Ophthalmoscopy
(This test is part of the initial diagnostic evaluation.)

Ophthalmoscopy is a method used to examine the back of the eye – the retina and its blood vessels, the optic nerve and the choroid (vascular layer of the eye).
The test is done with a special device called an ophthalmoscope.

The doctor shines a beam of light into your eye through the pupil and looks at the retina. By changing the angle and position, the doctor can see different areas of the back of the eye:

• the optic nerve head (optic disc)

• the macula (area responsible for sharp central vision)

• the retinal blood vessels

• the peripheral retina

The doctor can also see clouding in the vitreous body (the gel inside the eye) and in the lens.

Narrow pupil vs. dilated pupil

Ophthalmoscopy can be done:

• with a normal (narrow) pupil

• with a dilated pupil, after using special eye drops (mydriatic drops)

Dilation is used when:

• the peripheral parts of the retina are not clearly visible

• a more detailed examination of the retina is needed
  – for example, in high myopia, or if there is a suspicion of retinal tears, degeneration, or retinal detachment

Even with dilating drops, sometimes the doctor still cannot see absolutely all parts of the retina.
In such cases, an additional test with a Goldmann lens is used – this special lens allows the ophthalmologist to see the retina all the way to the very far periphery.

Why ophthalmoscopy is important

Ophthalmoscopy is part of a standard eye examination and is one of the most informative tests for understanding the condition of your eyes.

Very often, the results of ophthalmoscopy are important not only for the eye doctor, but also for other specialists:

• For general practitioners and cardiologists
  They are interested in the condition of the blood vessels in the retina in diseases like high blood pressure (hypertension) and atherosclerosis.
  Based on the description of the retinal vessels, they can judge how severe these conditions are.

• For neurologists
  They pay attention to the optic nerve head, the arteries and veins of the retina.
  These structures can change in cervical spine problems (cervical osteochondrosis), increased intracranial pressure, stroke and other neurological diseases.

• For obstetricians-gynecologists
  They need this information to assess the risk during childbirth.
  Ophthalmoscopy shows how high the risk of retinal detachment is during natural delivery.
  That is why an eye examination is mandatory for all pregnant women.

• For endocrinologists
  In diabetes, the condition of the retinal vessels gives important information about the stage and severity of the disease in the whole body.
  Regular check-ups with an ophthalmologist are very important for people with diabetes, because eye complications such as diabetic retinopathy and cataract are among the most common problems in this disease.

So, do not be surprised if one of your doctors sends you to an eye specialist for a fundus examination (ophthalmoscopy).
The opposite is also possible: if the ophthalmologist sees changes in the blood vessels or in the optic nerve head, they may refer you to a neurologist or cardiologist, because the cause of the problem seen in the eye may actually come from another part of the body, not from the eye itself.