Unwanted reflections during slit lamp assisted binocular indirect ophthalmoscopy

Binocular indirect ophthalmoscopy is a routine ophthalmic examination procedure. Two different apparatus setups are commonly employed; the head/spectacle mounted designs of Schepens and slit lamp assisted ophthalmoscopy, both typically performed through a fundus lens of high positive power. It can be difficult for clinicians to avoid unwanted back reflections primarily emanating from the fundus lens and the pre-corneal tear film, particularly when initially learning the skills required to perform the examination. In this investigation the illumination system of a slit lamp was modified to include a variety of obscuration designs optically conjugate to surfaces responsible for creating unwanted reflections. The modified apparatus was then used to perform binocular indirect ophthalmoscopy on an artificial eye and on real eyes. Clinicians used questionnaires to score the appearance of reflections. The mean scores were similar across all trials, including the control unmodified trial, indicating general consensus that the modified illumination system provided no substantial effect on the perception of these unwanted reflections.