mrbreakfast

2+ Year Member
Jul 15, 2017
358
556
Status
  1. Resident [Any Field]
As a neurology junior, I feel like I have a pretty decent comprehensive exam, but my fundoscopic exam is honestly trash, and it's something I want to focus on this year. While ophthalmoscopes are plentiful in the ED, they're rare on the floors, and most/all of my seniors have their own. I'm looking at my options in purchasing one myself, but I wanted to ask SDN's opinion:

a) As far as I can tell from reading online, Welch Allyn is the Littmann of ophthalmoscopes, but I hear the heart just fine with my off-brand stethoscope. Is a Welch Allyn scope worth it over the much-cheaper-looking scopes on Amazon/eBay?

b) I've heard the panoptic is incredible (never tried it) but even a used head would cost my entire book fund and then some. Also, I've had multiple attendings (including a neuro-ophthalmologist) recommend I focus on proficiency on the standard scope rather than resort to it. Thoughts?

c) Outside of practicing on friends, any recommendations for resources in improving this exam skill? I don't feel comfortable with my exam but also don't feel comfortable blinding my patients while I fumble around trying to get a good look.

Thanks!
 

Telamir

10+ Year Member
Dec 27, 2008
217
222
Status
  1. Attending Physician
A panoptic is ridiculously good. I'd try to use the regular scope and try to get okay-ish at it. That being said, here's my 0.02:

Honestly, I think fundoscopic exam for most neurologist myself included is trash. It's not a skill we practice very often during residency, and it's not that much more common in "attendinghood". I've called ophthalmology based on my "fundoscopic findings" only for me to look like an idiot when they actually dilate the eye. Their experience doing it is vast while ours is only complaint specific and even then not always necessary. You should try to get more comfortable with it but even in the best of cases a neurologist's fundoscopic exam will be hot garbage compared to that of a neuro-ophthalmologist or an ophthalmologist.

I'd recommend trying to get proficient at looking at the optic disc/cup and the retinal arteries. Everything else is best left up to someone from an "eye specialty" anyway.
 
  • Like
Reactions: 1 users

deathmerchant

7+ Year Member
Feb 27, 2013
235
174
New York City
Status
  1. Attending Physician
As a neurology junior, I feel like I have a pretty decent comprehensive exam, but my fundoscopic exam is honestly trash, and it's something I want to focus on this year. While ophthalmoscopes are plentiful in the ED, they're rare on the floors, and most/all of my seniors have their own. I'm looking at my options in purchasing one myself, but I wanted to ask SDN's opinion:

a) As far as I can tell from reading online, Welch Allyn is the Littmann of ophthalmoscopes, but I hear the heart just fine with my off-brand stethoscope. Is a Welch Allyn scope worth it over the much-cheaper-looking scopes on Amazon/eBay?

b) I've heard the panoptic is incredible (never tried it) but even a used head would cost my entire book fund and then some. Also, I've had multiple attendings (including a neuro-ophthalmologist) recommend I focus on proficiency on the standard scope rather than resort to it. Thoughts?

c) Outside of practicing on friends, any recommendations for resources in improving this exam skill? I don't feel comfortable with my exam but also don't feel comfortable blinding my patients while I fumble around trying to get a good look.

Thanks!

It certainly helps to have a nice pan-optic scope, but is by no means necessary.
As a neurologist you should be able to look at the disc and detect papilledema. Its good to learn using a regular ophthalmocope- I used to have a bottle of tropicamide in residency that I got from pharmacy and would dilate admitted patients and examine them. It doesn't take long to learn to see the disc.

As mentioned above, unless you are in neuro-ophtha, neurologists suck at rest of the fundus exam.
 
About the Ads

NOLADO84

2+ Year Member
Nov 20, 2018
65
69
My school required us to buy the Welch Allen that came with the panoptic. Paid off now, but boy was I pissed first year of med school.
 
  • Like
Reactions: 1 users

GuillainMollaret

2+ Year Member
Jul 23, 2018
47
41
Direct ophthalmoscopes are garbage. The field of view is extremely limited and you really need to scan the retina to get to the disc. After a lot of practice, I can now usually see the disc in 60 to 70% of non-dilated patients.

Panoptics are awesome with a super wide field of view, but certainly less common.
 

JumpingLumberjacksofMaine

10+ Year Member
Jul 6, 2009
20
14
Status
I got a pan-optic--around 2010, it was around 700 bucks--not cheap, but not a ridiculous amount particularly compared to the cost of training etc. I'm pretty sure that in order to document a full neurologic examination you need to at least attempt to look at the disk--if you do any outpatient, that means that you are practicing seeing the disk at least 3-4x/day (with most new patients). Sure, some of that might be silly, but with most headache patients I feel it's actually pretty important to see the disk (and often you can see spontaneous venous pulsations as well--makes raised ICP very unlikely). I always looked if only to build up my stock of what normal looked like, so that I could at least tell if something looked grossly abnormal. To me, it was definitely worth it to actually feel like I had done a good job at something I was doing so frequently. In addition, while no one will ever mistake you for an ophthalmologist, sometimes you'll run into situations where you can't get that next day ophtho consult.

I never dilated (was nervous about giving somebody acute angle closure glaucoma), though after broaching the question with multiple ophtho's/neuro-ophtho's and they felt it was a generally safe thing to do--you just warn pt's about this SE and to go to the ED if it happens--that would probably really make it much easier.

TLDR: I'd get the pan-optic and use residency as the time to practice the skill and get good at it.
 

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads