From the Guidelines
Retinal detachment can be seen with an ophthalmoscope, but it requires proper examination techniques and equipment, such as pupil dilation and specialized devices like slit-lamp biomicroscopy with indirect ophthalmoscopy, to ensure accurate diagnosis. When examining the eye with an ophthalmoscope, a detached retina appears as an elevated, wrinkled, gray or opaque membrane floating in the vitreous cavity, rather than lying flat against the back of the eye where it should normally be positioned. The detached area may have a wavy or billowing appearance, and blood vessels crossing the detached portion may appear darker and more tortuous than normal. According to the comprehensive adult medical eye evaluation preferred practice pattern guidelines published in Ophthalmology in 2016 1, high myopia and abnormalities of the posterior segment, such as retinal tears or retinal degenerations, increase the risk of retinal detachment.
Some key points to consider when using an ophthalmoscope to examine for retinal detachment include:
- Pupil dilation is typically necessary to allow better visualization of the peripheral retina where detachments often begin
- Ophthalmoscopic examination has limitations, particularly for small or peripheral detachments, and may not detect all cases
- More comprehensive evaluation by an ophthalmologist using specialized equipment provides a more definitive diagnosis
- Retinal detachment is a medical emergency requiring prompt treatment to prevent permanent vision loss, so any suspicious findings should trigger immediate referral to an eye specialist.
It is essential to note that while an ophthalmoscope can be used to detect retinal detachment, it is crucial to use it in conjunction with other diagnostic tools and techniques to ensure accurate diagnosis and prompt treatment. As stated in the guidelines 1, conditions that increase the risk of retinal detachment should be evaluated thoroughly, and any suspicious findings should be referred to an eye specialist immediately.
From the Research
Diagnosis of Retinal Detachment
- Retinal detachment can be diagnosed using an ophthalmoscope, specifically indirect ophthalmoscopy under pupil dilatation, as stated in 2.
- Indirect stereoscopic ophthalmoscopy with scleral depression is recommended for the preoperative examination of retinal detachment, as mentioned in 3.
- Nonmydriatic hybrid ocular imaging, which combines color fundus photographs and optical coherence tomography, can also be used to diagnose retinal detachment, with a success rate of 84.1% in diagnosing retinal detachments, as reported in 4.
- The small pupil ophthalmoscope is a valuable tool in examining the peripheral fundus in pseudophakic patients, who are at risk of retinal detachment, as noted in 5.
Examination Techniques
- Indirect ophthalmoscope laser delivery can be used for encircling (360 degree) retinal detachment prophylaxis, as described in 6.
- Biomicroscope and a three-mirror contact lens can be used to study the macula and suspected small peripheral breaks, as mentioned in 3.
- Careful examination of the fundus before and after cataract extraction is necessary to reduce the incidence of retinal detachment, as stated in 5.