6 min read
A systematic approach to the fundus
A repeatable search pattern for colour fundus photographs, so nothing is missed.
Learning objectives
- Adopt a fixed order for examining every fundus photo.
- Recognize the normal appearance of the disc, vessels, macula, and periphery.
- Flag the common abnormalities at each step.
1. Optic disc
Assess colour, margins, and the cup-to-disc ratio. Look for pallor, swelling, haemorrhage, and new vessels at the disc (NVD).
2. Vessels
Follow the arcades out from the disc. Note arteriovenous ratio, nicking, tortuosity, emboli, sheathing, and neovascularization elsewhere (NVE).
3. Macula
Inspect the fovea and surrounding retina for drusen, exudates, haemorrhage, oedema, pigment change, and a foveal light reflex.
4. Periphery
Sweep the four quadrants for tears, detachment, lattice, pigmentary change, and peripheral haemorrhage or exudate.
Pearls
- Always compare the two eyes — asymmetry is a powerful clue.
- Media opacity (cataract, vitreous haemorrhage) degrades the view; note it before calling a finding subtle.