is important to inform about any medication or over-the-counter prescription involved in daily routine.

The doctor should also be informed if there is a family history of glaucoma. Eye drops would not be used if there is a history as it would increase the eye pressure.

The doctor would check if the pupils are dilated and if the back of the eyes is visible. Three different types of examination are done:

• Direct examination
• Indirect examination
• Slit-lamp examination

In direct examination, the person is made to sit in a chair and the lights in the room are turned off. The doctor would sit across and examine the eye with an ophthalmoscope.

An ophthalmoscope is an instrument with a light and several small lenses present in it. An ophthalmologist may look through these lenses and examine the eyes.

The indirect examination allows the doctor to look at the structures in the back of the eye. The person is made to sit in a reclined position and the doctor wears a bright light positioned on his forehead. This light shines on the person’s eye while the doctor is holding a lens.

The doctor may look in certain directions while examining the back of the eye. Some pressure may also be applied to the eye using a small blunt probe.

This procedure gives the same view of the eyes as an indirect examination but here there is better or greater magnification.

An instrument is placed in front of the person and he is made to sit by resting his chin and forehead on the parts of the instrument.

Once the position is fixed, the doctor turns on a bright light and uses a microscope to view the back of the eye. The doctor may view the eye in different directions and may also enlarge it with a hand to get a better view.

Fundoscopy is a diagnostic tool that is helpful in providing information about the health of the eyes and managing eye diseases. The benefits of fundoscopy include:⁽³⁾

Early detection of the eye disease allows prompt treatment, with a better outlook. Fundoscopy enables early detection of several eye and systemic diseases such as diabetic retinopathy, glaucoma, hypertension, and multiple sclerosis, among others. Early detection of these diseases can help in starting timely treatment and reducing the risk of vision loss.

• Fundoscopy helps in diagnosing systemic diseases such as diabetes and hypertension which are known to have an effect on the eyes
• It monitors eye health without any incision or injection making it a safe and non-invasive procedure.
• Fundoscopy is a cost-effective method to examine eyes
• Fundoscopy can be used to monitor the progress of treatment for various eye and systemic diseases. It can help in assessing the effectiveness of the treatment and determining if any changes are needed.
• Fundoscopy can be used to monitor changes in the eye over time. It can help in detecting any changes in the retina or other structures within the eye, which may indicate the onset or progression of an eye disease.
• Fundoscopy is a non-invasive procedure that does not require any surgical intervention. The patient simply needs to lie down and look into the ophthalmoscope while the eye doctor examines the eye.
• Fundoscopy is a quick and easy procedure that can be performed in a doctor’s office. It does not require any special preparation or recovery time.
• Fundoscopy is a relatively low-cost procedure compared to other diagnostic techniques for eye and systemic diseases.
• Fundoscopy is a painless procedure that does not cause any discomfort to the patient.

Overall, fundoscopy is a valuable tool for eye care professionals and provides important information about the health of the eye and other systems in the body.

Despite being an important diagnostic tool for the evaluation of eye health there are a few limitations of this test. These include:

• Fundoscopy provides only a limited view of the eye and does not provide a complete picture of the eye and its structures. An MRI or an ultrasound may be needed to get a complete picture
• It requires pupil dilatation that may cause irritation and discomfort that may affect the vision
• A trained healthcare professional is needed to perform fundoscopy as interpretation needs the expertise and knowledge of the field
• Those with severe eye problems may not be able to undergo this test
• Fundoscopy requires specialized equipment such as ophthalmoscopes, which may not be readily available in all settings, especially in resource-limited areas.
• The accuracy of the exam largely depends on the skill and experience of the practitioner performing the exam. Inexperienced practitioners may miss important findings or misinterpret the results.
• Some patients may have difficulty lying flat or holding still for the duration of the exam, which can limit the findings of the exam. Additionally, some conditions such as cataracts or clouding of the lens may interfere with the view of the retina, making it difficult to perform an accurate exam.
• The view of the retina is limited by the anatomy of the eye, making it difficult to see certain parts of the retina or other structures in the eye.
• Fundoscopy can provide important information about the retina and other structures in the eye, but it is not a definitive diagnostic tool. It may show non-specific findings that require additional testing or evaluation to determine a diagnosis.
• Fundoscopy should not be relied upon as the sole method of evaluating the health of the eye and other related structures. Additional testing, such as ultrasound or imaging studies, may be necessary to fully evaluate the eye and make a diagnosis.

Fundoscopy is not painful but can be uncomfortable for some. A person may visualize images after lights are turned off, which may obviously go away after blinking a number of times.

In very rare cases, a person may have a reaction to eye drops, which may lead to:

• Dry mouth
• Flushing
• Dizziness
• Nausea and vomiting
• Narrow-angle glaucoma⁽⁴⁾

Fundoscopy is a procedure to examine the interior of the eye, specifically the retina. It involves directing light into the eyes and examining them with an ophthalmoscope to magnify the structures. This test is commonly performed by an ophthalmologist to diagnose diabetic retinopathy, glaucoma, and macular degeneration or to detect any general changes in the eye.