Limits...
The fundus slit lamp.

Gellrich MM - Springerplus (2015)

Bottom Line: The three lenses +90/+60/+40D are a good choice for imaging the whole spectrum of retinal diseases.A reconstruction of larger fundus areas is feasible for imaging in vitreoretinal surgery or occlusive vessel disease.Even a basic fundus controlled perimetry is possible.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmological practice, Ziegeleiweg 10, 25548 Kellinghusen, Germany.

ABSTRACT
Fundus biomicroscopy with the slit lamp as it is practiced widely nowadays was not established until the 1980-es with the introduction of the Volk lenses +90 and +60D. Thereafter little progress has been made in retinal imaging with the slit lamp. It is the aim of this paper to fully exploit the potential of a video slit lamp for fundus documentation by using easily accessible additions. Suitable still images are easily retrieved from videorecordings of slit lamp examinations. The effects of changements in the slit lamp itself (slit beam and apertures) and its examination equipment (converging lenses from +40 to +90D) on quality and spectrum of fundus images are demonstrated. Imaging software is applied for reconstruction of larger fundus areas in a mosaic pattern (Hugin®) and to perform the flicker test in order to visualize changes in the same fundus area at different points of time (Power Point®). The three lenses +90/+60/+40D are a good choice for imaging the whole spectrum of retinal diseases. Displacement of the oblique slit light can be used to assess changes in the surface profile of the inner retina which occurs e.g. in macular holes or pigment epithelial detachment. The mosaic function in its easiest form (one strip macula adapted to one strip with the optic disc) provides an overview of the posterior pole comparable to a fundus camera's image. A reconstruction of larger fundus areas is feasible for imaging in vitreoretinal surgery or occlusive vessel disease. The flicker test is a fine tool for monitoring progressive glaucoma by changes in the optic disc, and it is also a valuable diagnostic tool in macular disease. Nearly all retinal diseases can be imaged with the slit lamp - irrespective whether they affect the posterior pole, mainly the optic nerve or the macula, the whole retina or only its periphery. Even a basic fundus controlled perimetry is possible. Therefore fundus videography with the slit lamp is a worthwhile approach especially for the many ophthalmologists without access to the most recent diagnostic equipment or a professional photographer at hand.

No MeSH data available.


Related in: MedlinePlus

Slow progression of dry macular degeneration, sudden subretinal hemorrhage after 7½ years and subsequent scarring - documented with the slit lamp using a +90D lens at 20× magnification (dates given yy-mm-dd). Despite initiation of VEGF-inhibitor treatment (bottom, middle) soon afterwards massive subretinal bleeding occurred. Each picture composite is created from two individual video images by the program Hugin®. Changes between individual images are quite obvious, but alignment with PowerPoint® enables accurate comparison by flicking between consecutive foils. In this case all clinical decisions in 8½ years follow up can be adequately based on the slit lamp documentation.
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Fig10: Slow progression of dry macular degeneration, sudden subretinal hemorrhage after 7½ years and subsequent scarring - documented with the slit lamp using a +90D lens at 20× magnification (dates given yy-mm-dd). Despite initiation of VEGF-inhibitor treatment (bottom, middle) soon afterwards massive subretinal bleeding occurred. Each picture composite is created from two individual video images by the program Hugin®. Changes between individual images are quite obvious, but alignment with PowerPoint® enables accurate comparison by flicking between consecutive foils. In this case all clinical decisions in 8½ years follow up can be adequately based on the slit lamp documentation.

Mentions: As its name tells us, only a part of the fundus can be captured in one image with the slit lamp. There are programs available (such as Hugin®) that enable us to geometrically reconstruct a larger fundus area by creating a mosaic. For effective clinical use we advise to make the patient gaze in consecutive directions in a structured manner (Gellrich 2009b). In general this is done in the same way as during a normal clinical fundus examination with the slit lamp. Sufficient (usually approximately 2°) overlap between adjacent fundus segments is necessary, however, so that they can later be stitched together digitally (Figures 7, 8, 9, 10).Figure 7


The fundus slit lamp.

Gellrich MM - Springerplus (2015)

Slow progression of dry macular degeneration, sudden subretinal hemorrhage after 7½ years and subsequent scarring - documented with the slit lamp using a +90D lens at 20× magnification (dates given yy-mm-dd). Despite initiation of VEGF-inhibitor treatment (bottom, middle) soon afterwards massive subretinal bleeding occurred. Each picture composite is created from two individual video images by the program Hugin®. Changes between individual images are quite obvious, but alignment with PowerPoint® enables accurate comparison by flicking between consecutive foils. In this case all clinical decisions in 8½ years follow up can be adequately based on the slit lamp documentation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401483&req=5

Fig10: Slow progression of dry macular degeneration, sudden subretinal hemorrhage after 7½ years and subsequent scarring - documented with the slit lamp using a +90D lens at 20× magnification (dates given yy-mm-dd). Despite initiation of VEGF-inhibitor treatment (bottom, middle) soon afterwards massive subretinal bleeding occurred. Each picture composite is created from two individual video images by the program Hugin®. Changes between individual images are quite obvious, but alignment with PowerPoint® enables accurate comparison by flicking between consecutive foils. In this case all clinical decisions in 8½ years follow up can be adequately based on the slit lamp documentation.
Mentions: As its name tells us, only a part of the fundus can be captured in one image with the slit lamp. There are programs available (such as Hugin®) that enable us to geometrically reconstruct a larger fundus area by creating a mosaic. For effective clinical use we advise to make the patient gaze in consecutive directions in a structured manner (Gellrich 2009b). In general this is done in the same way as during a normal clinical fundus examination with the slit lamp. Sufficient (usually approximately 2°) overlap between adjacent fundus segments is necessary, however, so that they can later be stitched together digitally (Figures 7, 8, 9, 10).Figure 7

Bottom Line: The three lenses +90/+60/+40D are a good choice for imaging the whole spectrum of retinal diseases.A reconstruction of larger fundus areas is feasible for imaging in vitreoretinal surgery or occlusive vessel disease.Even a basic fundus controlled perimetry is possible.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmological practice, Ziegeleiweg 10, 25548 Kellinghusen, Germany.

ABSTRACT
Fundus biomicroscopy with the slit lamp as it is practiced widely nowadays was not established until the 1980-es with the introduction of the Volk lenses +90 and +60D. Thereafter little progress has been made in retinal imaging with the slit lamp. It is the aim of this paper to fully exploit the potential of a video slit lamp for fundus documentation by using easily accessible additions. Suitable still images are easily retrieved from videorecordings of slit lamp examinations. The effects of changements in the slit lamp itself (slit beam and apertures) and its examination equipment (converging lenses from +40 to +90D) on quality and spectrum of fundus images are demonstrated. Imaging software is applied for reconstruction of larger fundus areas in a mosaic pattern (Hugin®) and to perform the flicker test in order to visualize changes in the same fundus area at different points of time (Power Point®). The three lenses +90/+60/+40D are a good choice for imaging the whole spectrum of retinal diseases. Displacement of the oblique slit light can be used to assess changes in the surface profile of the inner retina which occurs e.g. in macular holes or pigment epithelial detachment. The mosaic function in its easiest form (one strip macula adapted to one strip with the optic disc) provides an overview of the posterior pole comparable to a fundus camera's image. A reconstruction of larger fundus areas is feasible for imaging in vitreoretinal surgery or occlusive vessel disease. The flicker test is a fine tool for monitoring progressive glaucoma by changes in the optic disc, and it is also a valuable diagnostic tool in macular disease. Nearly all retinal diseases can be imaged with the slit lamp - irrespective whether they affect the posterior pole, mainly the optic nerve or the macula, the whole retina or only its periphery. Even a basic fundus controlled perimetry is possible. Therefore fundus videography with the slit lamp is a worthwhile approach especially for the many ophthalmologists without access to the most recent diagnostic equipment or a professional photographer at hand.

No MeSH data available.


Related in: MedlinePlus