18 Posterior Segment

We know that you’ve had limited exposure to posterior segment disease in V680.  As a result, we’ll mostly ask you to describe lesions that you find in the posterior segment, and to venture a guess as to what they are.  You can describe lesions by specifying size, color, elevation, location using clock positions for peripheral findings (black and white scar @ 6; 1/2 disc diameter in size, flat) or anatomical location in posterior pole (single yellow deposit superior to macula within arcades).  However, as you progress from V786 to V789, we expect that you become more proficient in posterior segment findings and management.

Clean your lenses

A 20D or 78D/90D lens with dust or fingerprints can significantly reduce your view of the retina as both reflect light back at you.  Keep your lenses clean for the best examination experience.

Squinting Patient

If a patient has difficulty keeping their eyes open during the retinal examination, consider the following:

1. Turn down the light intensity.  Use the minimum intensity that gives you the maximum view.
2. Learn to hold patient eyelids open.
3. Use a 3-mirror flanged gonioscopy lens to keep lids open.  Examine the posterior pole with the central Hruby lens and the rectangular and trapezoidal mirrors to view the peripheral retina.