Year : 2016 | Volume
: 9 | Issue : 2 | Page : 79-
Imaging in ophthalmology and need for slit-lamp and ophthalmoscopy examinations
Professor Emeritus, Ludwig-Maximilians-Universität, München, München, Germany
Augenzentrum Brienner Hof, Briennerstrasse 12, D-80333 München
|How to cite this article:|
Kampik A. Imaging in ophthalmology and need for slit-lamp and ophthalmoscopy examinations.Oman J Ophthalmol 2016;9:79-79
|How to cite this URL:|
Kampik A. Imaging in ophthalmology and need for slit-lamp and ophthalmoscopy examinations. Oman J Ophthalmol [serial online] 2016 [cited 2020 May 26 ];9:79-79
Available from: http://www.ojoonline.org/text.asp?2016/9/2/79/184508
More than a century ago, Helmholtz invented the ophthalmoscope. The slit-lamp microscope gained wide-spread use and both of these examining modalities led ophthalmology to become a discipline in which exact diagnosis was possible. In addition to this, morphology-related research helped to understand disease processes and to decide on our therapeutic actions on the basis of a sound understanding of the findings of the anterior and the posterior segment of the eye. Thus, we could judge the condition of an eye in health and disease by rather simple "looking" into the eye.
During decades, the sequence of examining an eye was first to find the best-corrected vision, and then to look at the slit-lamp microscope, including taking the pressure of the eye and to perform an ophthalmoscopy to judge the entire retina including the macular area and the periphery of the retina up to the ora serrata. Every person who wanted to be an ophthalmologist had to be trained thoroughly to be very good in these examining techniques. This was the basis of an ophthalmologists judgment whether or not therapeutic action has to be taken.
More refined additional examining techniques such as ultrasound examination of the eye or fluorescein angiography were added but did not replace the primary examination of an eye. The added value of these "new" diagnostic modalities was important and advanced the field of ophthalmology, especially in retina. However, the ophthalmologist always had to make the findings plausible in view of the findings of the conventional examination of the eye.
During the last decade or so there has been a tremendous growth in the electronic acquisition of pictures of the anterior segment of the eye and even more so of the retina, especially the macula. Today, almost every part of the eye can be imaged electronically. The most recent advance is the measurement of flow in the retinal and choroidal vessels without using a dye as it was necessary in fluorescein angiography. Thus, we can acquire, within seconds by optical coherence tomography, the picture of an angiogram in an en face reconstruction. These pictures need to be interpreted and we all as ophthalmologist have to learn to interpret all the beautiful pictures and to learn more in a similar way as we did as fluorescein angiography was introduced.
What does this mean for our daily practice? I am often confronted with printouts of many beautiful pictures giving more or less perfect details of an eye but not allowing a precise diagnosis. What is mostly missing is an overall view of all the findings of the eye we used to obtain by simple slit-lamp or ophthalmoscopy examination. We do need the conventional examination to make the new images plausible by putting them into a context of the general condition of both eyes. Thus, we still do need our old examining techniques and we must not forget to teach them in our training programs and use them in our daily practice to keep ophthalmology a sound discipline.