Pre PACES Podcast #40 Fundoscopy
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Jul 31, 2022 Mr Steve Lash, consultant ophthalmic surgeon with prior optometry training and a retinovitreal fellowship, walks through fundoscopy and approaches to gradual visual loss. Short, focused segments cover cataracts, glaucoma, AMD, diabetic retinopathy, retinitis pigmentosa and practical fundoscopy exam tips. The show also dives into sports psychology for performance under pressure.
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Always Ask About Pain With Visual Loss
- Ask whether visual loss is painful or painless because pain points to corneal ulcer, angle-closure glaucoma, or giant cell arteritis whereas most retinal and lens causes are painless.
- Look for contact lens use, nausea/vomiting and a mid-dilated pupil for angle closure, and temporal headache or jaw claudication for giant cell arteritis.
Start By Asking One Eye Or Both
- Do note whether vision loss affects one eye or both to steer differential: one eye suggests ocular causes (cataract, AMD), both eyes suggest post-chiasmal or neurological causes.
- Use this early distinction to decide whether to perform confrontation fields or focus on fundoscopy.
Cataract Types Explain Symptom Patterns
- Cataract is clouding of the lens with patterns (nuclear, cortical, posterior subcapsular) that determine symptoms like glare and rapid progression.
- Surgery peels the capsule and replaces the lens with an intraocular implant; recovery is rapid and infection risk ~1/2000.