PanOptic Ophthalmoscope

[TulaneKid24]

Hi,

I have some questions about which ophthalmoscope to purchase.
Should I get a regular one or the new panOptic one. Is the new one that much better?? Also, should I get one with a lithum light weight battery or the regular one?

How much more functional are the panoptic light weight ones. Are they worth the extra money??

Thanks

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[doepug]

Get the Panoptic!

It's well worth the extra $. You'll be amazed how much more you can see with it. I think the Panoptic is a sound investment, and all your colleagues (i.e. residents, attendings) will want to play with your new toy.

My whole class put in a group order for ophthalmoscopes, so I was able to get the Panoptic/lithium handle combo for about 40% of retail price.

Go for it!
doepug

 

[southerndoc]

If you get the panoptic, make sure you get plenty of practice doing fundoscopies with the old style ophthalmoscope too. There's nothing more sad than someone becoming too dependent on the new gadgets, only to find them completely spastic when their new gadget breaks.

The new panoptics look nice!

 

[sadie]

I got a regular one with the lighter lithium battery and I'm happy with it. Since you need to learn how to use the regular old-style one no matter what (since most clinics still have that kind), it's actually better to have one at home to practice with. For me the key issue was weight/portability so it made sense to splurge on the lighter battery but get the regular opthalmoscope rather than the pan-optic. If you expect to do rotations abroad, especially in an underdeveloped country, you might think about the regular handle instead because apparently you can use regular batteries in that and don't have to worry about plugging it in.

The regular ones with the lighter battery by Welch Allyn come in a set with a soft case instead of a big hard case--that case is actually small enough to fit in your white coat pocket if you ever need to carry it. The pan-optic is not. I forget the actual prices, but even with the discount the pan-optic was much more expensive. The pan-optics are relatively new, so I would imagine they'll eventually get cheaper and/or smaller and less bulky--at that point you could sell your old one or trade it in if you had gone into something where you needed your own opthalmoscope.

 

[Mindy]

I'm not sure what this advise is worth, especially since I'm going to be a pathologist, but...

I have a welch allen ophthalmoscope that I have never stopped regretting buying (?too many verbs?). I HATE the fact that it cannot be carried easily in my pocket. I had the opportunity to buy a small portable pocket-sized ophthalmoscope, but was talked out of it because everyone said I would not be able to see the fundus well with it. If I had bought the small one, at least I would have used it...

I am not sure what these new ophthalmoscopes actually are that you guys and gals are debating, but if there is any instrument that *actually* does make it easier to see the fundus, it may be worth it. But, I used mine so infrequently and so frequently wished I'd bought the small, cute, lighter one...

Mindy

 

[The Pill Counter]

Our Consultant Opthalmologist is pushing us to buy a 3.5 V rechargeable opthalmoscope, but is it much better in visualising the fundus than the lighter, cheaper, battery 2.5V? Outside of opthalmology, how much would a GP or physician really need to elicit from a fundoscopy? In urban areas, don't optometrists do the bulk of the screenings that go on to referral to opthalmologists?
I played with the panoptic for a bit, and it was much easier to use, but if you're not in opthalmology, how do you justify the cost, size, etc? Would we really do that many optho exams?

 

[doepug]

Fundoscopy is critical for all physicians, especially GPs!

As a GP, you'll see manifestations of hypertension and diabetes in the fundus, along with a host of other conditions. While you may end up referring your patient to an ophthalmologist for evaluation, learning how to do a good funduscopic exam is critical to your patients' future.

I totally disagree some advice posted by others... if you get the PanOptic, you will NOT need to mess with old ophthalmoscopes! It doesn't matter what ophthalmoscopes any given hospital/clinic has, since you can (and should) carry your own scope around in your coat or bag.

Go for the PanOptic. You won't regret it, and you won't have to mess with other antiquated models.

Good luck,
doepug

 

[eyehope]

Not to be argumentative, but I rarely see any GPs doing a fundoscopic exam on HTN or diabetic patients. Firstly, without dilation, it is very difficult to appreciate any detail with a regular ophthalmoscope. There is no way you can see sufficient detail as to grade diabetic retinopathy on a regular undilated exam. Second, I doubt any office fundo. exam will affect the patient's immediate outcome (except for emergent conditions such as detached retina, hemorrhages).

Unless you plan on going into ophthalmology, save yourself some money and get the regular model. The PanOptic will eventually replace it, but there is no need to be an early adopter.

 

[southerndoc]

You've gotta be kidding me. I've never had trouble seeing AV nicking, neovascularization, etc. in undilated pupils.

Just because some GP's don't do fundoscopic exams doesn't mean the majority don't. Every physician that I have shadowed has done fundoscopy exams in my presence. Not every visit gets one, but every annual physical does.

What you are saying is equivalent to telling me not to listen to heart sounds because the patient sees a cardiologist, or not to listen to lung sounds because the patient's pulmonologist will treat the patient's condition.

 

[The Pill Counter]

In terms of eye care, can't you assume that the optometrist is the primary care provider who would refer on to an opthalomologist if necessary?
Geek, you must be a genius, cause, even our consultant says the amount of info illicited from an undilated eye is sketchy at best.

 

[southerndoc]

Genius? Far from it. Maybe I'm just getting lots of practice. Anyone else have trouble seeing in undilated pupils?

The problem I've seen with people who can't see stuff in the eye is because they're either 5 feet away from the patient or they aren't rotating the scope properly to see everything.

 

[mcwmark]

I've never had trouble looking in undilated patient's eyes. Granted, I'm still a med student, and it takes a little more work to see, but it's still all there...

That panoptic scope though, is much much much better at visualization.

Just my two cents.

 

[DuneHog]

I'm a 4th year and have looked in many undilated eyes. I can see the disk and vessels, but I would not feel very confident calling anything except abnormal vs probably normal. In watching and talking to my classmates, I don't think anyone else feels any more confident than I do (many still have trouble seeing vessels and optic disk). If it really was easy to pick out pathology in the undilated eye then it would probably not be recommended that diabetics have annual screening dilated eye exams. I agree - geek is either way beyond the curve or kidding himself that he can pick out pathology with such exactness.

As for the panoptic, I think it's a neat device but it may be a while before it is commonly used. Realistically, the only way it will ever completely replace standard opthalmoscopes is if physicians can bill for a more comprehensive eye exam if the used a panoptic. I don't agree with the person that said you should always carry your opthalmoscope in your bag. I have never met another med student that always carries a scope, and I don't do it myself. I only carry one for neurology and free clinics without wall scopes (mainly for the otoscope actually). I honestly think that you would look like a real dufus if you packed around a clunky panoptic everywhere you went on the wards - just like if you bought one of those electronic steths. That said, I would suggest buying the 2.5v combo because it is the most practical for those occasions when you do take your scope with you. The only way I would consider a panoptic is if you are going into optho.

 

[TulaneKid24]

Now, I am even more confused at which scope to purchase. No, seriously, I really appreciate all the good comments.

 

[GCS:3]

I rarely see any GPs doing a fundoscopic exam on HTN or diabetic patients. Firstly, without dilation, it is very difficult to appreciate any detail with a regular ophthalmoscope.

I think for the most part, using fundoscopy as a diagnostic/prognostic tool is outdated. It's too subjective. By the time you pull out your ophthalmoscope, you already know the patient is diabetic or hypertensive, so what's the point of looking for nicking, etc besides floating your own boat. I didn't buy one at all. Who needs it, they're all over the walls in the hospital anyway.

 

[southerndoc]

To all those that are against doing fundscopies, just make sure you at least look for papilledema before you do your LP.

 

[DuneHog]

To all those that are against doing fundscopies, just make sure you at least look for papilledema before you do your LP.

I certainly am not against doing fundoscopies. It is a good skill to learn. However, it is often too unreliable to make clinical decisions on fundoscopic exam alone. You bring up a good example - it would be rare to do a fundoscopic exam alone to check for increased ICP before doing a tap unless At my institution it is virtually universal to get CT or MRI if possible to look for an obstructive mass etc before doing a tap.

I think for the most part, using fundoscopy as a diagnostic/prognostic tool is outdated.

I don't think that fundoscopy is obsolete by any means. There are situations where you can't get imaging and you have to rely on papilledema as one sign of increased ICP. And sure you know that a patient is diabetic or hypertensive before looking for retinal evidence of their disease. You don't examine the retina to diagnose hypertension or diabetes. But fundoscopy adds to your database and can give you a better idea of the degree of end-organ damage.

Bottom line on the panoptic/opthalmoscope issue: I think it's still worthwhile to buy an opthalmoscope but the panoptic seems a little overboard unless you are going into optho.

 

[Adcadet]

hey all -
old thread, but the newer generations are always poking around. Thought I'd add my $0.02 on the debate.

I was recently accepted to med school, and visited my father for an eye exam (he's an optometrist) and a crash course on fundoscopy. He has all the gadgets you'd expect somebody to have who's been doing lots of fundoscopy for 30 years. He's also blind in one eye, allowing me to dilate the blind eye without annoying him too much. I could then compare his two eyes to see how a dilated vs. undilated exam differ. I played with the PanOptic, a standard direct opthalmoscope, and some crazy, 30 year old opthalmoscope that's no longer made (basically, it had a long barrel and gave greater maganification than the other scopes, but the field of view was pretty narrow). I found the standard direct opthalmoscope was pretty difficult for me to use in the undilated eye, and nearly impossible to use in the undilated eye. I'm sure learning is just a matter of practice. The PanOptic was usable for me in the undilated eye nearly immediatly, and easier still in the undilated eye. The wacky old direct opthalmoscope was actually easier to use than the standard one as the focus adjustment is continuous as opposed to the standard's discrete focus knob, and I thought the long barrel made it a bit easier to aim. The mag was great, but the field of view was horrible. My dad loves it, but he's been using it forever. If i had to choose one to use, hands down I'd go with the Panoptic. It was by far the eaiest for me to use. We'll see how much I appreciate it's extra bulk in a few years when I start hitting the wards.

 

[docB]

-I have trouble using the direct and I've been doing it for years. If I really need to see and I can't do it undilated I dilate them. Even then I don't find it that easy.
-We just got a new panoptic in one of the EDs I work at. I asked one of the other docs if he knew how to use it and he said yes. I asked him which end I look in and which end the patient gets and he didn't know. Clearly there is a learning curve.
-How much do the panoptics cost ballpark?

 

[neilc]

hey Adcadet...

you mentioned that your father is an optometrist and also blind in one eye...i myself am blind in one eye (undeveloped retina), and have been wondering about what is gonna happen when i start doing fundoscopic exams. (we are getting to them this semester in our Physical Dx class). it seems to me that it will be a bit akward for me when i am examining the pts left eye. it will be like we are making out! am i missing something basic, or is it something i will have to get used to...i guess i had better remember to brush my teeth before every exam!

 

[Adcadet]

Originally posted by neilc
hey Adcadet...

you mentioned that your father is an optometrist and also blind in one eye...i myself am blind in one eye (undeveloped retina), and have been wondering about what is gonna happen when i start doing fundoscopic exams. (we are getting to them this semester in our Physical Dx class). it seems to me that it will be a bit akward for me when i am examining the pts left eye. it will be like we are making out! am i missing something basic, or is it something i will have to get used to...i guess i had better remember to brush my teeth before every exam!

Hey Neilc -

I remember the Panoptic website mentions that one benefit of the Panoptic is that you can use your dominant eye to examine both of the patient's eyes. I think any long opthalmoscope will allow you to do this. I've never noticed anything strange about how my dad uses the standard opthalmoscope....yeah, I guess he does get close when he uses his left eye to examine my right eye. Probably just something you'll have to get used to.

I'm not sure if this applies to you, but my dad's retina is partially developed, making it pretty interesting to look at. If your blind eye is similar, perhaps your classmates will be able to use that eye to learn what some abnormalities look like. Of course, you may not like being the class guinnea pig.

 

[neilc]

yeah, when i was i kid i remember the doctor looking at my eye and then practically waving a flag out in the hall to get all the students to check it out...and, i already am the class pig, so i may as well add the "guinnea" to it!!!

so, i guess i get to look forward to getting close to my patients or buying the panoptic...decisions, decisions!

thanks...