Diagnostic Procedures in Opthalmology

1. ASSESSMENT OF VISUAL ACUITY 1
 Nitin Nema
History 1
Principle 1
Recording of distant visual acuity 2
Bailey-Lovie chart 2
Normal vision 3
Near visual acuity 4
Factors affecting visual acuity 4
Visual acuity assessment in infants and children 7
Procedure for testing visual acuity 9
Near vision in children 10
2. COLOR VISION AND COLOR BLINDNESS 11
 Harinder Singh Sethi
Color vision 11
Factors affecting color vision 11
Illumination 12
Theories of color vision 12
Anatomy of color vision 13
Anomalies of color vision 14
Color vision testing 16
Other tests 23
3. SLIT-LAMP EXAMINATION 26
Arulmozhi Verman
History of slit-lamp development 26
Types of illumination used in slit–lamp examination 27
Gonioscopy 34
4. CORNEAL TOPOGRAPHY 38
Francisco Arnalich, David Piñero, Jorge L Alió
History of corneal measurement 38
Shape of the normal cornea 39
Fundamentals and technological approaches to corneal topography 40
How to interpret a corneal topography map 42
A good topography examination 45
Quantitative descriptors of corneal topography: corneal indexes 46
Corneal aberrometry: fundamentals and clinical applications 48
Clinical uses of corneal topography 51
xviii Diagnostic Procedures in Ophthalmology
5. CORNEAL CONFOCAL MICROSCOPY 60 Manotosh Ray
Optics 60
Confocal microscopy in corneal pathologies 63
6. TONOMETRY 69 Shefali Parikh, Rajul Parikh
What is intraocular pressure? 69
7. GONIOSCOPY 77 Ronnie Jacob George, A Parivadhini, A Narayanaswamy, L Vijaya
Optical principles 77
8. OPTIC DISC ASSESSMENT IN GLAUCOMA 87 Nikhil S Choudhari, G Chandra Sekhar
Methods of optic disc examination 87
Features of glaucomatous disc damage 87
9. PERIMETRY 96 Devindra Sood, NR Rangaraj
Evolution of octopus perimeter 96
Basic terminologies in perimetry 98
Measurement strategies 99
Humphrey visual field analyzer 102
Humphrey field analyzer 109
10. IMAGING IN GLAUCOMA 118 Rajul Parikh, Shefali Parikh
Heidelberg retinal tomogram (HRT II
/HRT III) 118
Scanning laser polarimetry 123
Optical coherence tomography 124
11. OPHTHALMOSCOPY 129 Pukhraj Rishi, Tarun Sharma
Principles of ophthalmoscopy 129
Indirect ophthalmoscopy 129
Head mounted binocular indirect ophthalmoscopy 130
Monocular indirect ophthalmoscopy 134
Modified monocular indirect ophthalmoscopy 135
Penlight ophthalmoscopy 136
Direct ophthalmoscopy 136
Hruby lens direct ophthalmoscopy 137
Wide angle viewing system 137
12. OPHTHALMIC PHOTOGRAPHY 140 Sadao Kanagami
35-mm camera 140
Fundus camera 140
Photo slit-lamp (Kowa attachment) 142
Photography in operating theater 143
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Specular microscopy 143
Imaging system 143
Photography of face and skin 145
Photography of pupil 145
External photography 146
Optical system of fundus camera 147
Fundus photography 147
Fluorescein angiography 148
Monochromatic fundus photography 150
Photo slit-lamp biomicrography of anterior segment 151
13. FLUORESCEIN ANGIOGRAPHY 152
R Kim, S Manoj
History 152
Basic principles 152
Properties of sodium fluorescein 152
Technique and equipment 153
Digital angiography 153
Procedure for fundus fluorescein angiography 154
Stereophotography 155
Side effects and complications 155
Basic anatomic considerations 156
Normal fundus fluorescein angiography 156
Abnormal fluorescence angiography 158
Iris fluorescein angiography 165
14. INDOC YANINE GREEN ANGIOGRAPHY 167
Vasumathy Vedantham
Indocyanine green angiography vs fluorescein angiography 167
Indocyanine green 167
15. A-SCAN ULTRASONOGRAPHY 179
Rajiv Nath, Tinku Bali, Monica Saha
History 179
Physics of ultrasound 179
Instrumentation 180
Vector A-scan display 181
Basic screening examination 181
A-scan in common ocular pathologies 184
Biometry 189
Biometry in ocular pathologies 191
Limitations and pitfalls of A-scan 191
16. B-SCAN ULTRASONOGRAPHY 195
Taraprasad Das, Vasumathy Vedantham, Anjali Hussain, Sanghamitra Kanungo, LS Mohan Ram
Physics and basic technology 195
Ultrasound unit 195
Screening techniques 196
Structural anomalies 207
Immersion B-scan 208
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17. ULTRASOUND BIOMICROSCOPY 211
Muna Bhende, Vanuli Bajpai
Basic physics 211
Instrumentation 211
Technique 211
18. ELECTROPHYSIOLOGICAL TESTS FOR VISUAL FUNCTION ASSESSMENT 218
Subhadra Jalali, LS Mohan Ram, Garima Tyagi, Kallakuri Sumasri
Visual electrophysiology tests 218
Electro-oculogram 219
Electroretinogram 221
19. PENTACAM 251
Rohit Shetty, Ashwin Shetty
Output 252
Topography 253
20. ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY 263
R Ramakrishnan, Arijit Mitra
Principle of optical coherence tomography 263
Measurement tools 265
21. SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY 280
Sripathi Kamath, Rajeev R Pappuru
Spectral domain optical coherence tomography vIz time
domain optical coherence tomography 289
22. INTRAOCULAR LENS POWER CALCULATION 291
Himanshu Shekhar, Rajesh Sinha, Jeewan S Titiyal
Intraocular lens power formulas 291
Optical biometry 295
Intraocular lens power calculation in special situations 296
23. DIAGNOSTIC PROCEDURES IN INFECTIOUS KERATITIS 299
Savitri Sharma, Sreedharan Athmanathan
Corneal confocal microscopy 299
Molecular methods 308
Protocol for viral keratitis 308
24. DIAGNOSTIC PROCEDURES IN UVEITIS 314
Jyotirmay Biswas, Reesha KR
Anterior chamber paracentesis 314
Vitreous tap and diagnostic vitrectomy 316
Vitrectomy 317
Handling and testing of aqueous and vitreous specimen 317
25. RETINOPATHY OF PREMATURITY: DIAGNOSTIC PROCEDURES 321
Yog Raj Sharma, Parijat Chandra, Rajni Sharma, Raj Vardhan Azad
Etiology 321
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International classification of retinopathy of prematurity 321
Fluorescein angiography 324
Ultrasound biomicroscopy 325
Ultrasonography 326
26. LOCALIZATION OF INTRAOCULAR FOREIGN BODY 328
Amit Nagpal, Lingam Gopal
Types of intraocular foreign bodies 328
Ultrasound biomicroscopy 330
27. CONCOMITANT STRABISMUS: DIAGNOSTIC METHODS 333
Digvijay Singh, Harinder Singh Sethi, Pradeep Sharma
Diagnostic method 333
Qualitative tests 334
Quantitative tests 335
28. INCOMITANT STRABISMUS: DIAGNOSTIC PROCEDURES 343
P Vijayalakshmi, P Vrushali, R Muralidhar
Paralytic strabismus 343
Restrictive strabismus 355
29. DIAGNOSTIC PROCEDURES IN DRY EYE DISEASE 360
Jayesh Vazirani, Virender Sangwan
Definition 360
Dry eye diagnosis 360
Slit-lamp examination 360
39. EVALUATION OF EPIPHORA 364
AK Grover, Rituraj Baruah, Shaloo Bageja
Applied anatomy and physiology of the lacrimal apparatus 364
Tear secretion and elimination 366
Evaluation of epiphora 366
31. DIAGNOSTIC TECHNIQUES IN PROPTOSIS 376
Mandeep S Bajaj, Sanjiv Gupta
Diagnostic techniques 377
Imaging techniques 377
Blood tests 383
Biopsy techniques 384
Pathology techniques 385
Additional investigations 386
32. DIAGNOSTIC PROCEDURES FOR GENETICALLY TRANSMITTED EYE DISEASES 388
Sudha Dhandayuthapani, Sarangapani Sripriya, Nagasamy Soumittra, Jayamuruga Pandian Arunachalam
DNA-based gene screening (or) molecular diagnostics 388
Chromosomal study/cytogenetics 396
Genetic counseling 399
Quality management in a genetic laboratory 401
Safety in a genetic laboratory 401
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33. DIAGNOSTIC MODALITIES IN INTRAOCULAR MALIGNANCIES 404
Mohammad Javed Ali, Sneha Jay Shah, Santosh G Honavar
Ultrasonography 404
Fundus fluorescein and indocyanine green angiography 406
Computed tomography 407
Magnetic resonance imaging 409
Fine needle aspiration biopsy/cytology (FNAB/FNAC) 410
34. PUPIL 413
Navin Jayakumar
Functional anatomy and physiology of the pupil reflexes 413
Principles and techniques of pupil examination 416
Disorders of pupil function 423
35. PTOSIS EVALUATION 432
AK Grover, Shaloo Bageja
Classification 432
Clinical evaluation 432
Laboratory studies 438
36. OCULAR MOTOR NERVE PALSIES 440
Shivcharan L Chandravanshi, Nitin Nema
Oculomotor nerve palsy 440
Trochlear nerve palsy 443
Abducens nerve palsy 446