Top-list of errors in the management of glaucoma patients: ophthalmoscopy

This paper presents the history of ophthalmoscopy development and establishment, emphasizes the necessity of using this method for diagnosing various eye diseases. The initial changes in the fundus can be crucial for establishing the diagnosis and monitoring them is essential for assessing the therapy effectiveness, defining surgical indications, as well as predicting disease progression in glaucoma patients. The article underlines the necessity of a detailed description of all the changes in the optic nerve head (ONH) and the surrounding tissue. In addition to describing we suggest making ophthalmoscopic sketches of the optic disc and retinal nerve fiber bundles, because in some cases a doctor can note and depict some changes in the fundus, that are not always well visualized later photographic images. The article describes basic principles of such methods as stereophotogrammetry, stereochronoskopy, stereochronometry, raster stereography and mentions diagnostic equipment available at different times on the ophthalmic devices market. Advantages and disadvantages of fundus photography are brought forward, as well as the techniques of confocal scanning laser ophthalmoscopy. Confocal laser scanning tomography, laser polarimetry and optical coherence tomography, which can be justly called the modern technologies, are described in this article along with a range of modern diagnostic equipment, necessary to perform these procedures. In this paper we present our own data and that of other researchers, both Russian and foreign, on how frequently ophthalmoscopy, sketching and fundus photography are used, and the application of modern methods of recording the state of the optic disc and surrounding structures. In addition to that we present the data from Russian and foreign guides and reference books on the application of various methods of recording the state of the fundus all over the world and standard frequency of performing these studies. The percentage of progression of various diseases is estimated according to ophthalmoscopy results. Finally, the paper underlines the necessity of using this technique in routine ophthalmological practice for diagnostic purposes, assessment of the disease dynamics and progression, making a correct choice of therapy and surgical indications in order to preserve the visual functions and patients’ quality of life.

офтальмоскопия, глаукомная оптическая нейропатия, фундус-контроль, ophthalmoscopy, glaucomatous optic neuropathy, fundus-control

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