panoptic vs. regular opthalmoscope

[Yogi Bear]

Is the panoptic othalmoscope truely the way to go? We recently had a welch allyn rep talk about opthalmoscopes and how the panoptic is the way to go for med students. ie. 5x bigger image, easier to use, etc. however, i didn't see any of the doctors/residents using it when i recently had my routine eye exam. do you use it andrew? looks kinda like a hairdryer...hehe.

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[MacGyver]

usually I dont buy the salesman's pitch but in this case, panoptics are the way to go. They are SUBSTANTIALLY better than regular scope. You can easily visualize the optic disk and vessels. You can do it with undilated pupils, and you dont have to swivel around a lot to see stuff.

The 5X field of view is the big thing. Thats a huge advantage over a regular scope.

 

[cmz]

Is the panoptic othalmoscope truely the way to go? We recently had a welch allyn rep talk about opthalmoscopes and how the panoptic is the way to go for med students. ie. 5x bigger image, easier to use, etc. however, i didn't see any of the doctors/residents using it when i recently had my routine eye exam. do you use it andrew? looks kinda like a hairdryer...hehe.

Make sure you wipe these suckers down after every patient you come into contact with. In fact, it may make the patient feel more comfortable when they see you sterilize it before you jam this up against their orbit

On a side note, I don't know if this is true or not, but we hardly used ophthalmoscopes on medicine/peds, and everyone always wrote something to the effect of "clear fundus" or some other crap in every note. In fact, I didn't do a real focused eye exam until my second month of medicine when I started carrying drops around with me. Mind you, it wasn't by any means a "complete" eye exam

 

[Redhawk]

As noted, the advantage is the much larger view once you get the hang of it. However the size of the device can be a disadvantage. When I did my rotations I carried the "old fashioned" scope in my pants pocket. I couldn't have done such a thing with the panoptic. As far as ophthalmoscope usage by residents/attendings, I only saw a few use them (glaucoma docs just focusing on the disc). Every ophtho room is supplied with a normal ophthalmoscope.

 

[Eyesore]

Practically, the only time I use the direct ophthalmoscope is when the muscle light burns out and I need to check the pupils. Otherwise, I would not use the direct ophthalmoscope to examine patients.

As an ophthalmologist, I value the stereoscopic (binocular, 3D) image I get using indirect ophthalmoscopy. I believe you need the three dimensional view to properly assess the optic nerve. You cannot just base it on the color of the nerve, you really need a 3D view to evaluate for notching, thinning, etc. In fact, I'm sure at times many people get a false sense of security when examining the optic nerve with a direct ophthalmoscope because they base their assessment on the color, but they actually miss areas of actual thinning that you can only detect binocularly. Also, to assess other areas for elevation, to evaluate macular edema, tumors, shallow detachments, etc., you really need a stereoscopic view. This, you cannot get with the panoptic.

Furthermore, with indirect ophthalmoscopy, I don't have to get that close to patients. This is especially important if you do some rotations at the county hospital.

So if they can come up with a binocular panoptic, then I might be more interested. Otherwise, I don't think too many ophthalmologists will actually buy into it.

Now for primary care physicians, that's another story.... Too often, they don't know what they are looking at anyway. I know I didn't until I was knee deep into ophthalmology. They just don't teach you much in med school about ophthalmology. But with the panoptic, I guess you could actually start seeing stuff.

 

[BassDominator]

Panoptics definitely give you a better view.... I just don't think it's worth the extra money and bulk. I would argue against even buying a diagnostic set. You can always share with your physical diagnosis party.... or buy one super cheap on ebay or from a graduating student, if you really want to own one. They're almost always on the wall in clinic or the ED.... I know very people who actually carry one on them.

 

[Redhawk]

Panoptics definitely give you a better view.... I just don't think it's worth the extra money and bulk. I would argue against even buying a diagnostic set. You can always share with your physical diagnosis party.... or buy one super cheap on ebay or from a graduating student, if you really want to own one. They're almost always on the wall in clinic or the ED.... I know very people who actually carry one on them.

I agree. I never bought one, only borrowed one when I needed it. Save your money. You can always get one very quickly if you ever REALLY need one of your own for some reason.

 

[Andrew_Doan]

I agree with much of the above.

I use a regular direct ophthalmoscope, 90D, and 20D lenses. Much of what I need to see can be accomplished with these items.

 

[ckyuen]

I agree I think that buying your own opthalmoscope or panoptic is probably an overkill. You can usually find a direct hanging on the walls or there's one at the nurses station. That being said if you have a interest in examining the fundus routinely and are not an opthalmologist you may want to invest in a panoptic. At our hospital there is a medicine attending who makes his residents do dfe's on all their diabetics they admit, and they can accurately describe the fundus. Also if you are a neurologist and do many fundus exams it is probably worth it. You may want to look on ebay as I'm sure there are many students who bought a panoptic only to have it collect dust. The field of view is much larger, and the magnification is less than with a direct. With a direct viewing an emmetrope's eye you get about 15 x magnification ie the optic nerve appears 2.2 cm across. which means it will take you forever and a day to examine the fundus.