Ophthalmoscope

An ophthalmoscope is used to examine the retina and vitreous. Ophthalmoscopy aids visualization of the inside of the back of the eye including the retina, optic disc, choroid and blood vessels. It is often part of a routine eye examination. A direct ophthalmoscope is used for viewing the central retina. It is hand-held and powered with a light source. The instrument has to be adjusted constantly to focus on different structures within the eye. The light can be intense and disturbing. An indirect ophthalmoscope aids in examining the entire retina. This instrument is attached to the doctor's head and allows a clear view of the retina with a special lens. The patient may feel uncomfortable due to the intense light and pressure from the instrument.

Ophthalmoscopy is useful in detecting any changes in the retina due to diseases such as eye disease, diabetes, arteriosclerosis, high blood pressure or macular degeneration. Cataracts and other eye problems can be detected with an ophthalmoscope.

The patient's eyes are dilated so as to allow a good view of the insides of the eye. Some patients develop allergic reaction, vomiting, nausea and dizziness. This test is conducted in a darkened room where the patient is asked to look ahead at a distant spot. The eyes must be held steady without blinking. The ophthalmoscopy procedure may take just about 5 - 10 minutes.

Optic Disk Swelling

A doctor checks into the eye with an ophthalmoscope when there are regular complaints of headache, nausea or vomiting. This is to check for the appearance of the optic nerve and the blood vessels that pass through the eye. Swelling of the optic nerve is called Papilledema.

The optic nerve is a thick cord that connects the back of each eyeball and its retina to the brain. The cerebral spinal fluid protects the nerve between the brain and eye. Even if there is a slight increase in the pressure of this fluid, due to swelling in the brain, the optic nerve can get compressed around its whole circumference in a choking manner. The optic nerve can bulge whenever it develops inflammation on its own - causing Papilledema.

Such swelling of the optic nerve head can also be caused due to intracranial pressure. This could be due to an underlying brain tumor or brain infection such as abscess, meningitis or encephalitis. In fact many who are diagnosed with brain tumors exhibit Papilledema. Sometimes this can be caused due to high blood pressure.

Causes of Papilledema :

• Tumor of the Brain, Skull, Spinal column or cord, optic nerve
  
• Hydrocephalus - accumulation of cerebrospinal fluid within the skull
  
• Intracranial infections such as encephalitis, meningitis
  
• Abscess - Accumulation of Pus, Hemorrhage or trauma to the head
  
• Craniosynostosis - Abnormal closure of the skull bones
  

Symptoms of Papilledema :

• Headaches - especially the types which become severe on awakening; headaches that become exacerbated by coughing or holding breath
  
• Nausea and Vomiting
  
• Changes in vision manifesting in the form of double vision, flickering, transient blurring or graying
  

Pseudo tumor cerebri or benign intracranial hypertension is one condition which can cause increased pressure in the cerebral spinal fluid. This is caused when the body makes too much spinal fluid. This is common in women especially who are obese and of child bearing age, and at such times when the body is adjusting to hormone changes such as pregnancy, the first menstrual period or menopause. It is better to go in immediately for neuro-imaging and MRI to check the cerebral cenous sinuses. A lumbar puncture could be done to check the opening pressure as well as CSF (cerebro spinal fluid) test, Fluorescein Angiography - an eye test specifically intended to check the blood flow in the Retina and Choroid, if there is diagnostic uncertainty. In some cases ultrasonography and Retinal Tomography may be used to get 3D data and image.

Although a swollen optic nerve tends to improve over a period of time, it may take months for complete restoration of normal vision. Doctors usually treat with intravenous steroid drugs but this process may have little effect on vision in some cases, although it may help to improve overall health.

Pediatric Ophthalmologist

Pediatric ophthalmology is a sub specialty of ophthalmology concerned with vision care and eye diseases in children. A pediatric ophthalmologist provides comprehensive care in diagnostic, treatment and management of infant vision and common childhood vision disorders. Surgery to correct ocular misalignment and double vision in children are also performed by a pediatric ophthalmologist. Pediatric ophthalmologists are physicians who have completed a three year residency in ophthalmology after the medical school and one year internship and one or two year fellowship in pediatric ophthalmology and strabismus. Pediatric ophthalmology fellowships are accredited by the American Association for Pediatric Ophthalmology and Strabismus in the US.

Role of a pediatric ophthalmologist in child vision care:

• It could be opined that in young infants and children the visual system is not fully mature. As such, equal input from both eyes is required for proper development of visual centers in the brain in a human being. There could be the danger of permanent irreversible loss if the child's growing eye does not provide clear and focused image to the developing brain. A pediatric ophthalmologist provides early detection and effective treatment under such circumstances.
  
• Children suffer from reduced vision in one or both eyes from Amblyopia, uncorrected refractive errors and misalignment of the eyes called strabismus. It is the domain of the pediatric ophthalmologist to detect such innate errors in children and provide effective and efficient treatment. Among the vision problems that the pediatric ophthalmologist evaluates for the child include:
  
• Amblyopia: This is caused in an infant whose brain does not recognize the sight from the eye. In other words, there is poor vision in the eye appearing normal.
  
• Strabismus: This is misalignment of the eyes in any direction. About 4% of the children are affected by this disorder.
  
• Refractive errors: Such errors can cause decreased vision resulting in visual discomfort, eye strain and also Amblyopia.
  
• Genetic disorders: Approximately about 8% of genetic syndromes affect the eyes of children. Examination by a pediatric ophthalmologist helps to diagnose such genetic conditions. Sometimes certain eye conditions such as high internal pressure 'intraocular pressure' which can lead to glaucoma can be inherited in family members even when they are young. It is imperative on the part of the parent to inform the pediatric ophthalmologist about such conditions. Many pediatric ophthalmologists participate with multi disciplinary medical teams that treat children with genetic syndromes.

Tests conducted by pediatric ophthalmologist

• Penlight Eye Inspection: A small penlight is aimed into the child's eye, beginning with the newborn infants. The pediatric ophthalmologist checks and makes sure that the eye structures and eyelids appear normal and also if the eyes react appropriately to the presence of light. The pediatric ophthalmologist also checks for any early signs that eyes might be misaligned.
  
• Red Reflex test: The internal eye structure in particular, the red reflection from the inner back of the eye where the light sensitive retina is located is examined for the presence of any eye disease. This is done using an ophthalmoscope.
  
• Snellen Eye chart: This eye check contains letters and numbers which are used to test the sharpness of vision. This test can be done on children above the age of three years depending upon their comprehension. Sometimes certain cards with pictures are used to test for visual acuity testing.