Hi my friends, Below is some info for ophthalmoscope technique. Applicable to panoptic as well.
From my stand point, common mistakes for using a direct ophthalmoscope are below...
Mistake 1) Choosing a bright light.
It is very important that a pt can tolerate the brightness of this exam. I will chose the least bright and smallest light so that he or she can tolerate longer.
Mistake 2) Have a pt look straight.
It is important to get your patient to fixate on a precise area (for example, the corner of the room or curtain rail). If you are too vague about this they will move their eyes. Instruct the patient to look at this spot no matter what-even if you get in the way. This spot should be located so that they are looking slightly away from you when they are examined-that is, to the left when you examine the right eye and vice versa.
Mistake 3) Do not pay attention to your and his or her refractive errors.
Often the examiner try to take his or her glasses off. Also pt's glasses might be off. If you can examine both glasses on, probably that is the best way because you don't have to correct refractive errors. If you need get pt's glasses off, I will recommend you to estimate their diopters by using cheating sheet below from his or her visual acuity. That way you can have good estimation about how many diopter dial you will move.
Often time examiner will get close to the pt's face, and dial 4-5 diopters. Looking at the cheating sheet below, you will see how far you will go if you dial 4-5 diopters. If you are using your glasses on, I will recommend keep them on. If you need to take that off. You need make sure that you will adjust diopter prior to looking at pt.
-The dial is green for +, red for - for your reference.-
Refractive Error Myopia in Diopters Approximage Unaided Visual Acuity
-.50 D 20/50
-1.00 D 20/100
-2.00 D 20/200
-3.00 D 20/300
-4.00 D 20/400
-5.00 D 20/500
-6.00 D 20/600
-7.00 D 20/700
-8.00 D 20/800
-9.00 D 20/900
-10.00 D 20/1000
These approximations apply to nearsighted (myopia) patients wearing glasses. Obviously I am not good at ophthalmoscop technique and the info above could contain errors, feel free to give me any inputs. Thank you very much!