pikachu said:
You run into a big problem because you're shining a bright light into someone's eyes so the pupils constrict and make the fundus even harder to see. I never saw the fundus until I saw a dilated exam so you're not the only one.
Two ways to avoid this are to try to save looking at the macula until the very end of the exam, make the room dark, and use the ophthalmoscope on about half brightness.
Other strategies to get better:
Practice using the ophthalmoscope (at less than full brightness) on friends and family. Start with small goals that literally anyone can get and become more ambitious as your skills progress. 1) First focus on actually seeing ONE vessel and getting a feel for how to focus the ophthaloscope. 2) The next step is to get used to following the vessels to the disc. 3) Then get used to looking at the key features of the disc. 4) With practice, you can get the important stuff you need to know about the disc with only one to two seconds of looking at the disc (once you've found the disc). I'd argue getting this far is the minimum competency medical students need with an ophthalmoscope so that they can pick up big problems like papilledema or other optic nerve edema, high cup
isc ratio in glaucoma, etc. If you become comfortable with this you can move on to 5) more subtle things like A-V nicking, looking at the whole retina for small hemorrhages or other signs.
I'm not going into ophtho but I recommend doing a rotation in it because not only do you get practice in the fundus exam, you get an attending there either verifying or correcting your exam. If you practice without someone giving you feedback about whether what you think you see is right, it's much harder, I would think.
Regarding the panoptic ophthalmoscope: I bought one, it's very cool and it's easier to see stuff, true. But I have found that in kids under the age of about 16 it's much easier to see a disc with the old kind because if they don't comply with holding still and looking in one direction you can't see much at all with the panoptic. So if you're going into peds, I'd say don't spend the money.
bpkurtz