Abstract
Fundus biomicroscopy with the slit lamp as it is practiced widely nowadays was not established until the 1980-es with the introduction of the Volk lenses +90 and +60D. Thereafter little progress has been made in retinal imaging with the slit lamp. It is the aim of this paper to fully exploit the potential of a video slit lamp for fundus documentation by using easily accessible additions.Suitable still images are easily retrieved from videorecordings of slit lamp examinations. The effects of changements in the slit lamp itself (slit beam and apertures) and its examination equipment (converging lenses from +40 to +90D) on quality and spectrum of fundus images are demonstrated. Imaging software is applied for reconstruction of larger fundus areas in a mosaic pattern (Hugin®) and to perform the flicker test in order to visualize changes in the same fundus area at different points of time (Power Point®).The three lenses +90/+60/+40D are a good choice for imaging the whole spectrum of retinal diseases. Displacement of the oblique slit light can be used to assess changes in the surface profile of the inner retina which occurs e.g. in macular holes or pigment epithelial detachment. The mosaic function in its easiest form (one strip macula adapted to one strip with the optic disc) provides an overview of the posterior pole comparable to a fundus camera’s image. A reconstruction of larger fundus areas is feasible for imaging in vitreoretinal surgery or occlusive vessel disease. The flicker test is a fine tool for monitoring progressive glaucoma by changes in the optic disc, and it is also a valuable diagnostic tool in macular disease.Nearly all retinal diseases can be imaged with the slit lamp - irrespective whether they affect the posterior pole, mainly the optic nerve or the macula, the whole retina or only its periphery. Even a basic fundus controlled perimetry is possible. Therefore fundus videography with the slit lamp is a worthwhile approach especially for the many ophthalmologists without access to the most recent diagnostic equipment or a professional photographer at hand.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0838-5) contains supplementary material, which is available to authorized users.
Highlights
Biomicroscopy of the fundus with the slit lamp is the result of melding the two most important examination techniques in clinical ophthalmology, namely biomicroscopy with the slit lamp and fundoscopy
Till the introduction of the Volk lenses the concept of concave lenses for fundus observation with the slit lamp had been pursued (Littmann 1950b), which had been introduced by Leonhard Koeppe with a contact lens (Koeppe 1918) and Karl Hruby through a hand held lens (Hruby 1941; Hruby 1950)
The shape of the projected “slit” in the slit lamp is determined by the superposition of two aperture systems: 4 circular apertures and a crescent-shaped aperture located on a rotatable aperture plate for its basic shape (Zeiss type SL 105, Figure 1) and another “curtain-like” aperture which determines the width of the slit
Summary
Biomicroscopy of the fundus with the slit lamp is the result of melding the two most important examination techniques in clinical ophthalmology, namely biomicroscopy with the slit lamp and fundoscopy. Speaking, fundoscopy is the older examination technique, dating back to 1851 (Helmholtz 1909), while the slit lamp was introduced by Allvar Gullstrand in 1911 (Gullstrand 1911). It lasted several more decades until with the introduction of the +90 and +60D Volk lenses in the 1980-ies clinical biomicroscopy of the fundus gained its present form (Lundberg 1985; Volk 1986). This is even more astonishing as two important preconditions had been avaible. Its disadvantages are the small area of visible retina, the need of touching the cornea and dilating the pupils
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