|Year : 2019 | Volume
| Issue : 3 | Page : 251-254
Shahnas Valappil, Anupama Jayan
Department of Ophthalmology, Little Flower Hospital and Research Centre, Ernakulam, Kerala, India
|Date of Web Publication||31-Dec-2019|
Little Flower Hospital and Research Centre, Ernakulam, Kerala
Dr. Shahnas Valappil
Little Flower Hospital and Research Eentre, Ernakulam, Kerala
Source of Support: None, Conflict of Interest: None
Retinal drawings are important to document pathology, which help to compare the changes in pathology in follow-up visits, help in better communication when more than one physician is dealing the case, and help in easy follow-up of disease course with a glance. In retinal drawings, the instructor can monitor students – areas of omission and confusion can be detected. They are advantageous over photographs – they are less expensive, provide immediate record, and highlight details that are difficult to photograph and finally help you medicolegally.
Keywords: Amsler chart, fundus diagram, fundus, retina diagram, retinal drawing
|How to cite this article:|
Valappil S, Jayan A. Retinal drawing. Kerala J Ophthalmol 2019;31:251-4
| Introduction|| |
Retinal drawings are rarely ever used by practitioners although many of us has been trained well to draw the fundus.
Requisites for drawing
Examination table, indirect ophthalmoscope, 20 D lens, scleral depressor, colored pencils (red, blue, green, yellow, brown, and black), fundus drawing chart, and eraser.
The patient should be lying down comfortably with a well-dilated pupil. The periphery should be examined first as it is less sensitive to light than the posterior pole. To trace the lesion, observe the disc and follow a vessel to the periphery.
Fundus evaluation include:
- Optic disc evaluation: Size, shape, and color of the disc; vertical cup-to-disc ratio; neuroretinal rim; disc margins: distinct/blurred and peripapillary changes
- Retinal vasculature changes: attenuation, tortuosity, dilatation, and nicking, and ratio of artery size compared to vein size (A/V ratio) should be checked after the 1st bifurcation. The normal A/V ratio is 2:3
- Macula: Flat/intact and uniformly pigmented, yellowish foveal reflex. Look for any abnormal pigment/blood or fluid
- Vitreous and retinal periphery: Vitreous for clear/cells, posterior vitreous detachment. Periphery: complete 360° examination needed and look for retinal holes/breaks/blood.
Fundus drawings are made on a standard fundus chart, Amsler–Dubois chart, which contains three concentric circles – the innermost circle represents the equator, the middle circle represents the ora serrata, and the outer one is the junction between the pars plana and plicata [Figure 1]. The radial numbered in Roman numerical is used to designate the location and extent of the lesions in clock hours. The macula is drawn centrally, and the optic nerve head is located nasal to the macula.
Image observed in indirect ophthalmoscopy is inverted and reversed; hence, to overcome this, you may invert the paper and draw anomaly as it appears inside the condensing lens, in the same location as you are observing [Figure 2].
| Color Coding|| |
Following are represented in [Figure 3] and [Figure 4]
- Hemorrhages (preretinal and intraretinal),
- Attached retina
- Retinal arterioles
- Vascular abnormalities/anomalies
- Vascular tumors
- Open interior of conventional retinal breaks (tears, holes)
- Open interior of outer layer holes in retinoschisis
- Open portion of retinal holes in the inner layer of retinoschisis
- Open portion of Giant retinal tear (GRT) or large dialyses
- Inner portion of thin areas of retina
- Elevated neovascularization
- Subhyaloid hemorrhage
- Macular edema.
Following are represented in [Figure 5] and [Figure 6]
- Detached retina
- Retinal veins
- Outlines of retinal breaks
- Inner layer of retinoschisis
- Outline of lattice degeneration (inner “x”)
- Outline of thin areas of retina
- Outlines of ora serrata (some authors mentioned brown color)
- Outline of change in area or folds of detached retina because of shifting fluid
- Detached pars plana epithelium anterior to the separation of ora serrate
- White with or without pressure
- Rolled edges of retinal tears (curved lines)
- Cystoid degeneration
- Outline of flat neovascularization.
Following are represented in [Figure 7]
- Opacities in the media
- Vitreous hemorrhage
- Vitreous membranes
- Hyaloid ring
- Intraocular foreign body (IOFB)
- Asteroid hyalosis
- Frosting or snowflakes on cystoid degenerations
- Retinoschisis or lattice degeneration
- Outline of elevated Neovascularisation (NV).
Following are represented in [Figure 8]
- Uveal tissue
- Pigment beneath detached retina
- Pigment epithelial detachment
- Malignant choroidal melanomas
- Choroidal detachment
- Outline of posterior staphyloma.
Following are represented in [Figure 9]
- Intraretinal subretinal hard yellow exudate
- Deposits in the retinal pigment epithelium
- Post cryo/laser retinal edema
- Venous sheathing.
Following are represented in [Figure 10]
- Hyperpigmentation  as a result of previous t/t with cryo/diathermy
- Sclerosed vessels
- Pigment in detached retina
- Pigmented demarcation lines at the attached margin of detached retina or within detached retina.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dvorak L, Russell SR. Retinal drawing: A lost art of medicine. Perm J 2011;15:74-5.
Bowling Brad Retinal detachment In: Kanski's clinical ophthalmology, a systematic approach. 8th
ed. China: Elsevier; 2016. p. 687.
Chaudhuri Zia Retina and vitreous. In: Postgraduate ophthalmology. 2012th
ed. New Delhi: Jaypee; 2012. p. 1137–9.
Tandon Radhika Diseases of the retina. In: Parson's diseases of the eye. 22nd
ed. New Delhi: Elsevier; 2015. p. 303.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]