In this material we will talk about how the fundus of the eye is checked, why this procedure is performed, to whom it is indicated, what limitations and contraindications there are. Do not forget that before conducting any research, a face-to-face consultation with a doctor is necessary, since the information on the Internet is for informational purposes only.

Why is an inspection needed?

In medicine, checking the fundus of the eye is called ophthalmoscopy. Why is it needed? This examination allows you to accurately assess the condition of the retina and its individual structures: disc, macula area, choroid, and so on. Doctors say that during ophthalmoscopy one can “see” the vast majority of eye diseases and pathologies, while the procedure itself is neither long nor painful, requires minimal preparation and is practically safe, therefore it is prescribed even to premature babies and expectant mothers.

Preparation for fundus examination

Before the test, the doctor will drop special medications into the patient's eyes to dilate the pupil. As a rule, this is a 1% solution of tropicamide or a 0.5% solution of cyclopentolate (Midriacyl, Irifrin, Atropine and others).

A contraindication to the use of such drugs is a tendency to, if you know about this feature of your body, do not forget to tell the doctor about it.

No other special preparation is required for the examination. If you wear glasses, you must remove them before the examination. It is believed that there is no need to remove contact lenses, but it is worth checking this point with the doctor who will conduct the study.

How is ophthalmoscopy performed?

Ophthalmoscopy can be direct or reverse. In both cases, a special device is used - an ophthalmoscope, which can be conventional (mirror) or electronic. A conventional device allows the doctor to see the fundus of the eye, and an electronic device will also photograph all changes and save the picture for further analysis.

The most modern and accurate research method is laser ophthalmoscopy. Also, during the procedure, various magnifying glasses and other devices are used.

The examination is carried out in a dark room. The doctor shines a directed beam of light into the patient's eye, first from a short distance, then the device is brought closer and closer to the eye. The specialist may ask you to look around, at the tip of your nose, towards your temple. This is necessary so that the doctor has the opportunity to see the entire fundus, vitreous body and lens.

The fundus examination lasts about 5-10 minutes. In one session, both eyes are checked at once, even if the patient believes that they see exactly the same.

During the examination, the doctor examines the area of ​​the optic nerve head (normally it should be round or oval in shape, have clear contours and a pale pink color). The central region of the retina is also checked, its. In the center of the fundus of the eye is the macula (the so-called “yellow spot”), which looks like a red oval bordered by a light stripe (called the macular reflex). During ophthalmoscopy, when a directed beam of light passes to the bottom of the eye, the pupil will turn red (and this is normal), and any focal opacities will be visible against this bright background.

Who needs to check the fundus and when?

There are quite a lot of indications for this procedure. Fundus examinations are carried out even during routine medical examinations of workers. But there are conditions and diseases for which you simply cannot do without ophthalmoscopy:

• for atherosclerosis and hypertension;
• for cataracts, regardless of its cause;
• with diabetes, which can lead to the development of diabetic retinopathy;
• during pregnancy, since during childbirth there is a possibility of retinal detachment - timely detected disorders are an indication for or replacement of the pushing period with a cesarean section;
• with increased intracranial pressure;
• after a stroke;
• with osteochondrosis;
• it is mandatory to check the eyes of children born prematurely so as not to miss the development of retinopathy of prematurity;
• with diagnosed retinal dystrophy and any other visual impairments;
• with night blindness syndrome, when vision deteriorates in low light conditions;
• for color vision disorders.

This is not a complete list of reasons for examining the fundus. Even if you are not familiar with any of these problems, it is worth remembering that for adults it is considered mandatory to have their eyes checked once a year. The child should be shown to an ophthalmologist and have the fundus checked (even in the absence of complaints) at 3 months, at 4 years, and before school, at 5-6 years. Schoolchildren undergo medical examinations according to a separate schedule, and if their vision is normal, then these medical examinations will be quite sufficient.

Precautionary measures

As already mentioned, fundus examination is a safe diagnostic method. But there are a few points worth remembering.

1. if you were given drops before the procedure, this leads to temporary disturbances in focusing your vision, so it is strictly not recommended to drive for 2-3 hours until your eyes return to normal;
2. don’t try to specifically focus your gaze while the drops are working - you won’t be able to do it anyway, but your eyes may hurt
   from the bright light of the ophthalmoscope after the procedure, various spots may appear before the eyes, which will go away in half an hour or a little more;
3. When going out into bright light after an ophthalmoscopy, wear sunglasses, as bright lighting in the first hours can cause pain and discomfort in the eyes.

Contraindications

1. Fundus examination is usually not carried out in diseases accompanied by photophobia and lacrimation - such symptoms significantly complicate diagnosis and make the study virtually useless.
2. This examination method will not bring any effect to people with diarrhea who hardly dilate, even with medication.
3. Insufficiently transparent vitreous body and lens can also make the examination difficult or impossible.
4. Sometimes ophthalmoscopy is contraindicated for people with cardiovascular diseases; a therapist or cardiologist will tell the patient about this limitation.

Ophthalmoscopy is one of the main objective and most important methods for studying the inner membranes of the eye. The method was discovered and put into practice by Hermann von Helmholtz in 1850 on the basis of the eye mirror he developed - the ophthalmoscope. Over the 150 years of its existence, the ophthalmoscopy method has significantly improved and is currently one of the main ways to study the internal environments of the eye and fundus.
The technique of ophthalmoscopic examination of the fundus is mastered during the practical work of a doctor; it is described in detail in manuals on ophthalmology and textbooks on eye diseases. In this regard, there is no need to describe it in detail here.
The fundus consists of several layers, very different in color and transparency. The bottom of the eye is formed by: white sclera, dark red choroid, thin, light-retaining retinal pigment epithelium, transparent retina with the vascular network of the central artery and central retinal vein. The color of the fundus is made up of shades of light rays. A normal retina, when examined in white light, almost does not reflect light rays, remains transparent and practically invisible. All these different structures of the inner membranes of the eye and the optic nerve head make a certain contribution to the formation of the ophthalmoscopic picture of the fundus, which, depending on the many elements composing it, varies significantly in normal conditions and, especially, in pathology. In this regard, during ophthalmoscopy it is necessary to resort to different types of lighting, use different magnifications, and examine the patient not only with a narrow, but also with a medically dilated pupil (caution if the patient has glaucoma).
The fundus examination should be carried out according to a specific plan: first, examination of the optic disc region, then the macular region of the retina, and, finally, the peripheral parts of the fundus. It is advisable to examine the macular area and the periphery of the fundus with a wide pupil. The study involves searching for pathological changes in the fundus, studying the structure of detected lesions, their localization, and measuring area, distance and depth. After this, the doctor gives a clinical interpretation of the changes found, which allows, in combination with data from other studies, to clarify the diagnosis of the disease.
The examination of the fundus is carried out using special devices - ophthalmoscopes, which can be of varying complexity, but work on the same principle. A clear image of the inner membranes of the eye (fundus) is obtained only by combining the line of illumination of the fundus with the visual line of the observer or the lens of a photo and television camera.
Instruments for examining the fundus of the eye can be divided into simple (mirror) ophthalmoscopes and electric ophthalmoscopes (hand-held and stationary). There are two methods of ophthalmoscopy: reverse ophthalmoscopy and direct ophthalmoscopy.

Reverse ophthalmoscopy

When working with a mirror ophthalmoscope, an external light source is required (100-150 W table lamp with a frosted glass bulb). When examining the fundus using a mirror ophthalmoscope and a magnifying glass, the doctor sees a virtual image of the fundus area in an enlarged and reverse view. With ophthalmoscopy with a magnifying glass of +13.0 diopters, the degree of magnification of the area of ​​the fundus under consideration (about 5 times) is greater than with a magnifying glass of +20.0 diopters, but the area under consideration is smaller. Therefore, for a more detailed examination of the fundus, a magnifying glass of +13.0 or +8.0 diopters is used, and for general ophthalmoscopy, a magnifying glass of +20.0 diopters can be used.

Direct ophthalmoscopy

Using an electric ophthalmoscope, it is possible to examine the fundus directly (without a magnifying glass). In this case, the structures of the fundus are visible in direct and enlarged (about 14-16 times) form.
Electric ophthalmoscopes have their own illuminator, powered either from an electrical network through a transformer or from portable batteries. Electric ophthalmoscopes have disks or tapes with corrective lenses, color filters (red, green, blue), a device for slit illumination and transillumination (diaphanoscopy) of the eye.
Ophthalmoscopic picture of a normal fundus (examination in white achromatic light)
When performing fundus ophthalmoscopy, as mentioned above, attention should be paid to the optic disc, retinal blood vessels, macular area and, as far as possible, to the peripheral parts of the fundus.
The outer (temporal) half of the disc appears lighter than the inner (nasal) half. This is due to the fact that the nasal half of the disc contains a more massive bundle of nerve fibers and is better supplied with blood than the temporal half of the disc, where the layer of nerve fibers is thinner and the whitish tissue of the cribriform plate is visible through them. The temporal edge of the disc is more sharply outlined than the nasal edge.
The normal color variability of the optic nerve head should be distinguished from its pathological changes. A paler color of the temporal half of the disc does not mean the development of atrophy of the nerve fibers of the optic nerve. The intensity of the pink color of the disc depends on the pigmentation of the fundus, which is typical for blondes, brunettes, and brown-haired people.
The optic disc is usually round in shape or, less commonly, in the form of a vertical oval. The normal horizontal size of the disc is 1.5-1.7 mm. With ophthalmoscopy, its size appears significantly larger due to image magnification.
In comparison with the general level of the fundus, the optic nerve disc can be located with its entire plane at the level of the fundus or have a funnel-shaped depression in the center. The depression (physiological excavation) is formed due to the bending of nerve fibers from retinal ganglion cells at the edge of the scleral-choroidal canal. In the area of ​​excavation, the whitish tissue of the cribriform plate of the sclera is visible, so the bottom of the excavation looks especially light. The physiological excavation is usually located in the center of the disc, but sometimes moves to the temporal edge, and therefore has a paracentral location. Physiological excavation differs from pathological (for example, glaucomatous) by two main features: shallow depth (less than 1 mm) and the obligatory presence of a rim of normally colored disc tissue between the edge of the disc and the edge of the excavation. The ratio of the size of physiological excavation to the size of the disc can be expressed as a decimal fraction: 0.2-0.3.
With a stagnant disc, on the contrary, swelling and protrusion of disc tissue into the vitreous are observed, which is the main symptom of intracranial hypertension, often caused by brain tumors. The color of the disc becomes greyish. Phenomena of pronounced venous stagnation are noted.
During an ophthalmoscopic examination of the fundus, after examining the area of ​​the optic nerve head, attention is paid to the state of the retinal vasculature. The vascular network of the fundus is represented by the central artery and central vein of the retina. The central retinal artery emerges from the middle of the disk or slightly inward, which is accompanied by the central retinal vein entering the disk. Retinal arteries are noticeably different from veins. Arteries are thinner than veins, lighter in color and less tortuous. The calibers of arteries in relation to veins are related as 3:4 or 2:3. Larger arteries and veins have vascular reflexes, which are formed due to the reflection of light from a column of blood in the vessel. Often, a venous pulse is normally observed in the disc area.
It should be taken into account that the fundus of the eye is the only place in the human body where ophthalmoscopically one can directly observe the state of the vessels and their changes, both arteries and veins, not only in case of eye pathology, but also in general diseases of the body (hypertension, endocrine pathology, blood diseases, etc.). Pathology of the vascular system is accompanied by the appearance of a number of symptoms: copper wire symptom, silver wire symptom, Gwist symptom, Hun-Salus symptom, etc.
The size of the macula in an adult varies significantly; the large horizontal diameter can usually range from 0.6 to 2.5 mm.
It is better to examine the periphery of the fundus with a dilated pupil. With a high pigment content, the fundus of the eye appears dark (parquet fundus), and with a low pigment content, it appears light (albino fundus).

Ophthalmoscopic picture of the fundus in pathological conditions

In pathology, various changes in the fundus of the eye are noted. These changes can involve retinal tissue, the choroid, optic nerve head, and retinal vessels. According to the genesis, changes can be inflammatory, dystrophic, tumor, etc. In the clinic, qualitative and quantitative assessment of ophthalmoscopically visible changes in the fundus of the eye is very important, and the completeness of the examination and assessment of the condition largely depend on the qualifications of the doctor and the device with which the study is carried out.

Examination of the fundus of the eye in transformed light (ophthalmochromoscopy)

A valuable additional method for studying the details of the fundus is ophthalmochromoscopy, which allows you to examine the fundus in different colors (red, yellow, blue, purple and redless). In this case, it is possible to identify changes that remain invisible with conventional ophthalmoscopy in white light. Professor A. M. Vodovozov (1986, 1998) made a great contribution to the development of the ophthalmochromoscopy method and its application in the clinic.
With ophthalmochromoscopy, in-depth analysis of the structures of the fundus of the eye is based on the property of light rays with different wavelengths to penetrate tissue to different depths. Short-wavelength (blue, cyan) light rays are reflected predominantly from the outer limiting membrane of the retina. These light rays are partially reflected by the retina, and partially absorbed by it and the pigment epithelium.
Medium-wavelength (green, yellow) light rays are also partially reflected from the surface of the retina, but to a lesser extent than short-wavelength ones. Most of them are refracted in the retina, and a smaller part passes through the retinal pigment epithelium and is absorbed by the choroid.
Long-wavelength (orange, red) light rays are almost not reflected by the retina and, penetrating the choroid, are partially reflected and reach the sclera. Reflecting from the sclera, long-wave rays again pass through the entire thickness of the choroid and the retina in the opposite direction (towards the observer).
Modern electroophthalmoscopes have a set of three colored glasses (red, green and blue), which allows for fundus ophthalmochromoscopy.
Due to sufficient aperture and the presence of a blue light filter, the ophthalmoscope can be used not only for ophthalmochromoscopy, but also for ophthalmofluoroscopy. Ophthalmochromoscopy has a number of advantages over conventional ophthalmoscopy in identifying pathological changes in the fundus.

Red light ophthalmoscopy

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The normal fundus of the eye is dark red in color. The optic disc also appears red, but its color is lighter than in normal light. The macula area is poorly contoured. In red light, pigment spots and formations of the choroid are clearly visible, which acquire an intensely dark color. Defects in the pigment epithelium are also clearly visible.

Ophthalmoscopy in yellow light

The normal fundus of the eye appears brownish-yellow in yellow light. The optic disc becomes light yellow and waxy. The contours of the disc are clearer than with white light ophthalmoscopy. In yellow light, the retinal vessels take on a dark brown tint. The macular area is poorly visible.
In yellow light, subretinal hemorrhages, which look like dark brown spots, are clearly visible. This distinguishes hemorrhage from pigmented formations: the pigment in yellow light fades, and the contrast of hemorrhage increases.

Blue light ophthalmoscopy

The normal fundus of the eye appears dark blue in blue light. The optic disc in blue light has a light blue color, its contours look veiled. The retinal nerve fibers are visible as thin light lines on a dark background. The retinal vessels become dark in color. Arteries differ little from veins in color. The yellow spot of the retina looks almost black against the dark blue background of the fundus. The dark color of the macula is due to the absorption of blue rays by the yellow pigment of the macula.
In blue light, light, superficially located pathological foci, especially the “cotton wool” type, are quite clearly visible in the fundus. Subretinal and choroidal hemorrhages, clearly visible in yellow light, become indistinguishable in blue light.

Ophthalmoscopy in red-free light

The normal fundus of the eye in red-free light has a bluish-greenish color. The optic disc in red-free light acquires a light green color, its contours look unclear. In red-free light, the pattern of retinal nerve fibers and pathological changes in it are clearly visible. The retinal vessels appear dark against the bluish-greenish color of the fundus. Small vessels surrounding the macula and in the area of ​​the optic nerve head are especially clearly visible.
The macula macula of the retina is lemon-yellow in red-free light. Only in red-free light are the smallest (dust-like) opacities of the retina in the macula area clearly visible.

Purple light ophthalmoscopy

Purple light is made up of a mixture of red and blue light rays. The normal fundus under magenta light is bluish-purple in color. The optic disc in purple light appears red-purple, lighter and quite sharply different from the bluish-purple color of the fundus. The temporal half has a slightly bluish tint. Physiological disc excavation is colored blue. With optic nerve atrophy, the disc becomes bluish in purple light. This change in disc color is perceived better than with white light ophthalmoscopy and should be performed in cases of doubtful presence of atrophy.
Retinal vessels appear dark red in purple light. Veins appear darker than arteries. The retinal vessels may be surrounded by red and blue stripes. The macula macula is distinguished by its red color against the purple background of the fundus.

Ophthalmoscopy in polarized light

This method of ophthalmoscopy is based on the property of fundus tissue structures that have optical anisotropy, i.e. birefringence. This is confirmed by the visual phenomenon of Haidinger (“Haidinger’s brushes”), which are revealed in polarized light using a maculotest device. Ophthalmoscopy and fundus photography in polarized light can reveal anisotropic structures and changes in the fundus that are not visible with conventional ophthalmoscopy. Polarizing ophthalmoscopy in our country was developed by R. M. Tamarova and D. I. Mitkokh (1966). To examine the fundus of the eye, the FOSP-1 photoophthalmoscope device is used. There are also hand-held ophthalmoscopes with polaroids from the American company Bausch & Lomb and the English company Keeler.
The picture of the fundus in polarized light does not differ from the usual one. However, when the Polaroids are rotated, the plane of polarization of light changes and details of the fundus of the eye are revealed that have the ability to polarize light.
When ophthalmoscopy in polarized light, two types of peculiar light reflex are normally detected: one in the area of ​​the macula, the other on the optic nerve head. The polarization figure in the macula area looks like two dark red triangles, with their apexes facing the center of the foveola and their bases facing the periphery of the macula. In shape it resembles the figure of Heidinger’s “brush”. In the area of ​​the optic nerve head, in polarized light, a figure of a blurred light cross appears - yellowish in color on the red background of the fundus.
With lesions of the macula, especially those accompanied by swelling of the retinal area, the macular polarization figure goes out. In polarized light, papilledema in the initial stages of congestive disc and neuritis is more easily detected. With severe disc swelling or optic nerve atrophy, a cruciform figure does not appear on the disc in polarized light.

Examination of the fundus using stationary instruments (specifying ophthalmoscopy and scanning ophthalmography)

Stationary instruments for examining the fundus include: a large non-reflex ophthalmoscope, a slit lamp, fundus cameras, a Heidelberg retinal tomograph, and an optic nerve head analyzer.

1. A large non-reflex ophthalmoscope allows for detailed examination of the fundus at 10, 20 and 27 times magnification. In this case, already in the process of ophthalmoscopic examination, it is possible to quantitatively assess the normal and pathological structures of the fundus of the eye. In pathology, this method allows you to determine the size of various foci in the fundus - inflammatory, degenerative, tumor, retinal breaks; an increase in size and prominence (prominence) of the optic nerve head.
2. The slit lamp is used for clarifying ophthalmoscopy of the fundus. Using the binocular eyepiece of a slit lamp, a direct, magnified image of the fundus is obtained. Photoslit lamps have cameras for photographing the fundus of the eye. For the same purpose, you can use the RETINOFOT device from Carl Zeiss.
3. The Sapop company has released a new model of the CR3-45NM camera for photographing the fundus of the eye without first dilating the pupil. The camera has a wide lens coverage angle of 45°. The television monitor makes it easier to operate the camera and reduces patient fatigue during the examination. Along with ordinary color photography on 35 mm film, color photography with the Polaroid system is possible.
4. Examination of the fundus using a fundus camera is described in the section “Fluorescein angiography of the fundus.” In recent years, based on television biomicroscopy, computer analysis and a number of other technical developments, ophthalmological devices for examining the fundus of the eye have been created, manufactured and put into practice. Highly informative techniques are especially valuable for identifying initial changes in the optic nerve head and its evolution in various pathologies and especially with increased intraocular and intracranial pressure.
5. Heidelberg retinal tomograph II (Germany). The device is a confocal scanning laser ophthalmoscope. Using this device, it is possible to carry out a computer quantitative analysis of various parameters of the optic nerve head: the size of the disc, the amount of excavation, the depth of excavation, the distance of the disc above the surface of the fundus and other indicators. Using a retinal tomograph, it is possible to clarify the diagnosis of a congestive disc and monitor the dynamics of its development.
6. Optical coherence tomography (Humphrey Instrument, USA) uses light to measure the thickness of the retinal nerve fiber layer and is the optical equivalent of B-scanning ultrasound. The device uses an axial scan of the retina, which measures the thickness of the retinal nerve fiber layer. The device operates in low coherence mode using infrared light (850) from a diode source.

R. J. Noecker, T. Ariz (2000) provide comparative data on three devices used to study fundus structures: the optic disc and the retinal nerve fiber layer.

As can be seen from the data presented, the possibilities of studying the fine structures of the fundus have now significantly expanded and deepened. This makes it possible to identify pathology in the early stages of disease development and promptly begin rational treatment.

Ocular pressure is measured if eye pathology is suspected. There are contact and non-contact methods. Each manipulation has indications for use and contraindications for use.

Changes in eye pressure may not appear for a long time, but are a common cause of blindness. People who feel discomfort in their eyes are wondering how to check their eye pressure. How to promptly recognize and prevent the problem?

Checking eye pressure is a necessary measure. It is thanks to this procedure that the functionality of the organ of vision can be assessed. Ophthalmologists recommend preventive examinations and determination of eye tone annually. This warning especially applies to people whose age

• palpation-indicative;
• Maklakov’s technique;
• non-contact tonometry.

Intraocular pressure is a test for the presence of glaucoma. The measurements are based on the deformation of the eyeball. There are no generally accepted indicators for normal values. Pressure standards depend on the diagnostic method.

Palpation-indicative diagnostics

The method does not require any preparation. It is used when there are contraindications to other diagnostic methods. The procedure is based on the doctor's previous experience. To carry out the manipulation, the patient lowers his gaze downwards and covers his eyeballs with his eyelids.

The doctor rests his fingers on the forehead, and places the pads of his index fingers on the upper eyelids. By lightly pressing on the eyeballs, the ophthalmologist feels the pulsation of the sclera. Ophthalmotonus is assessed using the fingertips. Normal or reduced pressure does not require any effort during palpation. If the tone of the eye is increased, this will manifest itself in the absence of pulsating impulses under the fingers.

The density of the sclera is estimated by the doctor approximately. There are the following types of eyeball density:

When determining pressure, both eyes are assessed simultaneously. Palpation-indicative diagnosis is easy to use. The technique is used at home. By palpation you can independently assess the density of one eye relative to the other. So, in the early stages of development, you can independently suspect glaucoma.

Methodology according to Maklakov

The method was proposed by Maklakov and has been used since 1884. It is used when ocular pathology is suspected. The procedure is carried out with a special tonometer, which consists of two lead weights weighing 10 g each. The ends of the weights end in glass platforms with a diameter of 1 cm.

The procedure causes increased sensitivity in the patient, manifested in pain, burning, and lacrimation. Local anesthesia is used to avoid discomfort.

5 minutes after anesthesia, the patient is placed face up on the couch. The weights are moistened with special paint and placed in the center of the cornea. Traditionally, the event is carried out alternately on both eyes. The right eye is examined first, then the left.

Weights placed on the cornea give a special imprint. It depends on the density of the eyeball.

Then the weights are placed on a sheet of paper. Using a special graduated ruler, the trace of the dye that remains on the cornea is measured using a light imprint on the paper. After the procedure is completed, antiseptic solutions are instilled into the eyes, and the remaining paint is removed from the weights with a disinfectant solution, after which they are placed in a clean case.

The higher the ocular tone, the smaller the diameter of the unstained disc. Conversely, the lower the intraocular pressure, the larger the contact area between the weight and the cornea. Consequently, the light disk turns out to be larger. The dependence of the mass of the load on the diameter of the light disks is determined in millimeters of mercury. range from 15 to 25 mmHg.

Today, the Maklakov diagnostic method is considered the most accurate way to measure intraocular pressure. The duration of the manipulation is 10 – 15 minutes.

A feature of the Maklakov method is the displacement of a certain volume of fluid from the eye chambers. The measurement results seem to be somewhat overestimated. This pressure is called tonometric pressure. Therefore, patients suffering from glaucoma are recommended to control their pressure levels in only one way.

Non-contact tonometry

Today, non-contact tonometry is especially popular. It is applicable even for newborn children if there is a suspicion of congenital glaucoma or pathology of eye development. Using this technique, the doctor completely eliminates the risk of infection. The device is used for mass research in glaucoma screening.

To carry out the procedure, the patient takes a sitting position. His chin is placed on a special stand, and his head is fixed. The subject should open his eyes wide, then fix his gaze on one bright point. There is no need for anesthesia.

The procedure is unpleasant, but absolutely painless. It may cause temporary tearing or burning. An air stream released from the device with a certain force is directed into the eye. Over time, the shape of the cornea changes.

Iphthalmotonus is determined by the degree of change in the shape of the eye. is performed by an electronic tonometer, and the results of the study are displayed on the screen. The duration of the manipulation is only a few seconds. The more measurements are taken, the more accurately the pressure in the eye chambers can be determined. The average value of the measurements taken is selected.

Normal pressure values ​​are considered to be 10 – 21 mmHg. Art.

Such non-contact measurements can be carried out repeatedly. They do not cause harm to health, but the accuracy of the Maklakov method is much higher.

Conclusion

Increased ophthalmotonus is a consequence of internal changes and unfavorable external factors. Treatment consists of eliminating the pathological causes. Long-term changes in eye pressure can lead to complete loss of vision, so the pathology should not be ignored.

We receive most information through our eyes. This is why it is very important that your vision remains as clear as possible for as long as possible. Despite the fact that, thanks to modern online services, you can check the quality of visual functions via the Internet, we recommend that you replace such tests with a visit to an ophthalmologist.

Considering how important good vision is in our lives, it should be checked regularly. The very first vision test for children is carried out in the maternity hospital, especially if the baby was born premature. The next time vision is checked is after six months, then at three years, and for schoolchildren - every year. In the future, the acuity of students’ visual functions should be monitored at universities by conducting regular examinations. Then it is recommended to visit an ophthalmologist at least once every two years. If certain problems were diagnosed earlier, then you should make an appointment with an ophthalmologist annually. Upon reaching the age of 60 - as often as possible, at least once every six months, since at this age the risk of various ophthalmological pathologies increases significantly, each of which can lead to a complete loss of the ability to see.

How is a newborn's vision checked?

If we talk about the very first vision test, it is carried out in the maternity hospital, after the baby is born. If, during an examination by an ophthalmologist, any deviations from the norm were detected, then an ultrasound scan is prescribed for a more accurate diagnosis.
As a rule, all newborns are farsighted. This refractive error occurs due to the fact that the newborn’s eye is somewhat flattened, and therefore visible objects are projected further than the retina. The acuity of visual functions is quite low and, according to various estimates, can be from 0.005 to 0.015 diopters according to standard tables, reaching 0.01 by the end of the first month of life.
As for light sensitivity, it is minimally developed in newborns. If an ophthalmologist shines a laser pointer into a baby’s eyes, the baby will at most close his eyes or try to look away. A normal reaction usually develops no earlier than 3-5 weeks.

What pathologies can be detected?

So, what visual pathologies can be identified during the diagnosis of the vision of a newborn child? These may be diseases such as:

• Coloboma is a defect of the eye shell, which is characterized by the absence of one of its parts.
• hydrophthalmos is a disease expressed in increased intraocular pressure, which develops due to the accumulation of excess fluid.
• microphthalmia is a decrease in the volume of the eyeball, accompanied by a sharp decrease in visual acuity, myopia or farsightedness.
• Peters anomaly is a pathology characterized by the presence of primary signs of glaucoma and its rapid development:
• dyscoria is an abnormal shape of the pupil, and, at the same time, a violation of the reaction to light sources.

In fact, there are much more congenital pathologies. We have listed only those that are considered by experts to be the most common.

Vision check at three years

The vision of a three-year-old child is checked according to the table of ophthalmologist Orlova. This method is considered ideal for testing visual functions due to the fact that preschool children, in most cases, do not know the alphabet, and in the Eagle table the letters are replaced by drawings. The table itself consists of 12 lines located below and below, consisting of various pictures, the size of which decreases towards the bottom. To test vision using the Orlova table, the doctor sits the child at a distance of at least 5 meters from the table itself, usually hanging on the wall. He must definitely check with the little patient which line he sees best. Ideally, it should distinguish the tenth line. If this is so, it means that visual acuity is 100%. If, from a distance of five meters, a preschool child is able to recognize only the drawings shown on the first line, then the result is only 10%. During the examination, it is very important for parents accompanying the child to ensure that the child does not squint or spin around in the chair.

How is vision checked in preschoolers?

The next important stage of vision testing in children is carried out before the child goes to school. At this age, ophthalmologists already use a different method. The child’s visual abilities are tested using the Sivtsev table, which is well known to each of us. It was compiled by Soviet ophthalmologist Dmitry Aleksandrovich Sivtsev. As a rule, it implies knowledge of the alphabet, although in fact, the child will only need to know seven letters, which is exactly what the table includes.
In most cases, if not 100%, this table is used in conjunction with another, developed by another Soviet ophthalmologist Sergei Selivanovich Golovin. It is a set of rings by the Swiss scientist Landolt, the sizes of which decrease from top to bottom. According to ophthalmologists, it is much easier to determine the quality of vision using two tables at the same time, as this provides a more accurate result.
The verification principle is similar to the previous one, which we described earlier. The ophthalmologist takes the future student to a distance of five meters from the tables of Sivtsev and Golovin hanging on the wall and asks him to close one eye. From this distance, the child must name the tenth line, that is, the bottom one. The next condition is to close the other eye and look at the tables in the same way, determining which line is best visible. If the child does not make a single mistake, this indicates that he has 100% vision.

How should schoolchildren's vision be checked?

Objectively speaking, the ophthalmologist determines vision in both schoolchildren and preschoolers in the same way, that is, using the tables of Sivtsev and Golovin. During this period of time, it is very important for parents themselves to monitor the visual functions of their child in order to prevent wearing glasses. So, for example, if he complains of a headache, pressure in the temples, double vision and general blurred vision, he urgently needs to make an appointment with a specialist.
In this case, in addition to the tables above, the ophthalmologist can use the autorefractometry procedure. It is carried out using a computer and allows you to carefully examine the cornea of ​​the eye in order to identify refractive errors such as myopia and farsightedness. For example, with farsightedness, visual acuity can be equal to 1 diopter, however, long-term work at close range causes focusing difficulties. In such situations, the child may be prescribed glasses.

Another refractive error, myopia, is no less common. It is important to understand here - the earlier it arises, the greater degrees it will reach at an older age. In addition, it is often inherited, and therefore if there are people in the family who have difficulty seeing objects at a long distance, then the child should be shown to an ophthalmologist more often. This will allow the specialist to diagnose this disorder in time and prescribe corrective measures.

How are middle-aged people examined?

What can be said about testing the quality of vision in middle-aged people? As a rule, it begins with an external examination of the visual organs and collection of anamnesis. Further, according to tradition, the Sivtsev table is used. It is believed that if a patient sees less than ten lines, then he is prescribed glasses or contact lenses. Then, using the autorefractometry we previously mentioned, visual acuity and the presence of refractive errors are determined.

There are also situations when visual functions are completely poor and the patient cannot clearly see even the huge letters “W” and “B” located on the very first line. In such cases, the ophthalmologist, in the old fashioned way, determines the patient’s vision using his fingers. He shows him different numbers of fingers on his hand, gradually moving away to a greater distance.
Modern eye clinics, of which there are many open today, are equipped with various optical devices that allow the optical power of the eyes to be determined as accurately as possible. The advantage of these devices over conventional tables is that in 99% of cases they show the most accurate result, while a vision test using a particular table may still allow some deviations from the actual values.

How is vision checked in older people?

In old age, the risk of progression of age-related eye diseases significantly increases, for example, glaucoma, macular degeneration, cataracts, etc. To prevent or identify these and other pathologies in the initial stages, it is necessary to pay special attention to the state of vision. And with diseases such as diabetes and hypertension, regular vision diagnostics are simply necessary.
According to the World Health Organization, the main eye diseases leading to complete blindness are glaucoma and cataracts. How are they diagnosed? Let's start with cataracts, since they are considered a more common disease. How do ophthalmologists diagnose this pathology?

• To begin with, the doctor measures diopter power and refraction on dilated and then on narrow pupils.
• Using a slit lamp, the ophthalmologist evaluates the condition of the cornea, whether there are scars or opacities on it.
• An examination of the fundus of the eye is carried out, including its most remote areas.
• Using a non-contact tonometer, the doctor measures intraocular pressure.
• Carefully visually examines the visual field, measures and calculates the power of the artificial lens.
• Additionally, the ophthalmologist may prescribe an ultrasound of the eye.

According to WHO, glaucoma is in second place after cataracts among diseases leading to complete blindness. How is this disease diagnosed?

• Using biomicroscopy, the doctor examines the condition of the conjunctival and episcleral vessels of the eye.
• The ophthalmologist then checks the sensitivity of the cornea.
• Next, the iris is examined to identify atrophy of the stroma (eye support) and impaired ability to dilate the pupil.
• The anterior chamber of the eye is examined, since with glaucoma the chamber angle becomes wider.
• The lens is checked for opacities under the posterior capsule of the eye.
• The optic disc is examined and tonometry is performed - measuring intraocular pressure.

Another dangerous disease that leads to complete blindness is macular degeneration. How can an ophthalmologist determine its presence in a hospital setting?

• The number of cells capable of responding to light is checked. If there are fewer of them, then this is one of the signs of the disease.
• Using a biomicroscope, the doctor checks the level of growth of fat cells and changes in the blood vessels of the eye.
• The doctor analyzes the condition of the pigment epithelium, which is responsible for normal visual acuity.
• The specialist checks for hemorrhages, swelling or neovascularization on the retina.
• Using autorefractometry, the doctor checks peripheral vision, since it decreases with macular degeneration.

What advice do ophthalmologists give on how to preserve vision?

1. Give up bad habits. Regular smoking can negatively affect intraocular pressure.
2. Eat right, including greens, beets, blueberries, carrots, and sea fish in your diet.
3. Make sure the monitor is positioned correctly and maintain the required distance from your eyes.
4. When working at a computer, give your eyes rest and wear protective computer glasses.
5. Try to spend more time outdoors, but do not forget to protect your eyes from UV rays and use sunglasses.

Follow these simple tips and you can preserve your vision for as long as possible. If you notice the slightest deviations from the norm, immediately make an appointment with an ophthalmologist. Modern diagnostic equipment will allow you to conduct an accurate examination and make a timely diagnosis.