Interpret / Fundus

Disc. Vessels. Macula. Periphery.

Every fundus photograph is read in the same order so nothing is missed. Learn the order, describe the disc feature by feature, put normal beside abnormal, and then read the atlas, where the diagnosis stays hidden until you commit.

1. Optic disc

Assess colour, margins, and the cup-to-disc ratio. Look for pallor, swelling, haemorrhage, and new vessels at the disc (NVD).

2. Vessels

Follow the arcades out from the disc. Note arteriovenous ratio, nicking, tortuosity, emboli, sheathing, and neovascularization elsewhere (NVE).

3. Macula

Inspect the fovea and surrounding retina for drusen, exudates, haemorrhage, oedema, pigment change, and a foveal light reflex.

4. Periphery

Sweep the four quadrants for tears, detachment, lattice, pigmentary change, and peripheral haemorrhage or exudate.

Describe the disc

Mikael Häggström, CC0, source.

Describe the disc

Margins

Colour

Cup to disc ratio

Swelling

Haemorrhage

Vessels at the disc

Choose each feature to build the description.

Normal beside abnormal

What separates them?

Look first. Say out loud which is which and why, then reveal.

Every pair is two real photographs from the atlas; nothing is drawn on them.

The words

Microaneurysm: A tiny red dot, the earliest sign of diabetic retinopathy: a bulge in a capillary wall.
Dot and blot haemorrhage: Round haemorrhages in the deep retina, where the cells are packed vertically.
Flame haemorrhage: Feathery, in the nerve fibre layer, following the fibres: hypertension, vein occlusion, papilloedema.
Hard exudate: Yellow, waxy, sharp-edged lipid left behind by leaking vessels, often ringed around the leak.
Cotton wool spot: White, fluffy, soft-edged: an infarct of the nerve fibre layer.
Drusen: Yellow deposits under the RPE at the macula; the substrate of age-related macular degeneration.
Neovascularisation: Fine, lacy new vessels on the disc (NVD) or elsewhere (NVE): the retina is ischaemic.
Cup to disc ratio: The pale central cup as a fraction of the disc diameter; above 0.6, or asymmetric between eyes, think glaucoma.
Arteriovenous nicking: A vein pinched where a stiff arteriole crosses it: hypertensive change.
Cherry red spot: A red fovea against a pale, oedematous retina: central retinal artery occlusion.

The fundus atlas

All 39 in the atlas

132 images in the whole atlas, every one checked on its source page.