Dr Sabin SahuM.S. Ophthalmology

SCEH, Lahan

Retinal diagramsMost retinal surgeons are trained to create

formal retinal drawings of the fundus. Retinal drawings are useful to document

pathology, although more and more people now prefer fundus photographs.

Can be used for serial follow up of patients to document changes in the pathology.

Fundus evaluationA. Optic Disc evaluationSize, shape, colour of the discVertical cup-to-disc ratio (CDR)Neuroretinal rim Disc margins: distinct/ blurredPeripapillary changes

B. Retinal vasculature Changes: attenuation tortuous dilated nicking

A/V ratio: ratio of artery size compared to vein size, should be checked after the 1st bifurcation.

(normal 2/3)

C. MaculaFlat/intact and uniformly pigmentedYellowish foveal reflexLook for any abnormal pigment/ blood or

fluid

D. Vitreous and retinal peripheryVitreous: clear/ cells posterior vitreous

detachment

Periphery complete 3600

look for retinal holes/ breaks/ blood

Technique of retinal drawingView in the condensing lens is real and in

front of the patient:

Image is inverted and reversed

You may invert the paper and draw anomaly as it appears inside the condensing lens; in same location as you are observing.

Retinal charts/ Cartographs2 concentric circles:Outer: ora serrataInner: equator

Macula is located centrallyOptic nerve head is located nasal to the

macula

BLUE Retinal vesselsSub retinal fluid Detached RetinaEdema

REDAttached retinaHemorrhage (preretinal, retinal or

subretinal)Retinal tearMicroaneurysmPreretinal neovascularization

YELLOWYELLOWExudateInflammatiom (retinal)Cotton wool spotsDrusenSubretinal fibrosisAtrophic areas (paving stone degen.)White deposits (Stargardt’s Dis.)Amelanotic mass lesions

GREENMedia opacity (corneal pathology, cataract,

vitreous debris or hemorrhage)Pre retinal fibrosis or membranesVitreous detachment (Weiss ring)

BROWNMelanocytic lesionsUveal tissueMalignant choroidal melanomasEdge of buckle beneath detached retinaChoroidal detachment

BLACKRPE (Retinal pigment epithelium)Pigment clumpingRetinal pigmentationScar

Steps of retinal drawingHave available colored pensils and retinal

chart paper.Mark fovea and the disc.Draw boundaries of the RD by starting at the

disc and extending peripherally.Draw detached and attached retina.Indicate the course of retinal veins.Examine the peripheral retina with scleral

indentation.

How big is the lesion?Size in disc diameters (DD) compare lesion to optic nerve head size.

Where is the lesion:Location:Clock-dialsuperior, supero-nasal, nasal, infero-nasal,

inferior, infero-temporal, temporal, supero-temporal.

Anterior/ posterior to the equator/ oral lesion.

Distance:In disc diameter.May use relation to constant landmarks: optic nerve head vortex veins vessels