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. The view
Which eye, what the photograph covers, and whether the media are clear.
2. The disc
Colour, margin, cup to disc ratio, and the vessels at its edge.
3. The vessels
Out along each arcade: calibre, crossings, sheathing, new vessels.
4. The macula
Foveal reflex, drusen, exudate, haemorrhage, oedema, pigment.
5. The periphery
Four quadrants: tears, detachment, lattice, pigment, haemorrhage.
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
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
A routine fundus photograph at diabetic screening
Fundus photograph before a hypertension clinic review
Ultra-widefield image at a myopia review
Screening photograph in a patient with type 2 diabetes
Floaters in a patient with long-standing type 1 diabetes
Gradual central blur in a patient with diabetes
Distortion after previous retinal laser
Painless blur in one eye in a hypertensive adult
Flashes, floaters and a shadow in a myope
A curtain over the vision since yesterday
An incidental finding at a dilated examination
Poor colour vision in a young adult with a family history
Red-free disc photograph of a glaucoma suspect
A disc found at a routine sight test, in a patient with no symptoms
The same emergency in another eye
The fundus of a 58-year-old with a blood pressure of 175/105
An atrophic hole within lattice, on every modality
Criss-cross white lines in the far periphery of a 60-year-old
Swollen discs in both eyes of a young man with mouth ulcers
White necrosis and haemorrhage beside the disc in a transplant patient
Cotton wool spots and haemorrhages, labelled
Blurred reading in a diabetic, with rings of yellow around the macula
Diabetic macular oedema before treatment
A pale halo around the disc of a very short-sighted right eye
Papilloedema from early to atrophic, in four panels
The fellow eye at diabetic screening
Headache worse on waking, and a photograph of the right disc
Pain on moving the right eye, then the vision went
Sudden painless blur in one eye of a hypertensive 70-year-old
Reading is slower than it was, at 74
A blank patch in the middle of the page
Vision gone in seconds, painless, an hour ago
Floaters and blur in a patient with a very low CD4 count
Diabetic maculopathy, after the laser
The retina after panretinal photocoagulation
Trouble seeing in the dark since the teens: the early fundus
Bumping into things at the sides: the established fundus
Registered blind at 60: the end-stage fundus
A short-sighted 23-year-old with a normal examination
132 images in the whole atlas, every one checked on its source page.