Instrumental Strategies
From a Distance . . .
Take a step back for a better view with this ophthalmoscope.
By Philip M. Buscemi, O.D.

I've just walked into my hotel room in Japan and poured myself some excellent cold Sake made from only the cores of rice kernels. I slide open the elegantly crafted rice paper screens, revealing a sparkling panorama of the city that's bathed in the afterglow of the magenta sun.

When you're down in the streets of Nagoya, the more magnified view hides this beauty. The same can be true of direct ophthalmoscopy.

A scope with a better view

A regular direct scope has such a limited viewing range that it's easy to miss the broader picture, like a nevus or melanoma, for instance. Sometimes the edges of these lesions blend into the surrounding tissues.

With the new PanOptic Ophthalmoscope by Welch Allyn, however, you get the big picture -- you can see five times more of the fundus through an undilated pupil with no image flipping and increased magnification.

That's correct -- increased magnification -- 26% larger than a standard direct scope with a 25-degree field of view. The Axial PointSource Optics is the heart of the system.

It works by converging the halogen illumination to a point at the cornea, allowing you to see into a small pupil while providing a larger, more magnified field of view. The focusing range is from +20.00D to
-20.00D.

David Allyn told me this product was hot, and he's right. Use it on two patients and you'll want it handy for all of your exams. This is okay, because it will attach to all of your current Welch Allyn 3.5 volt battery handles and wall transformers.

The list price of the PanOptic is an affordable $595, which includes a corneal viewing lens, small, medium and large spot apertures, a slit aperture, a red-free filter, a cobalt blue filter and a magnifying lens.

Two thumbs up

This really is a well-designed piece of equipment that's ergonomic from both the doctor's and patient's point of view.

• From the patient's side, there's an eyecup that's large enough to clear the lashes and seal out external light, but not so big as to be intimidating to patients. The eyecup also serves to stabilize the instrument and allows you to look around without losing your view.
• From our side, there's a nice feeling, soft grip and the focusing wheel and aperture dial are within easy reach while performing an exam. With just a little practice, you'll be using the instrument like a pro.

Something to consider

The only negative aspect of this instrument that could use a little tweaking in my opinion is the light source. Sometimes patients find it uncomfortable, so contrary to the instructions, I like to turn it down and increase the intensity after I've visually entered the patient's eye.

True appreciation

I remember 25 years ago when I was looking into my first retina with an ophthalmoscope during lab in optometry school.

My partner, Tony Cranford, was patiently allowing me to get the image lined up and focused, but when it all came together, I thought it was one of the most beautiful things I'd ever seen -- kind of like Nagoya, Japan after a crimson sunset.

Welch Allyn has a great Web site for you to access more information on the company's PanOptic Ophthalmoscope. Visit www.panoptic.welchallyn.com/index.html. After that, go give one a try, but I'll warn you -- you may want one! 

Dr. Buscemi is vice president and general manager of Nidek Technologies America. He has no financial interest in the Welch Allyn PanOptic Ophthalmoscope.